‘I could relax’ Nitrous oxide regains popularity during labor, delivery

Lynn Gottlieb inhales nitrous oxide during labor at Charleston Birth Place. The colorless, odorless “laughing gas,” which is commonplace in dentists’ offices, is regaining popularity in hospitals and birth centers to ease anxiety during childbirth.

Sarah Sutton had been in labor for more than 12 hours when she asked her nurse-midwife for some nitrous oxide.

She knew the gas was an option at Charleston Birth Place, a freestanding birth center in North Charleston.

Her contractions, spaced about a minute or so apart, had become “excruciating.”

“I had it in my mind that it would take pain away,” Sutton said. “It didn’t.”

Two hours later, her son, Maxwell, was born.

Sutton said her husband definitely noticed a difference after she inhaled the nitrous oxide.

“It gave me something to focus on,” she said. “I could relax.”

The midwife birth center and only one hospital in South Carolina offer nitrous oxide to pregnant women to ease labor pain.

The gas, commonly used in dentists’ offices, was widely available in hospitals for women in childbirth until powerful, pain-killing epidurals gained popularity. Now, “laughing gas” is making a comeback, offering an alternative to patients who need some relief but want to keep their labor as natural as possible.

Lesley Rathbun, a certified nurse-midwife and owner of Charleston Birth Place, said 25 percent of her patients use nitrous oxide during labor.

Like Sutton, she said they don’t always know what to expect.

“Nitrous (oxide) does not really provide any pain relief at all,” Rathbun said. “It’s just an anti-anxiety agent.”

Anxiety and pain are closely linked, she explained.

“The more anxious you are, the more pain you have,” she said. The nitrous oxide doesn’t eliminate labor pain, but it tends to help women relax during contractions.

“It’s probably the most studied substance in history because it’s been used since the 1700s,” she said. “Really, there’s a lot of evidence around the use of it.”

Michael Civitello sells the Porter Instrument machine, called the Nitronox system, that Rathbun’s patients use at Charleston Birth Place.

Four years ago, Civitello said, only three or four hospitals and birth centers in the country used nitrous oxide for labor pain management.

Today, he estimated there are 150. It is already widely used in other countries, including the United Kingdom.

“It’s a new market, not new technology,” Civitello said.

Unlike the nitrous oxide machines commonly used in dentists’ offices, the FDA-approved Nitronox system is self-administered by the patient.

Patients in a dentist’s office generally inhale the gas continuously through a nasal cannula looped under their nose and around their ears. But the Nitronox system allows a pregnant patient to raise a mask to her face and inhale the gas during a contraction. She typically lowers the mask when the contraction is finished. There is no continuous flow.

The blend of nitrous oxide and oxygen in a dentist’s office may also be stronger than the blend used for laboring women.

Dentists can adjust the blend to a maximum 70 percent nitrous oxide and 30 percent oxygen for their patients. The blend administered through the Nitronox system does not change. It is always 50 percent nitrous oxide and 50 percent oxygen.

Rathbun said the machine cost about $5,000. Nitrous oxide is not covered by health insurance plans, so she charges patients $150 to use it.

Clarendon Health System in Manning offers it to pregnant patients for free. It is the only hospital that offers nitrous oxide to pregnant women in South Carolina.

Nurse-midwife Tom Chappell said the hospital bought the Nitronox system about 10 months ago.

“Many women are anxious in labor. They want everything to go well,” he said. “(Nitrous oxide) helps them relax and decrease anxiety.”

The gas isn’t risk-free. Patients who have had middle-ear surgery or who have a vitamin B deficiency should not use nitrous oxide. It’s also possible to overdose on the gas, but only in very high concentrations.

Rathbun said some studies have suggested that dental hygienists are more likely to miscarry because of prolonged exposure to nitrous oxide, but this exposure doesn’t seem to pose a risk to patients that only occasionally use it.

Lynn Gottlieb delivered her son at Charleston Birth Place in 2013. She said nitrous oxide helped “take the edge off” during labor.

“It did help me to focus on my breathing as you had to inhale and exhale through the mask with each contraction,” Gottlieb said.

Rathbun called it a “no-brainer” for most moms.

“It’s safe. It’s very effective,” she said. “It doesn’t completely replace an epidural. Women who are having really difficult labors, it will help them get further down the road, but it will at least delay that epidural so you’re not getting it way too early.”

Reach Lauren Sausser at 937-5598.

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