Nitrous Oxide: Why not available in the US?

[aikigypsy]

I'm pregnant with my first, due in the coming month or so, and have been hanging out on some international forums. In most of the rest of the English-speaking, internet-chatting world, women use gas & air/nitrous oxide/entonox as a first line of pharmecutical pain relief. It's fast-acting, quick to disperse, and has few known side-effects, but it's not effective for many of those who try it. Still, it seems far milder than what we have available here.

Does anyone know why nitrous oxide is unavailable as a form of labor pain relief in the US?

[homewithtwinsmama]

I went to a birth panel discussion this week and this was asked. It had to do with the history of obstetrical anesthesia in the US and how it developed. However, one woman/expert on the panel said there are some current studies being done about it and she believes that nitrous oxide will become available in the US in the next decade. Not that it helps you now, but its good news for women and also may help birth centers business wise if they have something women know are available who may be a bit too scared to try OOH birth otherwise.

[JanetF]

There are so many options for managing normal labour that are vastly superior for mothers and babies than drugs and that includes nitrous oxide which is freely available in hospitals and BCs across Australia. Why introduce yet another drug option? Once you get a drug in the system you won't get it out. Look at the dangers of cytotec which are greater than that of gas/air and yet still being used on women.

Andrea Robertson on risks for caregivers as well as women and babies.

http://www.birthinternational.com/di...es/000421.html



Manufacturer’s info on entonox.

http://www.acegraphics.com.au/diary/...es/000363.html

Patient-administered inhalation of nitrous oxide and oxygen gas for procedural pain relief

http://www.worldwidewounds.com/2003/...n-Relief.html#



NIOSH Warns: Nitrous Oxide Continues to Threaten Health Care Workers

http://www.cdc.gov/niosh/updates/94-118.html




(from ABC news online) 6 May 2005 No longer available online
Quote:
*Study highlights anaesthetic's risks*

A new study raises serious concerns about the side-effects of nitrous oxide, the
gas commonly known as laughing gas and used in general anaesthetics.

An Australian-led study of more than 2,000 patients in 20 hospitals around the
world has found the gas slows the recovery process and increases the rate of
serious vomiting, pneumonia and wound infections after surgery.

removed a large portion of the article for copyright reasons

[aikigypsy]

Yes, I understand that there are risks, and I'm planning to go drug-free unless there's some really horrible major complication, but the articles you cite above are mostly about the risks of prolonged, repeated exposure.

It still looks to me like the risks to mother and baby are much less than they are from other chemical pain relief used on labor. Oh well. Interesting that it's also not used in Europe.

[Jane]

Right now, the FDA has not approved the etonox mix of 50% Nitrous oxide and 50% oxygen. Therefore, it has to be mixed and that introduces an additional risk. If you don't have enough oxygen, it can knock you out and harm you. So, nitrous, as available in the US, is more dangerous than nitrous, as available in the UK.

[Kleine Hexe]

all I know is that I had it when I had my 4 wisdom teeth removed at the same time and how I would love to have it for labor. That dentist could have removed all my teeth and I would not have cared.

[JanetF]

It's just not necessary to have drugs in labour unless you have a complication. And if you have a complication serious enough to warrant drugs you probably need a c/s and so gas is irrelevant anyway. So many non-drug options for birthing, why choose yet another chemical option?

the articles you cite above are mostly about the risks of prolonged, repeated exposure.

It discomfits me that the exposure of hospital staff doesn't bother you.

[AlexisT]

Originally Posted by aikigypsy

Yes, I understand that there are risks, and I'm planning to go drug-free unless there's some really horrible major complication, but the articles you cite above are mostly about the risks of prolonged, repeated exposure.

It still looks to me like the risks to mother and baby are much less than they are from other chemical pain relief used on labor. Oh well. Interesting that it's also not used in Europe.

Entonox (50/50 gas and air) is commonly used in the UK; homebirth midwives have it.

I don't know about the rest of Europe.

[Kleine Hexe]

Originally Posted by JanetF

It's just not necessary to have drugs in labour unless you have a complication. And if you have a complication serious enough to warrant drugs you probably need a c/s and so gas is irrelevant anyway. So many non-drug options for birthing, why choose yet another chemical option?

It discomfits me that the exposure of hospital staff doesn't bother you.

You talking to me? Cause if you are don't let me cause you any discomfort.

I just want to make labor a little fun.

[2bluefish]

Originally Posted by JanetF

And if you have a complication serious enough to warrant drugs you probably need a c/s and so gas is irrelevant anyway.

When I was in transition labor for 12 hours waiting on my baby's head to mold so she could be born vaginally with an extended head - gas could have been a huge help and would have prevented the PTSD I experienced for months afterwards (and I suspect still crops up from time to time). Even Grantly Dick-Read would not deny women pain relief when needed. I didn't need a c-section - I did need more pain relief than hot water, position changes and relaxation exercises. In the UK, gas is used at homebirths. I totally think it is a crime it is not an option here.

[stayinghome]

I had my second child in a hospital in Bermuda. I used n.o. and i didn't think it helped much. It did for a short while, but once it wore off then what? I couldn't keep using it and using it and using it. I could see it helping in a short term situation though- like getting through a particulaly painful part, that would be over quickly. Taking it at 5 cm when you have hours and hours to go, probably not.

[transformed]

ummm...Isnt that the stuff that people put in racecars to make them go fast? You can get it at the auto parts store. Called NOS

I think dh used to use it in high school to get high too. I dont know where he got it though.

[BoringTales]

Originally Posted by AlexisT

Entonox (50/50 gas and air) is commonly used in the UK; homebirth midwives have it.

I don't know about the rest of Europe.

I would absolutely consider a homebirth if that was available here.

I've been wondering why this isn't available here as well for three births now.

[JanetF]

I birth at home to avoid all drugs so the idea of wanting drugs at home is seriously bizarre to me. If you want drugs birthing in a hospital is obviously right for you.

2bluefish that does sound intense and if it's causing you distress there are things you can do about that. Gas does not work for everyone so it's not unlikely it would not have performed what you're hoping at all. It gives you a dry mouth, a headspin, makes women disoriented, and is a very unpleasant experience for a lot of users. Using it for many hours would be really revolting. Emotional support is more valuable in every instance. I know a few women for whom experiences in normal physiological labour have caused PTSD, usually extreme pain from malposition or something like you're describing. It's good to seek support with that and there are lots of ways to treat and manage PTSD. I hope you find some healing for that.

[MamaRabbit]

A UK midwife friend of mine told me that some studies had shown that babies exposed to gas and air during labor had higher drug usage when older. Not sure if that's up to date or not. Entonox has just been introduced in the hospitals over here. I haven't attended any births where it's been used though I do have to teach the pros and cons for it in the CBE classes.

[JanetF]

http://www.acegraphics.com.au/parents/drugs/drugs.html

Nitrous oxide and oxygen (Entonox)
A combination of two gases, nitrous oxide and oxygen in provide pain relief. Many hospitals use a dispenser that allows the proportion of the gases to be varied within a given range.

Effects on the mother
Advantages: 1. An effective means of easing the pain, especially for the long and strong contractions of transition.
2. Extra oxygen can be beneficial.
3. Provides a distraction and a focus for attention during the turbulence of transition.


Disadvantages: 1. Nausea and vomiting can be side effects.
2. May make the mother drowsy and confused.
3. Some women find the face mask unpleasant, even claustrophobic.
4. Does not relieve the pain entirely.


Effects on the baby
Advantages: 1. Extra oxygen could be beneficial.


Disadvantages: 1. Research has shown a potential link between exposure of some babies to nitrous oxide during birth and their later development of an addiction to amphetamines as teenagers.

[2bluefish]

Originally Posted by JanetF

Emotional support is more valuable in every instance.

I vehemently disagree. I also think it is pretty ballsy to make a statement about what is more valuable in every instance. I can't and won't speak for every woman, but I know myself - and I know that my PTSD was caused by my well meaning "support people" not listening to my expressed needs (I've been in transition for X hours now, I need to go to hospital) and instead deciding for themselves what I needed (you're doing so good, they won't help you at the hospital, stay home). Sheila Kitzinger has writen extensively about women suffering PTSD when they feel they have lost control of their birthings. When we insist on one definition for homebirth, we are limiting women's options and offering them less control over their birthings.

I find it interesting that "doesn't relieve pain entirely" is listed as a disadvantage. I don't understand why partial pain relief is downplayed. My second birth was a transport to the hospital for pPROM. I used hypnosis the entire time on pitocin. However, when I got to transition, I wasn't allowed to move from the bed, and it became difficult to cope. The smallest dosage of Stadol was enough to allow me to rest for 20 min, and I went on to push my baby out in 10 minutes. I know lot's of women complain about this drug, but my experience was that it took the edge off enough to allow me to continue on with my hypnosis. People need to get out of this all or nothing mentality. Gas is something relatively safe that could potentially help some mothers. Not all mothers birth at home "to avoid drugs" - I birth at home to avoid episiotomy and c-section, I birth at home to avoid having my children abused and mistreated at birth, I birth at home so I have freedom of movement, etc. - I wouldn't automatically assume all women have the same motivations for choosing homebirth. One of my favorite books "Come Softly, Sweet Lucina" was writen by Pat Carter - she had 7 painless UCs in the 50s - she also advocated drinking heavily throughout labor!

I vote for giving women more choices in labor

[MsElle07]

I think the OP is wondering *why* it's not available here (I've wondered this myself), not whether it should be used or whether it's effective. It's just unusual that something so widely available elsewhere is not available here, especially in a drug-happy birthing culture.

[thorn]

i just had a drug free vaginal birth last week, I would have *absolutely* taken some nitrous during crowning if it had been offered to me - not sure it would have been a good idea though.

I have nitrous at the dentist every time (even for cleanings) and it is true I wouldn't give two hoots if the dentist told me he had to remove my head

It doesn't really take away the pain, it just makes you not really care anymore (at least that is the effect it has on me) so IMO it would be bad for childbirth because it could prompt a mom to say "just get the baby out whatever way possible" which many OBs would be more than happy to oblige...

however, I'm all for choice in childbirth, I know that I had the option for several anesthetics during labor I just didn't use them.

[2bluefish]

Well, I think one of the reasons "why" is that midwives in this country resist it and don't ask for it. I've seen several discussions of this over the years, and many midwives are convinced that it is unneccesary and unhelpful. I guess if women want it, they are going to have to be the ones out pushing for it.