Tuesday, April 27, 2010

The Case for Choice in Labor Pain Management

by Melissa Garvey, ACNM Writer and Editor

Early this year, ACNM released a new Position Statement on the use of nitrous oxide for managing labor pain. Unless you are a midwife or other clinician, it can be hard to understand why nitrous oxide and the ACNM Position Statement is such an exciting topic. I just finished combing through a thorough, informative post at Science and Sensibility that helped me realize why—as a 29-year-old woman hoping to someday experience pregnancy and birth on my own terms—my enthusiasm has piqued. Nitrous oxide has the potential to expand access to choice related to one of the most sensitive issues around birth—pain management.

As certified nurse-midwife Judith Rooks so aptly articulates in the Science and Sensibility post, “Every woman and labor is unique. There is no single best method of labor analgesia. Every method has advantages and disadvantages, and different women value different things.” Just as women need options in where and with whom to give birth, women need to be able to choose which methods of pain control best match with their beliefs, experiences, health status, and stage of labor.

I won’t even try to rival Judith Rooks’ overview of what nitrous oxide is, how it is used, and how it works. Instead, I leave you with four ways nitrous oxide has the potential to expand access to choice.
  1. More Options for Pain Management in Homes and Birth centers. While midwives can help women manage the pain of labor through a variety of options like massage, emotional support, and water immersion, many women find it comforting to know that their midwife can order pain medication if they end up needing it. In homes and birth centers, that drug could be nitrous oxide rather than an epidural, which is only available in hospitals.
  2. More Options for Pain Management in Hospitals. If a woman decides that she wants an epidural, she has to wait until labor is well established and for the anesthetist or nurse anesthetist to administer the epidural. That same woman can use nitrous oxide to take the edge off the pain while she waits to be able to have an epidural. Depending on her response to nitrous oxide, she may even decide she does not need the epidural.
  3. Freedom to Move. If delivered through portable equipment, nitrous oxide can be used without sacrificing movement during labor. Women can still change positions, walk, go to the bathroom, or soak in a tub.
  4. Freedom to Change Your Mind. If a woman decides that she does not like how nitrous oxide makes her feel or decides she no longer needs it, her body will be completely free of it in less than five minutes from the time she stops inhaling it.
According to Judith, only two hospitals in the US currently offer nitrous oxide for labor pain management. Most birth sites in the US do not offer the drug largely due to lack of equipment and manageable concerns over the risk of nitrous oxide to health care workers. The new ACNM Position Statement addresses some of the concerns related to nitrous oxide, and a new company is preparing to make the equipment. Let’s hope this is the start of a growing wave of support for more choice in how laboring women cope with pain.


Anonymous said...

OMG I am SO surprised at this! Only 2 hospitals in the whole US?? wow, up here in igloo land, we use it all the time. In my experience, about 1/3 women will LOVE it, and the other 2/3 will HATE it - but I always encourage women to consider it, as they never know until they try which side they will be on. And for those who love it, they say that "it didn't make the pain go away, I just didn't care"; which is a pretty useful thing, as it means mums will still move in response to contractions, pay attention to her body's signals etc. We use an American video in teaching about interventions, and parents always ask why nitrous oxide is not mentioned in the pain relief section - I tell them it is not widely used but I had no idea how NOT widely...
Choice is good - good luck getting more choices!!

pinky said...

My limited understanding is that the negative consequence is hypoxia in the newborn because (and I am going on memory, I have to check my facts) nitrous has an affinity for oxygen and this will take away from the oxygen available to the baby. Now this may be dose related. I would be interested in learning more. I remember thinking it was a wicked good idea until an anesthesia friend of mine told me the affinity for oxygen thingy.

Melissa Garvey said...

I definitely recommend reading the ACNM Position Statement. It addresses that concern. The post on Science and Sensibility also has some interesting info about it.

Elizabeth Moore said...

This is a wonderfully informative and helpful blog post and I thank Melissa Garvey for sharing news about research and relevant links.
After accessing the ACNM position link, reading the Science and Sensibility link and watching the birth video, I felt both excited and frustrated. The news that Nitrous Oxide may reemerge as a viable alternative for pain relief in labor is very encouraging! As a labor nurse in a hospital setting for many years, I struggle with knowing that the popular epidural is not the panacea women perceive it to be and am concerned with the way in which its risks are downplayed by clinicians. I am frustrated suspecting that the road to acceptance for Nitrous Oxide pain relief will likely be paved with obstacles having more to do with providers' profit motives. It wouldn't be the first time self-interest in the form of profit has masqueraded as "concern" over "safety". The research provided underscores the importance of professional nurses and midwives as advocates for women, first and foremost. They deserve to have this choice and it is every clinician's imperative to put patient welfare first!
Thank you again for raising awareness!
-Liz Moore, R.N.
Princeton, New Jersey

pain management emr said...

Interesting post! Well, my mom also have experience with that, she choose the painless delivery during her labor. And I agree with you there that, Every woman and labor is unique. Thanks for sharing.