Nitrous Oxide: Why not available in the US? - Page 2

[MsElle07]

But do you really think midwives have much power (if any at all) in what gets approved by the FDA? I don't think that can be the reason.

[2bluefish]

True... I don't think the doctors care about it cause they have much more powerful drugs avaliable to them, and they view partial pain relief as a disadvantage. So those in the best position to influence the FDA don't care... on down the line. I know I would like it avaliable, but I'm a little too busy birthing babies to be lobbying for gas. I think the motivation just isn't there, the money isn't there... I think there are lot's of reasons "why" - but none of them are really that substantial.

[crazy_eights]

Originally Posted by 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.

Yes, I've seen a few anesthesiologist written articles out recently pushing for the idea of nitrous being available in the US for childbirth. The reason I was told by the anesthesia dept that they don't use it is fear of any mask delivered anesthesia and risk of aspiration.

[momto l&a]

All I can say is heat, lovely heat. I have used water for 3 of my labors in which 2 I gave birth in it.

#3 labor/birth I used a a rice sock and it was wonderful being I didnt have time to use lovely warm water.

[crazy_eights]

As to "why introduce it" - I would say think of it this way: In the hospital we often have people that are almost ready to start pushing, they freak out, despite good support and ask for an epidural - and they get it. Labor often stalls, they find it hard to push.... wouldn't it be great to have another "tool" in the box to use in these situations, esp. for someone who is having a longer or traumatic transition.

[Human_Being]

Judith Pence Rooks, a CNM from the Seattle area, I think, has made this her latest quest, to get Nitrous Oxide approved for use in the US. She published about it in the March 2007 issue of the journal of "Birth".

She is the person who wrote the interpretation of the National VBAC study done by Birth Centers, and is very influential. She has gotten the National Birth Center Study/Normal Birth Study that will start this year to include the use of Nitrous Oxide in out of hospital settings. It is her position that if this relatively safe anesthesia was available, more women would use it instead of bigger guns meds like epidurals.

Becasue N.O. use will be included in the new Normal Birth/Birth Center study it WILL be used in many birth centers in the next few years, and I imagine it will make its way into conferences/discussions/practice in hospitals. We will ahve to see how quickly the midwife culture adapts to its use. It may be quite sometime before this is widely used in hospitals, becasue even though midwife culture may be slow to change and adapt, I bet hospital culture will be even slower. After all, people still do episiotomies 20 years after the research shows they do more harm than good. Provider atttitudes influence the use of interventions the msot, so even if its available, it needs to be suggested before its actually used!

Also, part of our hospital birth culture and the high rates of medications/epidural has to do with staffing models. One nurse can care for three numb women, but nitrous oxide will mean the woman is up, active, and requiring supervision and attention the way an unmedicated woman does. My local hospital has a 90% epidural rate and they are pretty put out by the noises, sights, and overall demands an unmedicated mother (and usually her doula) place on them. My guess is N.O. will not really ever take off and replace the other pain meds in the US, because in my opinion MOST of the reason for high medications rates in the US are because there is not enough nursing staff to manage the moms. The last thing they want is to introduce/advocate a practice that requires more staff time and attention, which I think nitrous would do. If everyone is strapped down, numb, silent she not much of a bother and is more or less another object in the room they can do their work on. My Swedish sister in law had gas for her birth in Swedish hospitals, and she was up, walking around, making noise, squatting and having the gas mask on. It is just not how we do it here.

I worked at a birth center where we had IV narcotics we could use at the birth center. Stadol, nubain, etc....It did broaden our marketing appeal to include the moms worried about pain, and it was useful in keeping some first time moms from becoming too exhausted in early stages of labor. It was something we used maybe 3 times a year out of 120 patients a year. I have since practiced with out pain drugs in birth centers and home, and certainly don't see the need for it, but it was nice to have the option. Pain meds not part of our midwife culture of birth, but I can imagine it being of appeal to many moms. Midwives just don't have a context to imagine it in. Americans have homebirths mostly because we don't want drugs, so it is a big leap in practice to introduce pain relief at home/birth centers for most. People think its really weird that I used to be able to use narcotics at birth cetners!

My dentist friend does not use N.O. because in his opinion the research lit form dental offices shows its just so dangerous for childbearing women to have repeated exposure. He never wanted to risk having it around because he wanted to limit occupational exposure in his staff of mostly childbearing age dental hygienists and office staff.

[Sileree]

Originally Posted by Human_Being

My guess is N.O. will not really ever take off and replace the other pain meds in the US, because in my opinion MOST of the reason for high medications rates in the US are because there is not enough nursing staff to manage the moms.

Also I think nitrous oxide will not take off here in the U.S. because it is less lucrative money-wise. Epidurals cost hundreds, or even a few thousand dollars. Who benefits financially from nitrous oxide? The company who makes the canisters, maybe.

Not anesthesiologists. You don't need one to administer it, the mother does it herself. In order to have a 24-7 staff of anesthesiologists for L&D, a certain amount of women HAVE to have epidurals in order to pay their salary. This is one big reason epidurals are pushed so hard by hospital staff. If you get nitrous oxide use dropping the epidural rate from 90-95%, no anesthesiologists will want to work there. A lot of hospitals are out there to make money. Always follow the money trail.

Another thought: I am wondering, what about NO's rate of effectiveness? People love to show off how epidurals are almost always effective. How often does NO work for partial pain relief? I hear a lot of people saying it doesn't really do anything for them pain-wise. I know for me, as a child, it just made me hallucinate. I still felt the needle from the numbing shot and it hurt like hell.

Would it traumatise women to be told using this gas will help and then it doesn't, and now its too late for an epidural?

[roxyrox]

Originally Posted by mom2seven

Yes, I've seen a few anesthesiologist written articles out recently pushing for the idea of nitrous being available in the US for childbirth. The reason I was told by the anesthesia dept that they don't use it is fear of any mask delivered anesthesia and risk of aspiration.

It's not "mask delivered" -it's generally a tube thing that you suck on. I used it a bit in labour but I didn't particularly like it. Some people get on well with it though. I do think it should be an option, especially at homebirhts, if the mama feels she needs something else.

[applejuice]

I do believe it was available in the 1930s-40s in America. The way my MIL described her labors to me from 1938, 39 and 42 seemed to me that she had an inhalant form of anesthesia through a mask and it was probably NO2. She said it worked quickly and wore off quickly also. It seems that the amnesiacs as twilight sleep took over after the war was over.

Would any one know about this?

[AlexisT]

Originally Posted by Human_Being

Also, part of our hospital birth culture and the high rates of medications/epidural has to do with staffing models. One nurse can care for three numb women, but nitrous oxide will mean the woman is up, active, and requiring supervision and attention the way an unmedicated woman does. My local hospital has a 90% epidural rate and they are pretty put out by the noises, sights, and overall demands an unmedicated mother (and usually her doula) place on them. My guess is N.O. will not really ever take off and replace the other pain meds in the US, because in my opinion MOST of the reason for high medications rates in the US are because there is not enough nursing staff to manage the moms. The last thing they want is to introduce/advocate a practice that requires more staff time and attention, which I think nitrous would do. If everyone is strapped down, numb, silent she not much of a bother and is more or less another object in the room they can do their work on. My Swedish sister in law had gas for her birth in Swedish hospitals, and she was up, walking around, making noise, squatting and having the gas mask on. It is just not how we do it here.

Actually it's completely the reverse here. A woman with an epidural requires 1:1 midwife attention (because of the risks of anaesthesia) but if she only has pethidine or gas and air, the midwife can attend multiple patients. I've heard of women requesting epidurals so the midwife has to stay.

[MamaRabbit]

Gas and air is here (delivered by mask). For the hospitals to make more money, they're telling women that an anestheisologist has to be there the whole time! :

[eirual]

when I went on my hospital tour (I was originally planning a hospital birth, but not after THAT tour! I was told that the gas wasn't available. In putting in the pipes for it in their new wing, once it all was done it was found that nurses working around the gas had a significantly higher rate of miss carriage (I don't know about other health problems) so unless the hospital set up a whole new set of return pipes for the gas to flow back out of the building with, it was deemed unsafe to those who worked in that environment.

I don't know the State's reasoning. But that's why some hospitals in Cananda don't have it. You'd have to entirely gut the walls to put in return pipes- $$$.

[eirual]

Originally Posted by roxyrox

It's not "mask delivered" -it's generally a tube thing that you suck on. I used it a bit in labour but I didn't particularly like it. Some people get on well with it though. I do think it should be an option, especially at homebirhts, if the mama feels she needs something else.

The reason above might also explain why it's now a mask system (in some places?) to keep it contained? .... if that makes a difference :

[AstridS]

I didn't use it for my births, but it was really great, when the midwife had to put in a few stitches after dd2 was born. I had a homebirth and I have been talking to several women who say that they will think about homebirth, now that they know that some painrelief is avaliable. Not for the actual birth, but for stitches. In Denmark unmedicated births are very common and most women don't fear natural childbirth. But many pregnant women are afraid of the possibility of needing stitches and not having painrelief. I don't know if I think it's a good reason, but it's one of the reasons I hear a lot, for choosing a hospital birth.

[transformed]

Originally Posted by applejuice

I do believe it was available in the 1930s-40s in America. The way my MIL described her labors to me from 1938, 39 and 42 seemed to me that she had an inhalant form of anesthesia through a mask and it was probably NO2. She said it worked quickly and wore off quickly also. It seems that the amnesiacs as twilight sleep took over after the war was over.

Would any one know about this?

I thought they were completley knocking women out at that time? Like sleeping while they gave birth.

[dinahx]

I don't doubt that some women desire pain relief during their labors, I just don't understand why it has to be delivered in such an invasive way . . . Or use such scary chemicals. Wouldn't a gentle opium tincture, administered in drops, be ideal, really?

[mamabearing]

it is used at UCSF

I attended a course where the CNM's there described how they use it this year. They seemed to think it has a place.

[mamabearing]

Originally Posted by mamabearing

I attended a course where the CNM's there described how they use it this year. They seemed to think it has a place.

If you do a google search with UCSF and nitrous oxide you can find the blog of a mom who used it and was very happy with it.

[JanetF]

You can read virtually any hospital birth story from Australia, everyone gets it even if it makes them vomit and pass out. I can't believe MDC members want to introduce *another* drug to the drug pushers' paradise we're all trying to get out of!

[Jane]

I think the idea is to have *something* available to convince women to birth out-of-the-hospital. I hear a lot of first time mothers say that they are planning a natural birth, but want to be at the hospital "just in case I want an epidural".