For women giving birth, nitrous oxide may be a viable alternative to having an epidural block, a recent study has found.
Although the researchers were quick to point out that nitrous oxide (N2O) may not be for everyone, it could stand in when an epidural block is contraindicated, or for women who simply do not wish to receive one. Likewise, they note that NO offers a safe alternative to IV narcotics.
The retrospective cohort study, presented at the 2014 Pregnancy Meeting (abstract 598), examined the outcomes of 6,192 laboring women at the University of California, San Francisco Medical Center (UCSF) between 2007 and 2012. The investigators focused on single-child, head-down births with no unusual complications.
NO was administered using an FDA-approved device called the Nitronox (Porter Instruments). The researchers accounted for the effects of age, ethnicity, insurance status and the length of each stage of labor in their comparison of outcomes between women who received N2O and those who did not.
Of the women examined in the study, 14% opted to use N2O for pain control during delivery. Of these, 42% also received an epidural injection compared with 76% of women who did not receive NO. Maternal use of N2O did not significantly affect the rate at which babies were admitted to intensive care, according to the researchers. Nor did N2O significantly affect the babies’ five-minute Apgar score or the odds of complications for the mother, such as acidemia or postpartum bleeding.
“The findings show that this offers a different option,” said Melissa Rosenstein, MD, a clinical fellow in the Division of Maternal-Fetal Medicine at UCSF. “No one is saying that women who want an epidural shouldn’t use one, but nitrous oxide is a good option for women who don’t want to be completely numb, but just want to take the edge off.
“What’s nice is that there’s no commitment,” Dr. Rosenstein added. “If the woman doesn’t like it, we can put it away and go back to breathing, or have an epidural if she prefers.” She also noted that, unlike an epidural, N2O can be used in the second stage of labor because it does not blunt the urge to push.
The results indicate that N2O should be more widely available for childbirth than it currently is, said Manuel Vallejo, MD, DMD, professor and chair of the Department of Anesthesiology at West Virginia University, in Morgantown.
“This study tells me that nitrous oxide can be safely used, with no harm to neonates. It tells me that it should be in the toolbox,” Dr. Vallejo said. “The epidural is still the gold standard, but using nitrous oxide, some women might be able to get further along before they need an epidural, and some women may not need one at all.”
NO also can be administered safely by a midwife in the event that an anesthesiologist is unavailable during childbirth, Dr. Rosenstein said. N2O is commonly used for anesthesia during labor in Canada and throughout Europe, but remains relatively uncommon in the United States.
“When I presented the findings, the international folks all said, ‘Yeah, we have this, it’s no big deal,’” Dr. Rosenstein said. “We wanted to release these findings to let people in the United States know about it. Trying to show that nitrous oxide is better or worse than an epidural is not the point,” she added. “The point is that it relieves pain in a totally different way.”
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