LivingIs laughing gas a good alternative to epidurals?

Is laughing gas a good alternative to epidurals?

The moment of delivery is an unforgettable experience for the mother and helps to have the best memory if it develops in the most natural way possible and the pain of contractions is controlled.

In most Spanish maternity wards, the option is to use epidural anesthesia or not, although it is not the only one.

Nitrous gas or Entonox, better known as laughing gas, is a type of pain reliever widely used in other European countries. In Spain it is still little used in childbirth, but it is a possibility and an alternative to epidurals. We tell you how it works and what its advantages are.

A pain reliever with a long history

The use of nitrous oxide in obstetrics as a pain reliever is not a new practice, but has a long history. Discovered in 1771, it wasn’t until a century later that it was first used in childbirth. And already in 1934, the English Minnitt introduced a device for self-administration by airway.

This is explained by a large study on the so-called ‘laughing gas’, which indicates that the use of 50% nitrous oxide together with oxygen is a common analgesic between 40 and 60 percent of deliveries in Canada, Sweden, New Zealand and Australia. And even more so in the United Kingdom (where it is the method chosen by women between 50% and 75% of deliveries) and in Finland (60%).

How does it work

According to the study published in the nursing journal ‘Inquietudes’, it is used under the supervision of doctors, midwives or qualified nurses as it is considered a safe method that does not show signs of complications in women with normal delivery, in newborns, or in staff health care provider that assists the pregnant woman during her administration.

It is an inhalable gas that contains 50% oxygen and 50% nitrous oxide. It works by neutralizing brain nerve transmissions, including pain.

When inhaled, the woman feels a pleasant dizziness and relaxation that can lead to laughter when there is no pain. At childbirth, she has a mask with a mouthpiece attached to a bracelet on her wrist.

When you start to feel pain, you have to inhale nitrous oxide in small, continuous doses. It is important that you do this before the true discomfort of the contraction begins so that when it reaches the climax you will not feel the pain.

Its effect lasts less than a minute, and it is the pregnant woman who decides whether or not she wants to ingest more. It is eliminated from the mother’s body in seconds, as soon as she breathes the air in the room.

Its effectiveness against epidural anesthesia

Administration of inhaled nitrous oxide produces moderate but satisfactory analgesia in labor.

This is described in the article published in the Andalusian nursing journal.

“The degree of analgesia is less than if other types of analgesics are used, but their proper administration significantly reduces pain in 50% of women.”

Among the advantages over other anesthetics used in childbirth, the American Pregnancy Association points out:

  • Its easy administration.

  • A short latency period.

  • It does not interfere with childbirth.

  • It does not harm the newborn or the mother.

  • It does not affect breastfeeding.

  • It does not cancel the push reflex, so the pregnant woman has freedom of movement and can adopt the position she wishes during contractions.

  • It can be administered in conjunction with local anesthetics if episiotomy is required.

  • It does not alter the release of oxytocin or affect infant alertness during the early period of bonding between a mother and her newborn.

  • Its effects disappear five minutes after cessation.

Some disadvantages

According to the American association:

“Nitrous oxide labor analgesia is safe for the mother, fetus and newborn. It is easy to administer, it does not interfere with the release and function of natural oxytocin and it has no adverse effects on the progress of labor ”.

To be safe, the administration of this gas must be carried out in adapted centers and by trained professionals, usually midwives.

Even so:

  • It can cause some side effects such as nausea and vomiting , or feeling dizzy or sleepy at the beginning of its use.

  • At the doses given during labor, nitrous oxide is a mild pain reliever , and it does not work for all women. With an epidural, labor does not hurt, but with nitrous oxide it does.

Women who use nitrous oxide during labor may still have an awareness of labor pain. However, many women find that it helps them relax and decreases their perception of labor pain.

It can be an intermediate solution for those women who go to the hospital with the intention of having a natural birth without anesthesia and when they are there the pain makes them rethink their choice.

In short, laughing gas is a pain reliever, not an anesthetic, so labor still hurts , but it will be a solution for many of these women, who will be able to have the desired labor by controlling the pain of contractions a bit.

Its specific use in a Spanish hospital

Nitrous oxide has been used in the Hospital de Cabueñes (Gijón, Asturias) since February 2018, to calm the pain of pregnant patients during contractions caused by childbirth.

From July 2018 to August this year, 303 women used it in combination with other alternatives such as a shower, massage or the Swiss ball. This is explained by the newspaper “El Comercio”, which includes the statements of the delivery supervisor.

According to Inmaculada Fernández, the profile of women who use nitrous gas are “that of young people, who are up to date, who have received sufficient maternal education in this regard.”

He assures that they choose to use it because of the fear of the epidural, which is “still a more invasive remedy than injected” , although he points out that “the results are more effective.”

From her point of view, “many women chose nitrous oxide at the beginning because it was the novelty. There was a lot of demand in the beginning. Now there is still, but it has been reduced a bit.”

“As soon as the pregnant woman understands that the pain relief is not the same as the one they had in her expectations, they warn to have the epidural put on them.”

Photos | iStock

In Babies and More | Analgesia in Labor: Pain Management Techniques Without Using Anesthesia, Why Labor Contractions Hurt

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