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Gas at homebirths in the US....

post #1 of 69
Thread Starter 
I know it hasn't been approved in the US and likely will not. But is there a way to be able to use gas at a homebirth? I am not sure if this is a silly post, sorry if it is.

ETA: This is NOT a debate thread. If you want to debate the use of gas at homebirth or express your opinion against, please start another thread. Thank you.
post #2 of 69
Do you mean like oxygen or nitrous oxide? Some midwives carry those things, some don't. I think it will all depend on your midwife. If having oxygen helps you during labor, try to find someone who will bring it.
post #3 of 69
Thread Starter 
Nitrus oxide -- really, in the US some will carry it?
post #4 of 69
My midwives are "looking into it" (Nitrous Oxide). You and me should lead a movement to get them all to. One obstacle is the fact that it is recommended that they track our O2 saturation (Oxygen in blood w/a pulse oxymeter) while we use it and they may not have one. I checked at a local medical supply place and got a quote of $499 for one. Not sure if there are also regulations about tracking use of it like narcotics? Anyway, we need to get past those challenges, because we stateside need this option.
post #5 of 69
I"ve just been looking through the archives. People are saying its "not approved" for that use, "not available", and such. I'd be curious to know if there really are laws AGAINST it. There are also people suggesting it is dangerous. Below are some abstracts and citations that conclude otherwise.

The ideal concentration is 50% Nitrous Oxide, 50% Oxygen. If there is more Nitrous Oxide, dangers arise (passing out, stopping breathing). Otherwise overdosing is prevented b/c mom's arm will relax and the mask will thus fall away from her mouth, then she'll exhale it all and be completely normal.

I found a/the product called Oxynox, available at:

Air Products and Chemicals, Inc.
7201 Hamilton Boulevard
Allentown, PA 18195-1501
USA
Tel 610-481-4911
Fax 610-481-5900
E-mail info@airproducts.com

the website doesn't have details.



1. Administration of Nitrous Oxide in Labor: Expanding the Options for Women
Nitrous oxide is an odorless, tasteless gas, which is administered by inhalation. A review of studies on the use of nitrous oxide in labor found it to be effective analgesia for many women while also being safe for the mothers, babies, and health care providers. How it actually works for analgesia is not well understood. Not all laboring women who try it find it useful. Those who do either report reduced pain or acknowledge they are still in pain but care less about it.
Judith T. Bishop
Journal of Midwifery & Women's Health
May 2007 (Vol. 52, Issue 3, Pages 308-309)
_____________________

2. Use of Nitrous Oxide in Midwifery Practice–Complementary, Synergistic, and Needed in the United States
A 50/50 mixture of nitrous oxide (N2O) and oxygen is a safe, inexpensive, and reasonably effective labor analgesic that is available and widely used and appreciated by women in Canada, the United Kingdom (UK), Scandinavia, Australia, and many other parts of the modern Western world, but is not even known to most women in the United States, where it is offered in only a few hospitals.
Judith P. Rooks
Journal of Midwifery & Women's Health
May 2007 (Vol. 52, Issue 3, Pages 186-189)

_____________________

Rooks JP.Nitrous oxide for pain in labor--why not in the United States?Birth. 2007 Mar; 34(1):3-5. No abstract available.
PMID: 17324171 [PubMed - indexed for MEDLINE]



_____________________
Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26. <img alt="Click here to read" border="0"> Links
Nitrous oxide for relief of labor pain: a systematic review.

Rosen MA.
Department of Anesthesia and Perioperative Care and Obstetrics, University of California, San Francisco, 94143-0648, USA. rosenm@anesthesia.ucsf.edu
post #6 of 69
Thread Starter 
Eliza -- where in the midwest are you?

In order to get the gas from the supply store -- can you do it? Or do you need a prescription or does a care provider have to get it? I agree, women in the US need more options.
post #7 of 69
IMO, any sort of inhalent for pain relief is an intervention. for me the point of having a homebirth was to avoid intervention. i also do not think that being in an altered state of conciousness during labor due to the effects of a drug would be good for me. it's sort of reminiscent of the 50s and 60s when they used inhalent anesthesia on laboring women, albeit it was general anesthesia then. i dunno, i guess it's just that i'd like to remember my birth experience and would wonder how that is possible when altered during birth.
post #8 of 69
Quote:
Originally Posted by liss_420 View Post
IMO, any sort of inhalent for pain relief is an intervention. for me the point of having a homebirth was to avoid intervention. i also do not think that being in an altered state of conciousness during labor due to the effects of a drug would be good for me. it's sort of reminiscent of the 50s and 60s when they used inhalent anesthesia on laboring women, albeit it was general anesthesia then. i dunno, i guess it's just that i'd like to remember my birth experience and would wonder how that is possible when altered during birth.
:
post #9 of 69
Thread Starter 
I don't want this thread to 1) turn into a debate and 2) be a place to pass judgment. If you notice my OP didn't ask for opinions on its usage or what people thought.

There are many valid reasons foer choosing homebirth and the reality is that gas is used at homebirths in many countries. And if homebirth is going to become more widely available to others then addressing pain control is a valid issue. Finally from my understanding, the effect lasts as long as the inhalation. Therefore it is nothing like the anasthea used in the past. There is much more control.

Please no debate or judgment.
post #10 of 69
Quote:
Originally Posted by southernmommie View Post
:
...and...the term "GAS" freeks me out. Oxygen tank is one thing, but "GAS" kills brain cells.
post #11 of 69
Thread Starter 
Quote:
Originally Posted by Demeter_shima View Post
...and...the term "GAS" freeks me out. Oxygen tank is one thing, but "GAS" kills brain cells.
I am going to repost my post from above.

Quote:
Originally Posted by 3cuties View Post
I don't want this thread to 1) turn into a debate and 2) be a place to pass judgment. If you notice my OP didn't ask for opinions on its usage or what people thought.

There are many valid reasons foer choosing homebirth and the reality is that gas is used at homebirths in many countries. And if homebirth is going to become more widely available to others then addressing pain control is a valid issue. Finally from my understanding, the effect lasts as long as the inhalation. Therefore it is nothing like the anasthea used in the past. There is much more control.

Please no debate or judgment.
If you are interested, there are many studies that show that nitrus gas is not harmful. Anyway, this is not a debate thread -- so PLEASE refrain from judgment or opinion on it. Thank you.
post #12 of 69
I think the use of nitrous oxide would have some definite benefits. It isn't like the old fashioned "twilight sleep" method where they knocked you so far out with scopolamine and morphine that you had to be chained to a table in case you had a seizure and hurt yourself. I remember being given NO for some dental work when I was little and I remember everything that happened. I had to have several baby teeth pulled that day! I was fully aware of what was happening and was not 'knocked out', it did not alter my memory of the event whatsoever. They don't call it "laughing gas" for no reason though...oh man was I silly after it started to wear off!

OP, good luck with everything. I'd be very interested to hear if this stuff can be purchased by the general public.
post #13 of 69
Thread Starter 
Well I remember it being present at parties in college, although I never took part. But I am not sure how that happened. I doubt it was *legal*....
post #14 of 69
I used entonox (as its called here) in my homebirth with my dd and would use it again if I felt I needed it.

It is widely used in labour here in the UK and has far less problems associated with it than any other pain relief drug. The effects wear off in about 10 minutes after stopping breathing it, and its completely controlled by the mother. I used it for an hour around transition time and then it ran out and I continued without it. I felt a little spacy when on it but still able to remember everything (as much as you can in labour anyway) and talk and make sense. It just helped to relax me a little and gave me something to concentrate on.

The main side effect to it is that it can make women feel nauseous but that passes very quickly when you stop using it.
I think its a good option to have to be able to try if the alternative is going to be to transfer to hospital for additional pain relief.

I will prefer to labour without it next time, and will ask that its left in the midwife's car so I can't see it on offer iyswim, but I would much much rather turn to that than have to go for an epidural or pethidine which are the other two main options here.
post #15 of 69
Thread Starter 
I have become obsessed and determined all in one day.

I just found this article, I am going to take it when I am interviewing care providers:

http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00150.x?prevSearch=$%7BresultBean.text%7 D&cookieSet=1

"Nitrous Oxide for Pain in Labor--Why Not in the United States?"

By Judith P. Rooks, CNM, MPH, MS11
Consultant and epidemiologist in maternal and newborn health, Portland, Oregon, United StatesJudith Rooks, 2706 SW English Court, Portland, Oregon 97201, USA.
Volume 34 Issue 1 Page 3-5, March 2007

Judith P Rooks CNM, MPH, MS (2007)
Nitrous Oxide for Pain in Labor--Why Not in the United States?
Birth 34 (1), 3–5.



Official citation: Judith P Rooks CNM, MPH, MS (2007)
Nitrous Oxide for Pain in Labor--Why Not in the United States?
Birth 34 (1), 3–5.

Here is the article:

Rooks, 2706 SW English Court, Portland, Oregon 97201, USA.
Why is nitrous oxide for pain relief unavailable to most women giving birth in the United States when it is available in so many other countries? Most U.S. women also lack access to many nonpharmacologic methods to cope with labor pain that, although less effective than epidural analgesia, provide sufficient and satisfactory pain relief to a significant proportion of the women who use them during labor.

Labor pain is a subjective, multidimensional, and highly individualized response that occurs in the context of a particular woman’s physiology and psychology. Her own and her family’s beliefs, expectations, and values, as well as the environment in which she labors are all involved, and, in turn, her response to pain is affected by the beliefs, expectations, and values of her health care providers (1). Personal expectations, caregiver support, the quality of the practitioner-patient relationship, and the woman’s involvement in making decisions about her care can override many other factors that influence satisfaction, including pain (2). With such variation in women’s experiences of, and attitudes toward, labor pain, providing a single highly effective but expensive and intrusive analgesic, such as an epidural, is simply not enough.

In the context of obstetric analgesia, "nitrous oxide" usually refers to a half-and-half combination of oxygen and nitrous oxide gas, called by the trade name "Nitronox" (in the United States) and "Entonox" (in the United Kingdom). It is self-administered by the laboring woman using a mouth tube or face mask, when she determines that she needs it, about a minute before she anticipates the onset of a strong contraction until the pain eases (3). Its use can be started and stopped at any point during labor, according to the needs and preferences of the woman. It takes effect in about 50 seconds after the first breath and the effect is transient—essentially gone when no longer needed (3). That is an enormous advantage over epidurals for women who want to have an unmedicated birth but may need help at some point during labor and want whatever method they use to be under their control.

Although nitrous oxide provides much less complete pain relief than an epidural, it is enough for many women. It is eliminated through the lungs rather than the liver, and so does not accumulate in the mother’s or baby’s body. Unlike opioids, it does not depress respiration. If the absolute rule of self-administration is violated by someone who attaches or holds the mask to the woman’s face, and the woman becomes groggy or even unconscious, a few breaths of room air or oxygen resolve the problem quickly. Fifty percent nitrous oxide with oxygen does not cause newborns to be groggy (3).

Routine co-interventions associated with use of epidurals (intravenous lines, frequent blood pressure monitoring, mandatory continuous electronic fetal monitoring) are not needed with nitrous oxide, nor is the more frequent use of many others (Pitocin augmentation, urinary bladder catheterization, and the need for either a cesarean section or use of forceps or vacuum to achieve a vaginal delivery, replete with an episiotomy and, not infrequently, the subsequent need to repair a 3rd or 4th degree laceration) (4,5).

A recent U.S. survey based on interviews with a representative sample of nearly 1,600 women who gave birth in American hospitals in 2005 provides information on use of 5 pharmacologic and 9 nonpharmacologic pain-relief methods used by women during childbirth in U.S. hospitals during that year (6). The 4 pharmacologic methods used by women who gave birth vaginally were epidural or spinal analgesia (71%), parenteral narcotics (24%), nitrous oxide (1%), and pudendal or other local block injections (1%) (C. Sakala, personal communication; unpublished data, December 4, 2006). Many women used more than 1 pharmacologic method during labor, and 14 percent used no pain medication at all (7). Use of epidural or spinal analgesia by all women (vaginal plus cesarean births) increased from 63 percent in the first survey (data collected from mid-2000 to mid-2002), to 76 percent in 2005 (7). Inversely, nonuse of any pain medication fell from 20 percent in the first survey to 14 percent in 2005. The 9 nonpharmacologic methods were all used more often than nitrous oxide.

By comparison, nitrous oxide is used by the majority of women in many countries that are relatively similar to the U.S. in general socioeconomic and medical standards. Nitrous oxide was used by 48 percent of the women who gave birth in Finland in 2005 (8), and 46 percent of those who gave birth in New South Wales, the largest state in Australia, in 2004 (down from 49% in 2000) (9).

In Canada, 43 percent of women who gave birth in hospitals in British Columbia during 2004/2005 used nitrous oxide alone or in combination with other methods of pain relief, a decline of more than 2 percent since 2000/2001 (M. Klein, personal communication; data from C. Johnson, Provincial Perinatal Analyst, British Columbia Reproductive Care Program, October 30, 2006). The use of nitrous oxide was highest (50%) among women who labored in hospitals with the highest volume of births per year, and lowest (22%) in hospitals with fewer than 10 births per year, a finding that contradicts the idea that its use is higher in hospitals that cannot provide 24-hour-a-day-every-day-of-every-week access to epidurals. Nitrous oxide can also be taken to home births by midwives in British Columbia, although few carry it with them, since "most of our homebirth women are very committed and do fine without any drugs" (K. Campbell, Division of Midwifery, University of British Columbia, personal communication, October 1, 2006).

Based on data from a sample of women who gave birth in 8 locations within the United Kingdom in 2000, approximately 62 percent used nitrous oxide (J. Green, personal communication, October 8 and December 1, 2006; unpublished data from the 2000 Greater Expectations study, Mother & Infant Research Unit, University of Leeds). Forty-two percent of women who used nitrous oxide also used parenteral Demerol or other narcotics (Pethidine, meperidine), 31 percent used transcutaneous electrical nerve stimulation (TENS), and 33 percent used epidural analgesia. Twenty-one percent of the entire sample used nitrous oxide but none of the 3 other methods. Including all women who used nitrous oxide, 38 percent judged it to be "very effective," 47 percent only "partly effective," and 15 percent "not effective at all"; 68 percent of those who used it were very pleased. Three percent of women who used it felt that they were under considerable pressure to try it; 9 percent felt "a bit" of pressure, and 86 percent said, "No, not at all"; 1 percent of women were encouraged not to use it. Its use among first-time mothers was lower compared with those having a second or higher-order baby.

Nitrous oxide also provides a unique advantage when pain relief for a procedure is suddenly needed, such as manual removal of a placenta, vacuum extraction or forceps on a woman without an epidural, or manual rotation of an occiput posterior fetus per vagina. Nothing is as quick as nitrous oxide; in its absence some women have to endure these procedures without any pain relief (P. Simkin, personal communication, December 1, 2006).

Despite its wide and popular use in many countries, nitrous oxide for the relief of labor pain is largely unknown in the U.S., where the expanding use of epidural analgesia has resulted in an evolving epidural monoculture in some hospital obstetric units. The assumption seems to be that every woman who goes to the hospital to labor (not for a prescheduled cesarean) should have an epidural as soon as she begins to experience any pain. In such settings, women who want to avoid an epidural are asking for "special" care and may disrupt staff routines and expectations. Some women feel pressured to accept an epidural but lack access to other effective pain-management methods. A woman who wants to achieve a normal birth may find herself "between a rock and a hard place"—that is, without any satisfactory option. She certainly also lacks the autonomy and informed choice now being cited as the ethical imperative driving the concept of elective cesarean births (10).

My search into the history and use of nitrous oxide in several countries, as well as its benefits and risks (including occupational reproductive health hazards for women who work with women during labor in settings with obsolete equipment and inadequate ventilation), suggests an explanation for its very limited use in the U.S.: obstetric use of nitrous oxide in America is similar to that of any older, inexpensive, off-patent, unglamorous, safe and reasonably effective but not highly potent drug. Nitrous oxide is like an "orphan" drug—little known, outside of dentistry, lacking élan and pizzazz, with no companies or influential professional groups that stand to profit by its greater use.

Some obstetricians and hospitals are afraid to use it because of the possible risk of environmental contamination and occupational hazard. But modern American hospitals are well ventilated, and modern equipment for the administration of nitrous oxide "scavenges" the unused gas (3). As with the use of many other potentially hazardous substances, hospitals must establish safe practices and train their staff to use them. Preventing the use of nitrous oxide for women during labor out of concern about environmental hazards is a conspicuous red herring.

Although nitrous oxide is a natural adjunct to the midwifery model of care, few American midwives have had any experience with it, and its use is not taught in midwifery educational programs. Natural childbirth supporters are not attracted to it because it is a drug (but not a narcotic!). But among the few American women who have used it in other countries or in U.S. hospitals that have since discontinued its use, some have become greatly disturbed when they learn that it is not available.

Nitrous oxide has significant cost advantages. It is much simpler and less expensive to use than epidural analgesia and does not result in complications that require additional treatments and both mother and baby days of hospitalization. It should be attractive to those concerned about the extremely high cost of health care in the United States, where clogged coronary arteries and pregnancy were reported to be the two most expensive conditions contributing to $790 billion in annual hospital costs (11). The care of pregnant women was the biggest cost for private insurance companies and Medicaid in 2004.

My intent in writing this editorial is to issue a challenge to U.S. midwives and midwifery educators to become informed about nitrous oxide, to natural childbirth leaders to consider its benefits versus the current options for women who want to achieve a spontaneous vaginal birth in U.S. hospitals, and to all who support the concept of a pregnant woman’s right to autonomy and informed choice about major elements of her care during childbirth.

Judith P. Rooks, CNM, MPH, MS11Consultant and epidemiologist in maternal and newborn health, Portland, Oregon, United StatesJudith Rooks, 2706 SW English Court, Portland, Oregon 97201, USA.
Acknowledgments Go to sectionTop of pageAcknowledgmentsReferencesUsers who read this article al...
I am very grateful for the help of Michael Klein, Canada; Josephine Green, United Kingdom; Sally Tracy, Australia; and Mika Gissler, Finland, for providing information and, in some cases, special analyses of unpublished data on the use of nitrous oxide in their countries. I also wish to thank Penny Simkin, Carol Sakala, and Mark Rosen, for their valuable information and assistance in the United States.

References Go to sectionTop of pageAcknowledgmentsReferencesUsers who read this article al...
1. Lowe, NK. The nature of labor pain. Am J Obstet Gynecol 2002;186(5):S16–24.
2. Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: A systematic review. Am J Obstet Gynecol 2002;186(5):S160–172.
3. Rosen MA. Nitrous oxide for relief of labor pain: A systematic review. Am J Obstet Gynecol 2002;186:S110–126.
CrossRef
4. Mayberry LJ, Clemmens D, Anindya D. Epidural analgesia side effects, co-interventions, and care of women during childbirth: A systematic review. Am J Obstet Gynecol 2002;186:S81–93.
CrossRef, Medline, ISI
5. Lieberman I, O’Donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. Am J Obstet Gynecol 2002;186:S31–68.
CrossRef, Medline, ISI
6. Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection, October 2006:31–33.
7. Declercq ER, Sakala C, Corry MP, et al. Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experience. New York: Childbirth Connection, October 2002:18–23.
8. STAKES. Official Statistics of Finland, Health 2006: Statistical Summary 18/2006. Available at: http://www.stakes.fi/NR/rdonlyres/8D...t18_06_ok.pdf; accessed December 2, 2006.
9. NSW Department of Health. New South Wales Mothers and Babies 2004. December, 2005:25. Available at: http://www.health.nsw.gov.au/public-...sup/mdc04.pdf; accessed September 26, 2006.
10. Minkoff H. The ethics of cesarean section by choice. Semin Perinatol 2006;30(5):309–312.
CrossRef, Medline, ISI
11. U.S. Agency for Healthcare Research and Quality, HCUP Statistical Brief #13. The National Hospital Bill: The Most Expensive Conditions, by Payer, 2004. Available at: (PDF file, 307 KB; HTML); accessed December 2, 2006.
post #16 of 69
3cuties: I don't know for sure, but I bet you have to be a professional or have a prescription to get the 50/50 nitrous. One of my midwives was yammering on about having to track something else in addition to Narcotics and reporting missing stuff to the powers that be, yada yada. It does sound like a pain, but I don't think she knew the specifics. Your link to blackwell synergies didn't work. Some kind of Cookie failure. Can you send a reference to it? Like Title, Author, Publication date, etc?

When my midwife started expressing reluctance to providing it, my DP said "I'll just call up my buddy from college..." Whoah, nelly. I doubt those whippets (Nitrous Oxide cartridges) are 50% Oxygen, but if they were, or if there were a reliable way of mixing them, I'd pursue it.

Liss, Southern Mommie, and Demeter: If you'd like to discuss and the pros and cons of using Nitrous Oxide during labor I'd love to take part. Just start a new thread and we'll go to town.
post #17 of 69
Thread Starter 
I recopied the link and fixed my post above. If you copy and paste the link it should work. Additionally, I added the citation informatino.
post #18 of 69
Nope, I still don't have the cookie it wants that you must have. Maybe one needs to sign up for an account on the site first? It's one I've seen the abstract for though, so I'm good for now. Keep me posted on your discoveries!
post #19 of 69
Isn't Ni/Ox used by some scuba divers? I think the reason they use it is to help them stay submerged longer, and it also allows them to 'de-gas' more quickly when they are on there way up. I also think it decreases the likelihood if getting "drunk" at certain depths. But, I think Ni/Ox is only good for use down to around 130 feet I think. You might want to look at its use in diving situations and study the physiology of it there.

Good luck,
Jenny
post #20 of 69
Thread Starter 
Quote:
Originally Posted by elizaMM View Post
Nope, I still don't have the cookie it wants that you must have. Maybe one needs to sign up for an account on the site first? It's one I've seen the abstract for though, so I'm good for now. Keep me posted on your discoveries!
Very weird! If you are on a different computer -- maybe try that? Or if you present your midwives with the citation, maybe they can access it. Is it against MDC policy for me to copy the article in this thread if I cite to it?
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