Labor and Delivery No Laughing Matter

Chicago - Women have long sought ways to ease the pain of labor without detracting from the experience of childbirth. While epidural anesthesia remains the most popular and effective method for managing labor pain, nitrous oxide – laughing gas – is gaining some interest from expectant mothers. Before planning to laugh your way through labor, however, consider the pros and cons of the two common pain-relief methods.

More than 60 percent of U.S. women have an epidural (or spinal) to manage pain during childbirth, and these methods provide the most effective relief, according to the Centers for Disease Control and Prevention (CDC). While nitrous oxide is common in labor and delivery rooms in other parts of the world –60 percent of women in England opt for it – its availability in this country is limited and only about 1-2 percent of women use it during labor, according to reports.

When performing an epidural, a physician anesthesiologist will insert a needle and tiny tube (catheter) in the lower part of your back. Local anesthetic provided through the tube numbs only the lower part of your body below the belly button. With nitrous oxide, you inhale a blend of 50 percent nitrous oxide and 50 percent oxygen through a mask and feel the effects of the medication throughout your entire body. 

“It’s wonderful that women have options for pain relief during childbirth,” said Edward A. Yaghmour, M.D., chair of the American Society of Anesthesiologists® Committee on Obstetric Anesthesia. “But it’s important to understand the different ways these two methods help provide relief and the research that has been published about each method before making decisions to attain their childbirth goals.”

Here’s what you should know about these two methods of managing labor pain.

• What kind of pain control is provided?
  • Epidural: An epidural blocks the pain while letting you stay clear-headed and “in the moment.” You will still feel pressure to push when it’s time to deliver your baby.
  • Nitrous oxide: Nitrous oxide doesn’t eliminate pain, but makes you less aware of it by making you feel woozy. Because nitrous oxide is not a local anesthetic, you will not feel numb.
• How quickly does relief take effect and how long does it last?
  • Epidural: It can take about 10-15 minutes for the pain medication to work, but a physician anesthesiologist can perform a combined spinal epidural to provide immediate relief if desired. When the spinal dose wears off, you can continue to receive pain relief through the epidural as long as you need it.
  • Nitrous oxide: Nitrous oxide takes effect about 30 seconds after it is inhaled and the effects last about three minutes. It can be repeated as needed.
•  Do I have control?
  • Epidural:  Yes. After the physician anesthesiologist places the catheter, you will be given a button to push to give yourself more medication if needed.
  • Nitrous oxide: Yes. You place the mask over your nose and mouth, and inhale when pain control is needed. Most women use it before each contraction to take the edge off.
• What about safety and risk?
  • Epidural: Used widely to manage pain during childbirth since the 1970s, epidurals have been extensively studied, have been shown to be safe and have continually improved over time. Risks can include a decrease in blood pressure (countered by extra IV fluids or medications); a temporarily sore back where the needle was inserted; and, rarely, a headache.
  • Nitrous oxide: While nitrous oxide has long been in use in Europe, there is a lack of high-quality studies of its effect on mothers and infants. It can potentially affect your breathing and make you feel nauseated and dizzy.  

Epidural anesthesia has continued to evolve and improve. Initially one dose of an epidural was given to women, and the physician anesthesiologist returned to provide more if needed. That evolved into a system of providing a continuous epidural infusion of medication and allowing women to give themselves more if needed, through the push of a button. The most recent version, called programmed intermittent epidural boluses, provides medication at set intervals (vs. continuously) and still allows women to give themselves more if needed. This maximizes the pain relief while minimizing the amount of anesthetic given.

Nitrous oxide doesn’t prevent you from having an epidural. In fact, some women opt for nitrous oxide because they want to wait until later in the birth process to have an epidural. For more information about managing pain during childbirth, visit www.asahq.com/WhenSecondsCount.

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THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology.  ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves. 

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.