Midwives, pain relief, and hypocrisy

Woman hiding under the happy mask. Hypocritical, insincere, two-

Below are the characteristics of two types of pain relief in labor. Guess which one is favored by midwives.

Pain relief chart

If you guessed “B,” you’d be wrong.

True, it is easily adjustable, non sedating, has no impact on memory or oxygen levels and crosses the placenta in miniscule amounts if at all. But it’s the dreaded epidural and it’s bad, bad, bad.

“A” is, in fact, favored by midwives and used extensively by midwives around the world at home and in the hospital. Indeed, many midwives believe it is perfectly compatible with natural childbirth despite the fact that it is most certainly a drug, marketed by a pharmaceutical company, is difficult to dose effectively, causes sedation and impaired memory, and readily crosses the placenta in large amounts where it sedates the baby.

Shocked? You shouldn’t be. Drug “A” is nitrous oxide and American midwives are clamoring for its use.

A new patient handout prepared by the Journal of Midwifery and Women’s Health expounds on the virtues of nitrous.

… Many women in Europe and other countries, such as Canada and Australia, use it to help cope with pain in labor. It is so common that in some countries as many as 8 in 10 women use nitrous oxide to help with labor pain. Women in these countries have been using this method of pain relief in labor safely for many years. Nitrous oxide hasn’t been used as often in the United States, but that is changing.

The handout acknowledges that nitrous produces altered consciousness and distorted memory, but apparently does not consider that a problem. The handout glosses over the impact of nitrous on the baby:

Nitrous oxide is the only pain relief method used for labor that is cleared from your body through your lungs. As soon as you pull the mask away, the effect of breathing the gas is gone within a few breaths. No extra monitoring is needed for you or the baby because you are using nitrous oxide. If you did get too sleepy, a monitor to check your oxygen levels might be placed on your finger. Nitrous oxide is safe for your baby, so if your baby’s heart rate is being checked intermittently (off and on) rather than continuously (all the time) with a fetal monitor, that is still okay…

Midwives are apparently unconcerned that nitrous crosses the placenta easily and in large amounts, producing sedation and altered consciousness in the baby. In fact, it would be quite accurate to state that nitrous “drugs” the baby whereas epidurals do not.

What’s the impact of nitrous on breastfeeding and newborn behavior? That’s not clear because very little research has been undertaken on the impact of nitrous on the newborn.

So by every parameter we can measure, nitrous has far more impact on women and babies than an epidural, yet nitrous is “good” and epidurals are “bad.” What accounts for this paradox?

It’s simple: midwives can administer nitrous, but lack the skills and training to administer epidurals.

All the pious wailing about the effects of epidurals are nothing more than hypocrisy. It really makes no difference to midwives whether women use “drugs” in labor to relieve pain, even if those drugs limit ability to move in labor, alter consciousness, impair memory, decrease oxygen levels, readily cross the placenta and sedate the fetus … just so long as they can administer the drugs.

  • Oana

    I had it (in a Dublin maternity hospital) at the birth of my son while waiting for the epidural which I didn’t eventually get because he was coming too quickly. I have to say It offered me no relief; the only thing it gave me was a terribly dry mouth and throat.

  • Sarah

    I was told by all NHS information (UK) that etonox has no ill effects for the unborn baby and I’m horrified to read from this post that it might. I had etonox for my daughter’s birth and it was great, had been planning to use it again for any subsequent births but perhaps epidural is safer for baby? I had thought that the dangers of etonox were from long-term / frequent exposure i.e. to the medical staff, not to one-off users (mum and unborn baby), is that incorrect? Is the hypoxia that the table says it can cause in the fetus reversible rapidly enough that it’s not actually dangerous? (for me each breath wore off within a really short time). I know the post is pointing out hypocrisy of the NCBers rather than discussing nitrous itself, but I’m really concerned about where I can get accurate information now.

    • Young CC Prof

      Chronic exposure to entonox in early pregnancy can cause birth defects, this doesn’t happen with exposure during labor. Oral or IV narcotics definitely can cause hypoxia in the newborn, but several studies found entonox had no effect on newborn APGAR scores. However, epidural anesthesia drugs don’t get to the newborn at all. I think epidural actually is safer.

      • Sarah

        Thanks!

    • http://anniedeezy.tumblr.com/ Annie

      When I need information about something really important that is controversial, I look at as many official sources of information as possible. Dr. Amy is great because she cites credible information, but at the end of the day, she’s still just someone on the internet with an opinion. You never, ever, ever want to base such decisions on that.

      Go to different government health websites, from different governments. Go to major medical university websites. Bring printouts to doctor appointments and have questions ready for them, point by point.

      For the record, I absolutely agree that the epidural is safer. But, I’m just a person on the internet. ;) Good luck, and congratulations.

  • Obgyn mountain view, ca

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  • araikwao

    Sorry in advance if this has already been posted, but nitrous isn’t even an effective method of pain relief, according to the relevant Cochrane review (epidural is). No time to add the rant I’d like to about why ineffective methods of analgesia (this and IM pethidine) are “acceptable” to midwives, yet the effective one is demonised. Well, I guess that was the nutshell version.

  • The Bofa on the Sofa

    It seems that a lot of people are missing the point of this post. Dr Amy is NOT talking about whether nitrous is good/bad/ugly or whatever. She is talking about the hypocrisy of midwives and those who go on about NCB and avoiding the evil epidural, making up all these reasons as to why epidurals are bad, but then have no problem with a patient using nitrous oxide “to take the edge off” or whatever, despite the fact that N2O has known risks that epidurals do not.

    She isn’t suggesting that nitrous should not be available. Then again, she doesn’t oppose epidurals. This post is talking about those who oppose epidurals but, for some reason, don’t have a problem with nitrous oxide.

  • anion

    Thank you for this post. I’ve wondered for a long time about the possible effects of nitrous on the baby, and why in the world people who advocate “natural” birth would advocate it. It just never sounded very nice to me. That weird floating-head-with-a-tight-band-strapped-around-it feeling while in labor? Eek. Breathing gas? Gas that’s used to make cars go faster? I’ve seen more than a couple of people I knew turn into zombies from huffing on a regular basis; obviously the use in labor isn’t the sort of habitual use they were engaged in, but I still can’t imagine that’s a good idea to do for hours on end.

    Personally, I love me some opiate painkillers. I think they’re *awesome.* But I’ve had nitrous at the dentist and I didn’t like the feeling at all; it made me sort of dizzy and queasy and stupid, and just generally weird. I just don’t get why someone would *want* to feel that way, especially at a time like that, and especially when they can get something so much better? I had IV Demerol in early labor with my first and it was loooovely.

    I have to have dental surgery after the new year and am dreading the nitrous I’m sure I’ll be given. And the fact that chances are I won’t be sent home with anything better than codeine, since there really isn’t much else available here.

  • siri dennis

    Hang on a moment though, Entonox is used in practically all labour and delivery settings in the UK, with a very high uptake; the majority of multips, in my own limited experience, arrive on labour ward with a strong wish for it because they found it helpful in a previous labour. I myself have used it throughout five labours, and found that its drawbacks are easily outweighed by its advantages. All my babies have arrived alert and keen to feed, even though I also had pethidine in four of the labours. It obviously isn’t midwives who decide what analgesia should be made available; clinical directors etc are invariably consultant obstetricians, and they presumably base their decision on the available evidence. I am aware that in some countries Entonox has been discarded because of its possible effects on staff, but I have never heard anything about it having a detrimental effect on babies. I think that if Entonox were to be removed from childbirth settings, there would be many very angry and disappointed women. Are there studies that show a detrimental effect on babies? I was always a gas guzzler in labour; during my homebirth, I depleted the unit’s stock of portable gas canisters, and a student midwife was despatched to the hospital to fetch a huge one that had to be wheeled down the road to my house on trolley lol. I was on the stuff continuously for six hours, and my daughter arrived full of vim and vigour. She also had her cord twice around her neck and once slung across her body, and there were three – 3! – true knots in it…

    • AmyP

      “It obviously isn’t midwives who decide what analgesia should be made available; clinical directors etc are invariably consultant obstetricians, and they presumably base their decision on the available evidence.”

      Evidence plus cost, presumably. Anesthesiologists are expensive critters, even in the UK or BC.

      • guest

        But those are available too. It’s not like in the UK you can have entonox or nothing! A lot of women are really happy with just entonox, I was and I know that I’m not alone. Liked the fact that as soon as I breathed it out the effects were gone and I could get up and do what I wanted.

      • siri dennis

        Perhaps a new breed of lay anaesthetist would be good? A sort of CPA if you will, equipped with herbs and other ways of knowing? They’d certainly be cheaper!

  • KarenJJ

    When I did the antenatal classes at my hospital, one of our tasks was to list some of the different pain relief options we’d heard about and what words/phrases we’d heard about them.

    Under epidural the words/phrases were “heavenly, amazing, needle” and under gas was “rubbish, doesn’t work, feel sick”.

    The other thing I’ve heard of midwives doing is handing over the gas handset/mask thingy without turning on the gas. So the patient sucks madly thinking their getting pain relief but they’re getting nothing. Then suddenly baby arrives and mum has managed to push the baby out without pain relief and all can hail the mighty natural birth that happened after all. Not sure how true that is though.. I can imagine it happening though.

    • Mishimoo

      My best friend was using the gas in the birth centre to help with the pushing stage because her pain levels had shot right up and it did nothing (CNM had told her to push before she was actually ready). She ended up insisting on being transferred to L&D ward for an epidural, which the CNM tried to delay, and gave the gas another try while waiting for the epidural. It actually worked that time! I wouldn’t be surprised if something like you described had happened to her.

      • palma fm

        Slightly different thing happened during my recent labor (in a good private (non woo) hospital). Was offered gas after they had to rupture my membranes at 7cm which I used. Was effective only to take the edge off of the pain and it made me very nauseous. Then it wasn’t effective even for that anymore…turns out the bottle had run out. MW declared its okay that its finished because we don’t need it anyway!

        • Anj Fabian

          “we”?
          Put her uterus in a clamp and have her repeat that glib assertion.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      I would not be surprised at any level of dishonesty at this point.

    • Sue

      Nitrous oxide is commonly used in Australian public hospitals – it’s certainly not a substitute for epidural – but it IS better than nothing. The real problem is the variability of effect – great if it works, but can cause vomiting.

      Oh, and speaking of Australia, while driving to work this morning listening to Radio National, whose voice should appear but Dr Amy -talking about the UK trial of payment as BF incentives. Good discussion!

    • siri dennis

      I find that hard to believe; most midwives and lay people regard it as one step below an actual drug, whether or not that’s correct. Every midwife I know would readily offer Entonox to labouring women to take the edge off the pain. Plus there is a valve, so if there’s no gas you can’t inhale through the mouthpiece, so you’d know right away that you weren’t getting anything.

      • AmyP

        Unless you were a first-timer, in which case you wouldn’t necessarily know.

        • siri dennis

          Yes you would, because nothing would come out through the mouthpiece! It would just go click click and you’d realise there was nothing there, not even air.

      • Antigonos CNM

        Many, many years ago, When The World Was Young And All, a woman was brought to our L&D unit completely hysterical, screaming incessantly at the top of her lungs, with or without contraction. Now, a sign of concealed abruptio placentae can be acute incessant pain, so we needed to get a fetal heartbeat right away before anything else. She was throwing herself around on the stretcher in spite of the restraints so that was impossible -this was before Dopplers. The anesthetist took the mask off the anesthesia machine in the delivery room and, putting it [completely unconnected to anything so she was breathing pure air through the hose hole], over her face, told her to “breathe deeply!” Within seconds not only had the screaming stopped, she was unresponsive to all but the strongest stimuli. We had to “wake her up” to get information from her! So much for the power of suggestion.

    • Hilary

      I call bullshit on this. On labour wards (in the UK at least) it is piped in from the wall. I don’t think you’re even able to disconnect the supply.

  • SkepticalGuest

    I totally agree, but…I wish that the nitrous oxide were available in the hospital for cases where the epidural fails to provide adequate pain relief. In a hospital, where mom and baby could be monitored, I don’t see why there aren’t alternatives for those of us who don’t respond well to the epidural.

  • madwife

    Noooo you are wrong. .. they don’t use any pain relief. . They just put them in the bath. .. water absolves all pain and they have research from 1999 to prove it!

  • EllenL

    I thought A was going to be Pethidine. It seems to fit the description. Midwives (in the UK at least) seem comfortable using it – I suppose because they can.

    Meanwhile, epidurals continue to have a bad rep despite giving truly effective pain relief, with no serious drawbacks and a high rate of patient satisfaction.

    • Mishimoo

      I tried Pethidine with my first, all it did was make my eyes unable to focus.

      • Anj Fabian

        Pethidine apparently works best on women who are exhausted. They fall asleep.

        • Mishimoo

          I wish it did that for me! I was heading into my 3rd night of no sleep. On the 2nd night, the CNM gave me temazepam (on doctor’s instructions) to try and help me sleep with no effect either.

          • http://oolon.co.uk/ oolon

            Exactly my wife’s experience of pethidine – did nothing for her and she’d had 3 nights of no sleep, so was definitely exhausted!

      • http://www.europeanmama.eu/ Olga Mecking

        I had it with my third, first I got dizzy but then the pain got so much better- I am still impressed by what it did!

    • AmyP

      Epidurals HAVE to bad, because they work.

    • Dr Kitty

      Remifentanyl is the new thing, better than Pethidine. Very popular.
      My friend described Entonox as being “about as helpful as someone trying to distract me with hand puppets”. YMMV.

      My own experience is that nervous dads in the delivery room can hijack the Entonox if you don’t watch them…

      • siri dennis

        CPMs use organic hemp sock puppets that have been imbued with sacred magic during a midnight blessingway in the remote New Jersey outback. And knitted in the vagina of an Elder Birthkeeper. You’re supposed to be a doctor; get your facts straight!

        • Young CC Prof

          Hey, we have bears and eagles and coyotes here in the NJ outback! Though I suppose that doesn’t make crawling through the woods at night more attractive…

  • Courtney

    I don’t consider myself educated enough in the world of medicine and drugs to say that it shouldn’t be used or to say I am against nitrous oxide, but having been dosed with it at what I would consider too high of a level once in a dentist’s office I can’t see it being a preferred drug for labor – I wouldn’t want my newborn to feel what I felt. The drunk head spinning dizzy slight nausea confused can’t focus feeling left me sitting in my car while I sobered up enough to drive – which thankfully was only about 5-10 minutes because it is removed from the body so quickly, but definitely longer than a couple of breathes in my experience. I really don’t remember the dental work prior to that, I know I was there and I remember the beginning of the appointment before one of the techs turned up the gas and then I remember them telling me that I was done and I could leave now, the walk to the front and check out is a haze, I am pretty sure they knew they had turned it up too high either that or I remember thinking that it was too much. The usual dose at the dentist is just enough that the edge is off and that does go away extraordinarily fast, but that higher dose took the laugh out of laughing gas for me and I have avoided it since… left that feeling in my body like when a specific food makes you sick and you just don’t want it again.

  • AnotherGuest

    It is so refreshing to hear negative views of nitrous oxide. It was terrible for me, and left me completely confused and exhausted. But nitrous oxide never seems to be blamed for anything in the UK.

    • Sue

      Great when it works well, but the effect is so variable between individuals.

    • siri dennis

      What do you think it should be blamed for?

      • Lilly de Lure

        In my case confusion, dizziness and nausea so extreme that the ambulance I was in (I was being carted in for abdominal pains that turned out to be appendicitis at the time) had to be hosed down once I had arrived, despite them offering me puke bowls. When (if) I get pregnant, no nitrous oxide within 20 feet of me during labour is a request that is going straight on my medical notes!

        • siri dennis

          Nobody disputes that it can have that effect, and I would always outline the possible side effects before giving it to a client. Fortunately the side effects are transient, and normally disappear after a little while. Pethidine is also likely to cause nausea, so we give an anti-emetic with it. Labour in itself can cause nausea and vomiting, as can the drugs given in 3rd stage of labour. When you said blame, I imagined something more serious or long lasting.

      • The Computer Ate My Nym

        Here’s the package insert: http://afrox-co-za.win32.glodns.net/Downloads/products_services/gases/300_package_insert_Entonox.pdf

        Apparently, it can be blamed for everything from hypoxia to global warming.

  • thepragmatist

    When I was in my teens, it was popular to use nitrous oxide from canisters available at many of my friend’s workplaces to get high. I did it once and thought, “This is what dying feels like. My brain cells are dying…” and I never did it again. I can’t imagine willfully using nitrous during labour, no way. And I am not sure how it would help anything anyway, as it lasts for such a short time. Meanwhile, you don’t want to know what happened to the friends I had who kept messing around with nitrous oxide. I watched them do it at parties and it was pathetic to see after a few huffs… No thanks! Give me a spinal. I loved my spinal prior to going into my c-section. My back was sore where the spinal was inserted for a few months (only if I pushed hard there) but the relief was immediate and I had no change in consciousness. I had a dip in blood pressure on the table, I think: something made me nauseous and my heart race, but it was easily fixed. I ENJOYED my c-section and was talking and cracking jokes with the staff the whole time.

    Also, one of my friends, in our twenties (Bipolar), killed himself by using nitrous and a plastic bag. :( That stuff is not natural, it’s not particularly nice, and I can’t imagine why anyone would choose it over an epidural that leaves you perfectly conscious and aware of your surroundings.

    • indigo_sky

      Nitrous Oxide certainly isn’t natural. But is it really fair to compare stupid kids using it to get high to the carefully controlled use of it while under the care of medical professionals and with proper monitoring in a hospital setting?

      I used it briefly after I’d asked for an epidural while waiting to actually get it. Being short acting was a plus as I did not feel high between contractions. It didn’t end up working for me because it kept making me feel like I was going to throw up which was too much for me, but it really did help take the edge off the pain an at least make it much more bearable.

      It certainly isn’t comparable to an epidural. I don’t think that means it can’t be useful though, especially in situations where an anesthesiologist isn’t immediately available to do an epidural, or in fast labor when there simply isn’t time for one.

      • Lisa the Raptor

        Usually it’s food grade. Which is scary. Looking back at myself years ago it’s scary what things we tried.

      • thepragmatist

        Well, personally, I’d rather have morphine but I don’t get high from opiates. To each their own. I just think it’s not comparable and can’t imagine much pain relief– only feeling sick, woozy, out of my body and not out of pain. It’s meant to be mostly dissociative with some analgesic effects.

    • Lisa the Raptor

      Considering that medical grade is a controlled substance, am I the only one who can see a home birth midwife bringing a box of whippits, a cracker and some balloons to a birth?

      • thepragmatist

        Envisioning it now and it is funny! I could see that.

        • Lisa the Raptor

          Food grade N2o is much more natuchral!

    • anion

      I looooved the spinal I got for my planned c-section (my first was done under epidural because I went through labor). I felt like I as floating on air.

      I am so sorry about your friend.

  • http://www.europeanmama.eu/ Olga Mecking

    In the Netherlands (and I apologize for writing about it all the time, but this is what I know), they stopped using gas and air because it resulted in many problems when pregnant midwives applied it to their patients (oops, client)- somehow they didn’t monitor how it was applied and the gas and air went into circulations and caused all kinds of problems for the midwives’ unborn babies. Now they want midwives to re-introduce it at some hospitals. This post was interesting becuase it reminded me why they stopped using it in the first place.

    • Turkey Sandwich

      I believe it is available again in certain Amsterdam hospitals as of June this year, but don’t quote me on that.

      • http://www.europeanmama.eu/ Olga Mecking

        The last time I checked (and I am in The Hague area), they were about to introduce it next year or something, they were training the midwives how to do that.

        • Turkey Sandwich

          Yeah, I’m sure it varies by city. I gave birth in May and I remember my midwife telling me it wouldn’t be available for a couple more months when I asked about it at one of my last appointments. However, I do remember those guys using it in that episode of proefkonijnen that went viral last year. They were at a birth center, so I think it has been a slow roll out.

          • http://www.europeanmama.eu/ Olga Mecking

            Yes, the differences are hhuuuuge! Youa re right they guy did use it at the Proefkonijnen episode (it was hilarious, a pity that they shown the one guy who went without meds as happy with the experience!), and I think when I gave birth last March they told me it would be another half a year or so.

    • Sue

      The real problem is the mode of delivery, and whether any scavenging system is used – otherwise too much leaks into the room.

      • siri dennis

        One of my canisters had a leaky valve, and for a while there was a very jolly atmosphere in my room!

    • Nashira

      I wouldn’t feel bad for writing about the Netherlands all the time. How many of us write about the US or the UK or Canada or Australia or wherever, since that’s where we are and what we know? :)

      • Jocelyn

        Yes, and I love hearing the different perspectives!

  • PJ

    I would have actually really appreciated NOS being available when I gave birth to my second child in the US. The only pain relief options on offer were IV pain relief, which was unappealing because of its impact on the baby, and an epidural, which is unappealing for lower level pain. As it turned out I didn’t need it, but it would have been nice for it to have been available.

    • anion

      Sorry, I’m genuinely confused. IV pain relief was unappealing because it affected the baby, but you would have liked NOS which also affects the baby?

      (Again, I’m totally not trying to sound bitchy, I’m honestly confused as to why gas is better.)

      • PJ

        I was told that it has a transient effect on the baby (as it does on the mother), which sounded better to me than the IV medication.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    re:epidurals. My biggest fears were:
    1.a FUO
    2. the pain relief being incomplete (while also immobilizing me)
    3 spinal headache requiring a blood patch
    . Luckily I did not get a fever or a spinal headache, but I did get incomplete pain relief while being immobilized. The urinary catheter hurt incredibly bad the entire time it was in until the dosage was increased. : / I remember thinking “jeez I just can’t catch a break today”

    • slandy09

      Doesn’t Better Birth offer nitrous oxide now? I wonder how they got that stuff legally.

      • thepragmatist

        They probably just hung out in a kitchen for a bit…

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        See, when I looked into it utah dentists weren’t allowed to give it out without specific permits, but then the professional licensing division told some nitrous supplier that anyone who is an adult can buy and use it for whatever reason they want to. There seems to be a major disconnect between how the division enforces law and what the rules actually say.

    • Captain Obvious

      A low grade fever associated from an epidural is just that. You cannot call it a FUO, if you know what the origin is from. I haven’t seen high fevers associated with epidural.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        they can’t tell if its from an epidural or an infection until test results come back, can they?

        • araikwao

          It’s not PUO/FUO unless it’s 2 weeks of fever >38.3C at on several occasions, without results from intelligent investigations (or something like that)

    • Lisa the Raptor

      Meh, I had a dural headache. It was livable. I got some Vicodin and laid in bed for a few days.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    So much for ‘natural’ birth! I heard that they use this a lot in the UK. I’m betting midwives are only down with it because they can get it without a prescription.

    • staceyjw

      They would push narcotics and epidurals if they could do them.

      Really I think they only want to give women half assed relief. Taking pain away entirely is not on their agenda.
      (I know nitrous works for some,but it is a half measure.)

      • Amy Tuteur, MD

        Exactly! The definition of “natural birth” is anything midwives can do, natural or not.

        • Guest

          I thought the proper definition of a “natural birth” is a vaginal birth, with or without pain meds? Just means you didn’t have a c-section. That’s always how I think of it.

          • Wren

            There actually seem to be many definitions, depending who you ask.

        • Lynnie

          Oh, does that mean my pitocin induction was “natural” because my birth was attended by a CNM? Or does it have to be a CPM or a DEM for it to be “natural”? (Read in the implied sarcasm. I don’t really care if my son was born “naturally” or not.)

          • The Bofa on the Sofa

            You had a medwife.

          • Lynnie

            Oh, so not natural at all? OK. I see. Like I care.

      • siri dennis

        And you know what UK midwives’ agenda is because…you are a UK midwife? Or an UK obstetrician? Or a UK resident? Or are you just taking snide pot shots at a group of professionals you’ve never encountered? How non-judgmental of you.

        • Amy Tuteur, MD

          Siri, you don’t see the hypocrisy of opposing epidurals as “unnatural” but promoting nitrous instead?

          • siri dennis

            I wouldn’t expect any midwife, in any setting, to place her own opinions or values or agenda above the interests of her clients. Analgesia/anaesthesia belong on a spectrum, from least medicalised if you will, to a fully functioning epidural. At all times, it is the midwife’s job to empower and support her client, which means a full explanation of pain relief methods etc. The client gets to decide, and the midwife is responsible for facilitating that choice, whether that means running a bath, fetching some paracetamol, drawing up some pethidine or bleeping the anaesthetist. End of. Nothing less is ever acceptable, unless there are clear reasons why any particular method isn’t feasible or available. As a midwife, I don’t CARE whether anything is natural or not; those opinions belong in the private sphere, and I leave them behind when I enter the hospital. That’s professionalism.

          • siri dennis

            And I have yet to meet a midwife who ‘opposes’ epidurals; if I did, I would report her to the Head of Midwifery. We are there for the clients, not the other way around. I have spent more 12-hour nightshifts than I care to remember caring for women with epidurals; it’s in many ways an easier job, because with continuous CTG you don’t need to keep reminding yourself to listen in, and a pain free client may well sleep for a while, so won’t need quite such intense support. Not that I grudge that support; the point is, this culture of evil midwives opposing epidurals is just as wrong and absurd as all the drivel about evil OBs. I wish you could make that connection, because this endless, mostly groundless midwife-bashing is really depressing.

          • An Actual Attorney
          • The Bofa on the Sofa

            Oh come on, just because it’s in midwifery today doesn’t mean that midwives actually believe that!

            (oh, how I wish that were true)

          • Young CC Prof

            I especially love the claim that epidurals CAUSE the baby’s head to be in the wrong place. Because, you know, there’s no way most babies are delivered in the same position they were in when the mother arrived at the hospital. Or that sunny-side-up babies take longer and hurt more, hence increasing the chances of epidural.

            Yes, there is an association between having a sunny-side-up baby and getting an epidural. In the real world, though, badly positioned babies cause epidurals. On Planet Midwifery, getting an epidural causes your baby, already engaged in the birth canal, to turn over mid-labor.

    • Wren

      To be fair, most midwives in the UK can give narcotics and will still have most of the care for women with an epidural, though they cannot put them in themselves.

      • siri dennis

        No, they won’t. The only pleasure they get in their miserable lives is watching women suffer and locking the door so the anaesthetist couldn’t get in. Midwives have no code of practice, Midwives’ Rules don’t exist, and midwives invariably flout hospital policy. Furthermore, midwives are not governed by the NMC, and the NMC doesn’t investigate complaints and hold formal fitness to practice hearings. No one is ever struck off the register. Can I please ask all you midwife-bashers to look up the NMC and take a look at the many hearings held and their outcomes? Scroll down until you find a midwife, and read the transcript of the hearing. Then remind yourselves that ANYONE, employer, colleague, client or member of the public can make a complaint to the NMC, with very grave consequences for that midwife’s career, livelihood and good character. That’s called accountability; midwives are accountable for their actions and omissions, and are held to a very high standard. People have lost their job and registration over an ill-judged Facebook entry; imagine what would happen if someone treated a patient dishonestly. ..

    • AmaryllisZ

      Natural birth my butt! My mom always wondered why women are expected to have natural birth, but nobody asks men to have a natural bypass surgery.

    • siri dennis

      Indeed they do. There isn’t a single honest, capable, caring, reputable midwife in all of the UK. When I was a midwife I was evil and dishonest, and so were all my colleagues. We used to bet on who could deceive the most women, and kill or maim the most babies (the killed ones we took home and cooked into Irish stew for our equally evil husbands and children. God, I miss those days of unbridled sadism and mayhem…

      • siri dennis

        Sorry, forgot to close those brackets – too busy salivating as I relive those glory days.

      • anion

        Jesus, dude. Talk about tone.

        Nobody suggested all UK midwives are evil, just that they perhaps like to advocate the form of pain relief they’re qualified to give. Nobody is suggesting all midwives everywhere are evil. Nobody is suggesting that no UK midwives ever do a good job, either, or that they don’t care.

        • siri

          My name’s not Jesus, and I’m not a dude. And it’s being said up and down this thread how dishonest midwives are, and how they don’t want to see women pain free. If you can’t see that that’s insulting, you’re obviously not a midwife. I don’t mind criticism based on facts; just the kind that arises from ignorance or prejudice.

          • Amy Tuteur, MD

            They don’t want to see women pain free in labor. It is official RCM policy to promote “normal birth.”

          • siri dennis

            But Amy, who is ‘they’? Sorry to harp on about this, but you must realise that staff midwives up and down the country are more interested in doing a good job and serving their clients than in what the RCM has to say. The RCM is a trade union; I am a member because not being one would be pretty stupid – I may well need them to represent me at some stage. But when I was working as a midwife, my job was to care for women and babies, not be the embodiment of some random values held by people who were no longer practising! I wish you could spend a couple of shifts in a UK labour ward and observe what goes on there, at the business end so to speak. I think you and I would have worked well together, Amy!

      • Young CC Prof

        I have no idea what all UK midwives believe or do. Most of them work hard to help mothers and babies, I’m sure.

        The issue is that SOME prominent midwives have, in writing, stated that epidurals are unnatural and dangerous and that nitrous oxide is a safer and better option. In places like trade journals. In addition, significant numbers of women (it’s tough to do a survey without running into sampling bias, but it seems the number is significant) want epidurals and, for one reason or another, can’t get them.

        Now, for some women in some particular situation, epidural might be better, for other women nitrous might work well. The purpose of this post is to explain why it’s pretty silly to deride epidurals as unnatural drugging and yet praise nitrous (or oral pain meds, for that matter.)

  • Guest

    I’ve always heard that nitrous is more for helping you to relax, not for actual pain relief. I had it to get my wisdom teeth pulled and it was just to help me relax when I panicked about the freezing needles.
    I’ve also heard both good and bad epidural stories, so I think it’s about moms choosing what they think will be best for them during labor. A couple of friends had no pain medication, made it through with breathing, massage and acupressure from their helpers during birth and were quite content with that. One friend had a great epidural, got to feel the sensation to push, but not the pain of contractions. Another friend had a horrible experience with her epidural.
    Some women prefer not to take medications period, whether in labor or for other issues. Let’s not forget that it’s the moms who are going through this, not the OB, anesthesiologist or the midwife, so informed choices are the way to go. We all want a healthy baby and a safe birth, but if you’re against meds, you need to find other ways to cope. Nothing is 100% effective or safe, you have to weigh the risks and do your research. IN MORE THAN ONE PLACE! Try not to take the word of one person or one group of people who may have ulterior motives for their recommendations.

    • The Bofa on the Sofa

      I’ve always heard that nitrous is more for helping you to relax, not for actual pain relief.

      Nitrous and a hot toddy?

      • Guest

        That would be nice during labor…

    • Sullivan ThePoop

      Nitrous more than relaxes you. It is a very weak general anesthesia. That means that it affects much more than one system. You wouldn’t want it for surgery because we have much more effective compounds for that, but don’t discount the fact that it effects the exact same systems and can cause the exact same side effects as other, more powerful general anesthetics.

      • theadequatemother

        it also has analgesic properties…unlike other anesthetic gases. There was a time when people experimented with low concentrations of halothane and sevoflurane for labour…but they dissociate you with no analgesia so that was abandoned.

        • Squillo

          Interesting. Way back when I worked for a veterinarian, we used to induce anesthesia with Ketamine then maintain with halothane. Would that likely mean that some patients had little analgesia? Yikes.

    • Lisa the Raptor

      My dentist said it would be like having a few beers. I don’t know what kinda beer he drinks, but….

    • Sue

      Nitrous oxide is quite a good analgesic – but much too variable in effect to be used alone routinely.

      It’s used in painful procedures for kids – like changing burns dressings or stitching wounds – I’ve had some toddlers giggling through the procedure, others distressed and vomiting and having to stop and use another method.

      But it is cheap, relatively safe and easily available – it should be part of a suite of pain relief solutions, tailored to need and effect.

  • theadequatemother

    I guess all that is technically true but….nitrous can be very useful. It makes you feel high and sometimes nauseous. It is eliminated incredibly quickly so “drugging the fetus isn’t much of an issue IMHO. You can see hypoxia during elimination due to the second gas effect but only if you don’t administer supplemental oxygen. Entonox is 30:70 so that’s not more than a theoretical problem. Unless you already need more than 30% o2 to keep your says up.

    The trouble with nitrous is that you have to time it. You need to begin sucking on it just before the contraction starts so that it is at high enough concentration to be analgesic when the peak I the contraction hits. Then while still at the peak you need to stop using it so that it disappates by the time the ctx ends. That minimizes feeling high but is difficult to do…

    Unless your contractions are tetanic like mine….then you can huff continuously and not feel high.

    It took the edge off and allowed me to stay still for the epidural attempt. At least until my water broke on the anesthesiologist, the head slammed down onto the perineum and the nurses panicked because they couldn’t find a heartbeat.

    And that’s where it’s useful – it can help women gett through fast transitions, sit still for procedures and for some, it’s enough analgesia for labour. But it is ineffective compared to epidurals and comes with it’s own set of side effects.

    The trouble with midwives who are against epidurals is that they will push this instead. Ideology shouldn’t come into pain management. It should be driven by the woman in labour who should be educated as to all her options and allowed to pick and choose.
    I would be sad to see nitrous disappear from our labour rooms – unless someone invented an alternative that was better other than an epidural. Because there will always be women that don’t want or can’t have a neuraxial technique.
    I w

    • attitude devant

      Adequatemother, when I did my anesthesia rotation we were taught that you can actually get hypoxic if the partial pressure of NO3 is too high compared to the partial pressure of O2. Is this not so? So do you not have to monitor the mother’s O2 sats and by extension the fetal heart rate? (You actually do address this tangentially above, I know, but the midwifery document Dr. Amy linked to makes it sound like no special monitoring is necessary. So I want to address these points specifically. thanks)

      • theadequatemother

        http://www.perinatalservicesbc.ca/NR/rdonlyres/3E14B2A9-142F-4615-BB83-FD0C355ECE69/0/CoreCompDSTAdminofNO25A.pdf

        I was incorrect the mix is 50-50. Pulse oximetry is not part of the monitoring protocol. But close assessment by a trained nurse is!!!!

        Hypoxia can occur during wash in and wash out if supplemental o2 is not given. That is due to the second gas effect. This is why we give a mix of nitrous and o2 rather than nitrous and air.

        • theadequatemother

          My sleep deprivation is intense. It’s heliox that’s 30-70

          • araikwao

            We have mobile units here in Aus (at least in the public hospitals I’ve seen locally) and I understand the concentration can be increased, but don’t know the parameters.

    • SkepticalGuest

      Wow, this further convinces me that nitrous oxide might’ve actually been a great tool for pain control in my labor. My epidural mostly failed to control the pain, I had very long contractions (initially 5 minutes long, malpositioned baby), and, most surprisingly, I could feel the contractions coming right *before* the monitor registered that they were starting.

      In fact, it was a sort of game with the L&D nurse. I’d say, “Next one is coming!” and she’d look and say, “Not yet…oh, wait there it is.” And later, “You never missed one!”

      The contractions would rise in strength slowly and stay peaked for a long time. I think I could’ve timed the nitrous oxide quite nicely.

      Also, I am about 99% sure that they used it on me as a kid for dental work (maybe pulling teeth?) and I had no problem with it whatsoever.

      • toni

        5 minutes long ctx? Mother of God! What position was your child in that made them so bad?

  • amazonmom

    My husband got nitrous for a root canal. He said after 5 minutes he believed he was in the Matrix and heard the Agent searching around to kill him. Fortunately he just moved the mask away and it all went away. He can’t imagine a woman in labor wanting to be that far out of it, but he also says he imagines being in the Matrix as more pleasant than passing a baby through the vagina. Men! Lol

    • Awesomemom

      When I was a kid I used to have to have it for dental anxiety and one time I saw the music floating out of the speakers in the room. Not something I would want during labor.

      • theadequatemother

        The nitous gave you synesthesia!

    • The Computer Ate My Nym

      I have to say that my hallucinations under nitrous were much more pleasant. Well, for the most part. Mostly, I just felt like I was floating and when the dentist said something I thought, “What’s he doing up here?” There was the one time where I had a vision of myself being in my own mouth having to dodge instruments, but for whatever reason that came off as amusing rather than frightening.

    • Mel

      I had an awesome set of hallucinations in which the moon aliens who live in the acoustic ceiling tiles explained that when their civilization grew too large for the moon they decided that they needed to colonize Earth. They were worried that if they just moved to Earth the cats would eat them, so they created acoustic ceiling tiles that mimic their home planet while using up extra space along the ceiling that we weren’t using anyways. I was greatly impressed by their pragmatism.

      • Josephine

        Well it’s nice that your hallucinatory aliens were sensible and considerate!

      • AmaryllisZ

        I expect to see Spielberg’s adaptation of this in time for the summer blockbuster season.

      • Wren

        I’m jealous. Nitrous, even huffing as hard as I could when I was being stitched up after the birth, did not lead to hallucinations. I did misunderstand my friend who told me I was “spaced, man” and thought she was calling me a spaceman though.

      • Sullivan ThePoop

        I had a hallucination that was just like people describe a near death experience. The tunnel and the light, seeing what was going on down below. Although, when I got to the other side instead of seeing my loved ones I was trying to get tickets to a concert on the last day of the world or something.

      • The Computer Ate My Nym

        They were worried that if they just moved to Earth the cats would eat
        them, so they created acoustic ceiling tiles that mimic their home
        planet while using up extra space along the ceiling that we weren’t
        using anyways.

        And thus is the mystery of the ceiling cat explained…

    • Staceyjw

      I tripped my ass of on nitrous at the dentist. Cannot fathom doing that during birth. To each their own.

    • SkepticalGuest

      @amazonmom: I’m going to disagree…I would’ve given anything to be that out of it. I had a very long, extremely painful labor with back labor and a baby who was asynclitic. My epidural mostly failed. It was 50 hours of sheer hell. (Yes, that’s not a typo, most of my labor didn’t “count” since my contractions were 5 MINUTES long and therefore 7 minutes apart.) Almost 4 years later, I still get flashbacks.

      • amazonmom

        I think it counts! The more of these stories I tell the more my hubby wonders why more women don’t ask for c sections right off the bat. I’m sorry about the flashbacks, it took a couple years of therapy for my childbirth related flashbacks to go away.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    Sadly, in some Canadian hospitals epidurals are unavailable and women must resort to either IM narcotics or NO or forego pain relief. I can’t help but think either choice is more likely to lead to birth trauma than an epidural.

    • indigo_sky

      A friend in Medicine Hat Alberta had two deliveries with morphine due to not being able to get an epidural. At the time, only a small number of vaginal births were done with epidurals due to a shortage of anesthesiologists. That was a decade ago, so I think the situation has improved there since then (though I’m not 100% sure), but it is still a problem other places.

      Is this just a problem in Canada though? I thought it could be an issue at small hospitals in rural areas in the states too.

      Are epidurals always available immediately at US hospitals?

      Where I am, epidurals are generally available an most women get them. With both my second and third child though, I arrived at the hospital early in the morning and was told that if I wanted an epidural, I should get one right away or I would have to wait a few hours due to most anesthesiologists getting tied up in scheduled c-sections, which meant I likely wouldn’t have been able to get one with my third as he was born within a couple hours of the epidural. (I didn’t get one anyway with my second as it was already too late as he was born only fifteen minutes or so after I asked for the epidural!)

      We have had a huge population surge and baby boom in the past decade that infrastructure has not managed to keep up with (though it is slowly catching up now) so the hospital I was at handles thousands more births a year than it was designed too. It can be insanely crowded there.

      • SkepticalGuest

        Sadly, epidurals are NOT always immediately available in the US. I had a friend deliver at a hospital in the suburb of a very large, affluent city. And it turned out that the anesthesiologist was “on call” but could take up to an hour to get the epidural. This is a problem if you need something urgently. Like my friend whose epidural somehow went awry (she never understood the problem, why it abruptly stopped working) and she couldn’t get it fixed before a vacuum delivery. Ouch!

        More worrisome is what would happen if you needed an emergency c-section. And this wasn’t at some po-dunk rural hospital.

        Moral: when choosing a hospital, ask if they have an anesthesiologist on staff 24/7. Don’t choose one that doesn’t unless you really don’t have other choices.

        I get that this will happen in remote areas, but personally I don’t think hospitals in major metro areas should even be allowed to do births unless the can provide 24/7 anesthesiology coverage.

    • Lisa the Raptor

      That’s evil. No first world country should not offer epidurals. It’Rawr!

  • The Computer Ate My Nym

    As soon as you pull the mask away, the effect of breathing the gas is gone within a few breaths.

    Is this true? I last used NO when I was about 5 and getting my teeth filled and my memory is that I felt woozy for some time after finishing the procedure. I also remember feeling distinctly out of it and hallucinating a bit while taking nitrous. Plus still feeling the lidocaine injection quite strongly, so no real effect on sharp pain. Not something I’d want during a delivery. I’d much rather be alert, oriented, and out of pain with an epidural.

    • indigo_sky

      I didn’t really like it so only used it for a couple of contractions (I was waiting for my epidural anyway) and so don’t know how it would have been for longer use, but I only felt the effects while the mask was on, then my head cleared pretty much immediately when I took it off. The hospital I was at has you hold the mask to your own face. They will not strap it on or allow anyone else to hold it, so you just lift it to your face when needed then let it drop again at the end of the contraction. They told the idea was that if you did start to get to woozy, you wouldn’t be able to hold it up as your arm would drop on its own.

      • Wren

        I had a mouthpiece rather than an actual mask, but yeah, I had to hold it myself. It meant I could only huff so much before I had to stop.

    • theadequatemother

      Are you sure they didn’t also give you something else? Chloral hydrate? Oral Midaz? Maybe you felt funny because of the epinephrine in the local?

      • The Computer Ate My Nym

        Not at all sure. I was maybe 5 or 6. It could easily have been something else altogether. I’m assuming that it was nitrous because they called it “laughing gas”, but don’t really know. My memory of how long it lasted could be at fault too…it’s been a while…

  • Mel

    Nitrous oxide can be dangerous, even with trained people using it.

    I did have a close call with nitrous oxide the first time I used it as a 12 year-old.
    I’d never had it before so when I started feeling light-headed, I thought it was a normal part of the administration. Then my chest started feeling weird and I started seeing stars. The hygienist had left the room to get some materials. Thankfully, my mom was there and pulled the mask off when I passed out cold. Turns out the oxygen canister’s pressure regulator was screwed up and was showing oxygen in the canister when the canister was empty.

    I woke up with my feet in the air and an oxygen mask on. I needed to use my inhaler since the hypoxia triggered an asthma attack. I didn’t have any long term effects, but I wasn’t pregnant, either.

    I still use nitrous oxide during dental procedures since it controls the anxiety I feel about having sharp metal objects in my mouth. I doubt I’d use it during labor since it doesn’t really do anything for the pain.

    • theadequatemother

      When nitrous is used with a gas blender – ie nitrous and oxygen are given through different canisters as opposed to the premixed form we use now, current standard of care is to require an oxygen concentration sensor in the circuit as well as pulse oximetry in order to present exactly what happened to you. That would not happen today.

      • Mel

        Oh, good. I’m glad for that.

      • Sue

        In Oz there are three main delivery systems:
        - Pre-mixed canister of 50:50 with oxygen
        - Blender (like a simple anesthetic machine) with two separate dials – minimum oxygen/maximum nitrous is 30:70%
        - Piped in the wall, with outlet plugs on labor ward (don’t know the concentration)

        I suspect some of the dizziness is a result of hyperventilation and low carbon dioxide in the setting of significant pain and being asked to ”suck on the gas”..

  • the other John

    Midwives should never be allowed to administer nitrous oxide or any other drug let alone attend a birth unless they have the equivalent education of a Nurse Practitioner, right? Think about it. Would your really want someone with a GED and a bunch of internet courses in charge of dosing. I guess if you are buying weed – that’s one thing but this is life and death.

    • staceyjw

      This is for in hospital MWs, not the HB MWs. Thankfully.
      I am sure their use of nitrous is part of what qualifies them for the ire of the nickname “MED wife”.

      • Amy Tuteur, MD

        Nitrous (Entonox) is also used at homebirths.

        • siri dennis

          Thank God for that! I couldn’t have coped without it. Remember, its use is optional; midwives can offer it, and women can decline.

    • siri dennis

      Midwives shouldn’t be allowed to do ANYTHING; they should be rounded up and removed from the planet. Or made to inhale Entonox until they explode. Midwives of any stripe have no place in civilised society, and they can easily be replaced in hospitals by self-service machines. Or hundreds more obstetricians could be hired; I’m sure they’d be thrilled to work for salary of £20000 and up…

  • Lisa the Raptor

    So….their idea for pain relief is to use….whippits?…..wah wah wah. *If you don’t get that, just carry on*

    • Certified Hamster Midwife
      • An Actual Attorney

        But really quite cute.

      • The Computer Ate My Nym

        Actually, distraction is somewhat helpful for pain control, so a good whippit might be of some benefit

        • The Computer Ate My Nym

          Whippets. Spelling: it matters.

    • An Actual Attorney

      I was going to say, nothing my druggie college BF used for recreation should ever be used in a medical setting.

      • theadequatemother

        So no nitrous no narcotics no alcohol no ketamine…..?????

        • An Actual Attorney

          Also no pot, no shrooms…

        • staceyjw

          NO Ketamine for me! Never, ever, again!
          I had used it recreationally, so I knew about what it was like. When they wanted to give me some for my cerclage removal (turned out to be tricky and the fentanyl did nothing), I only reluctantly agreed after being promised it would be nothing like recreational use/overuse.

          I was SO WRONG. I had a freaking horrible, terrorizing trip. It was by far the worst part of my entire stressful, awful, high risk pregnancy and DD’s premature birth. Had I seen that doc again, I may have punched him, though I know he did nothing wrong and probably used it frequently with success.

          I now say no to the Ketamine :)

          • Guest

            Wait, are you serious? Please excuse me if you are, but other than illegal recreational use, isn’t Ketamine only for animals? Not the human kind? That’s horrible!

          • theadequatemother

            oh no…ketamine is a VERY useful sedative. We use it all the time in combination with other drugs (benzos, propofol, narcotics)…postop very low dose infusions of ketamine (10 mg an hour) are very useful for controlling pain in major cases (like spine) where local and neuraxial can’t be used. Ketamine also decreases the hyperalgesia and acute opioid tolerance you can get in long cases that require opioid infusions (again, major spine with monitoring by SSEPs and MEPs etc).

          • thepragmatist

            I actually had a doctor suggest Ketamine to me for pain control. I’m on a Fentanyl patch, because you can’t get access to it outside palliative care and also, above post. Fentanyl changed my life and the patch is a dream for someone like me who is super busy and doesn’t want another med to keep track of. Prior to that, they had me staggering hydromorphcontin: what a disaster that was.

            I come out of surgery fighting. I wonder if that has anything to do with the Ketamine. I had insane dreams the last time I had conscious sedation.

          • Veterinarian

            I thought it was a dissociative anesthetic, providing good somatic analgesia and reducing wind-up. I use in multi-modal pain protocols but only adjunctively because there are significant contraindications – it lowers the seizure threshold, can cause tacchyarrhythmmias (sp?). Also I hate how my patients was up on it – my practice is almost 100% cats and they are already very anxious. Ketamine tends to exacerbate that in the worst way. The major players for pain are pure mu agonists and locals. I like to induce with benzo + propofol. I often use minute doses of phenothiazines to potentiate the effect of the opioids and to reduce dysphoria. Ironically, I believe that ketamine is actually the only injectable anesthetic labeled for cats.

          • Trixie

            Ever hear the sounds of a cat coming off ketamine after surgery? Dear god, it’s horrifying!

          • The Bofa on the Sofa

            Yeah, but cats sound horrifying while they are mating, too, so I’m not sure how to interpret that.

          • Trixie

            Good point lol

          • thepragmatist

            In my rave days, I avoided Ketamine. To me, it just seemed like everyone who took it passed out in a pool of their own vomit. It didn’t seem to be a reasonable recreational choice vs. MDMA. Likewise, avoided PCP, another totally WTF drug in my humble opinion.(PS. I’ve not been a raver for ten years, so NO GLOWSTICK JOKES! and yes I could do really cool things with them.)

          • Lisa the Raptor

            Anyone remember that drug G that came out around the early 2ks? I never even saw any but I heard stories from friends that were just awful. I think it was some sort of cleaning product. Yuck. Sorry, “raving” made me think of this. Do they still rave, the young’ ins?

        • Lisa the Raptor

          And no pot, you damn hippie!

    • The Bofa on the Sofa

      Are you sure that’s not WHY they use it?

      To enhance the orgasm of birth?

      You can almost hear it…”Hey, high school boys are using this stuff to get better orgasms. Maybe we should have women use it during labor?”

      And Mayim Bailick can write a book, “Beyond the Orgasmic Birth”

      • Karen in SC

        You may have something there. I definitely felt like my dental procedures were one incredibly long orgasm when on nitrous oxide. I was so disappointed when we moved and my new dentist didn’t offer it routinely.

        • Certified Hamster Midwife

          I have awful dental anxiety and have never been offered nitrous. Maybe I should ask.

          • AmaryllisZ

            Ask to try it out without a procedure going on first, or maybe during a cleaning rather than actual work. I had a nasty experience with NO, some people get vicious headaches, etc. If you’re like me about dental work, you don’t want to add anything else bad to the mix.

          • Sullivan ThePoop

            I freaked out twice at the dentist. Once I had cracked off a tooth below the gum and had to have it pulled and after that I got my first cavity in my thirties and imagined getting one drilled to be the worst experience in the world. The first one was kind of traumatic, the second turned out to be nothing and I felt really silly.

          • Karen in SC

            My dentist at the time had the nitrous oxide plus headphones and your choice of music (or bring your own).

          • AmyP

            Choose Pink Floyd.

          • thepragmatist

            Trust Pink Floyd

          • fiftyfifty1

            I would recommend an oral dose of a benzo instead (valium, ativan, xanax etc). More predictable.

      • anion

        I wondered that, too!

    • Trixie

      A couple months ago I ordered some punch balloons on Amazon, and the other day when I logged in, every single item it recommended for me was some form of nitrous oxide. Amazon thinks I have a problem.

    • auntbea

      My dog is a whippet. I find that she is often very soothing.

  • Burgundy

    I have couple moms questioned me about the epidural (I had it for both births) and the misinformation they heard from NCB are grossly negligence. They thought your spin would break and hurt for years, your hip bone would be sore for months, the kids would not bond with you as well, and you would have trouble breast feeding, just to name a few…. ARRRR. I was glad that I could be their real life positive example before they made the decision. One had the epidural and another couldn’t because she went to the hospital too late. She said to push the baby out was the most agonizing 45 minutes in her life.

    • Trixie

      I did have some pain at the insertion site of my epidural for several months after. I think that’s a occasional side effect.

      • MaineJen

        I did as well, the second time around. The pain was minimal, though, and did eventually go away. That one also HURT going in; I kept getting ‘zaps’ down my right leg before they finally got it in right. But that one at least worked right away. Ah, bliss! I could still feel the pressure to push, but the ctx pain was gone. During my first birth, the epidural was one-sided at first; still felt every contraction on my left side! Ack! It was eventually corrected though. That time I didn’t feel the needle at all (though I think that had more to do with the 9-cm contractions I was having at the time).

    • stacey

      I notice that many blame all the pain from past pregnancy on the epidural. As if all the changes your body went through have no effect.

    • thepragmatist

      LOL my mom told me if I had an MRCS my bowels would FALL RIGHT OUT through the incision. Then she told me that daily through out my prelabour week of hell, trying to talk me into a natural birth, even though she hated hers, tore terribly, had two repairs, etc.

      • Anj Fabian

        Had two repairs and a c-section is bad?

        Her story would have me cringing!

        • thepragmatist

          Her story is the number one reason I decided to have a c-section. 4th degree tear in the rectum. I was OP like my son was right up until the day of delivery. She did 28 hours of labour without meds. No thank you!

    • Anj Fabian

      Currently listening to women on one group blame their epidural for their back pain – which is all undiagnosed of course.

  • Therese

    Does nitrous oxide ever cause permanent damage to the mother? Has the use of nitrous oxide ever led to the death of the mother? Yes, I know that both those complications are extremely rare with epidurals…but it’s still terrifying to think of and if those risks could be avoided by nitrous oxide I could see why it would be better to try it first rather than going straight to an epidural.

    • moto_librarian

      But it can potentially cause damage to the baby, and it is relatively ineffective at controlling the pain. I asked several women who used it and they all agreed that the only benefit was that it made you feel high. It did pretty much nothing about the pain.

      • Therese

        I’ve heard women who were happy with their use of it during labor. According to this 30% of women who chose nitrous oxide were very satisfied with it: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049002/

        It seems like it should at least be an option as long as women understand the effect it can have on the baby.

        • DaisyGrrl

          Let’s review the entire paragraph you pulled that from:

          “Four studies compared women’s satisfaction with pain management with nitrous oxide or epidural.56, 58, 62, 71 In a prospective cohort study, only 5.5 percent (3 of 55) of women who had an epidural were not satisfied with the pain relief compared with 45.6 percent (31 of 68) of women who had Entonox and pethidine.56 Of the women who chose Entonox in another prospective cohort study, 60 percent (12 of 20) reported that the pain relief was adequate, compared with 98 percent (49 of 50) of women who chose epidural analgesia.62 In a third prospective cohort study, 33 percent (66 of 200) of women who chose Entonox rated the pain relief adequacy as good, compared with 94 percent (75 of 80) of those who chose an epidural.58 A cross-sectional study found 30 percent (40 of 115) of women who chose nitrous oxide were very satisfied with the relief of pain, compared with 49 percent (58 of 118) of those who chose an epidural.71″

          Looks like the epidural is the clear winner in patient satisfaction.

          • Elaine

            On the plus side, though, it’s a lot easier to administer, you don’t have to wait for the anesthesiologist to show up to start using it, it isn’t invasive, and if you decide you don’t like it, it’s a lot easier to stop using it and the effects are gone pretty quickly. And even if not as many people are satisfied with it as with the epidural, we still see from this that some fairly decent percentage were satisfied. So why not have it available? Doesn’t hurt to have more options.

        • Guest

          30% efficacy? Hm. I’m no doctor but as a patient I would not be inclined to try something with risks to the baby and a 70% failute rate.

          • indigo_sky

            I wasn’t happy with it, so I stopped using it after just a couple contractions. Doesn’t seem like a big deal? I’d try it again in certain situations.

        • Wren

          Anecdotally, it worked fairly well for me. I used it in both labours, the first one while waiting for a C-section and the second only for a little while. The pain was still there, but I didn’t care about it, as opposed to the spinal where the pain was gone, gone, gone. I also ended up being stitched for a small tear after my 2nd delivery (VBAC) with nitrous oxide because the danged local would not take. It finally did, after she was done with the stitches. Turns out both my mother and grandmother have the same problem with locals.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      Do you count birth trauma as permanent damage to the mother? What about maternal suicide as a result of birth trauma?

  • Zornorph

    How can you allow your patients to get Nitrous Oxide? Won’t that cause them to miss some of the wonderful moments of the birth, surrounded by candles and essential oils?
    I’m going to hire some midwives and start pushing for Spanish Fly to be used during birth to help facilitate ‘orgasmic birth’ and see if it catches on.

    • The Bofa on the Sofa

      “We don’t prevent you from eating during labor. In fact, we provide the oysters…”

    • indigo_sky

      Do people who use Nitrous typically use it for the actual birth? I only used it for a few contractions before getting an epidural, but I think it would have been difficult to hold the mask on while pushing and kind of though most people just used it for transition.

      • moto_librarian

        I know of two who used it during pushing. They were committed to going “natural.”

    • thepragmatist

      How about pot? Here, I had a friend’s midwife from one of the clinics (she has hospital privileges and all– legitimate licensed midwife) encourage her to smoke pot the entire labour. *facedesk* Next it will be magic mushrooms and some absinth.

      • The Bofa on the Sofa

        Mitch Hedberg tried absinth in Ireland, because he heard it was a hallucinogen, and he likes to hallucinate, but he didn’t feel remotely trippy, so he had to fake it.

        “Why is the floor all the farther down I can fall?”

        (sorry, all this talk of hallucinations has gotten this into my head)

    • siri

      You’re one to talk – who names their kid after a painkiller?!

      • Zornorph

        My kid is named ‘Casper’ – I must have missed the painkillers named after that in the pharmacy. ‘Zornorph’ is my doggie’s name and it means ‘The one who comes by night to the neighbor’s yard’.

  • mtbakergirl

    This is all I was offered, and I have to agree with Dr. Amy that it is essentially useless for actual pain management. I got the strong feeling its true purpose is to muffle your screams for an epidural.

  • Kathleen Neely

    Oh the stupidity…..its just, unbelievable…whatever hapoened to common sense????

  • http://kumquatwriter.wordpress.com/ Kumquatwriter

    I love nitrous oxide at the dentist, but that is so different from birth…cant see the appeal of that dizzy almost-blackout wah-wah-wah sensation while trying to actively participate in the birth! Sounds nightmarish, to be honest.

    • Lisa the Raptor

      Ha! It’s like Jimmy Hendrix is in your head, yo! lol

      • thepragmatist

        Jimmy Hendrix is not a library book, bitch! Trust Pink Floyd.

        I want this on a t-shirt, right now.

        • Lisa the Raptor

          Oh mah gawd, me too lol

    • Burgundy

      My dentist won’t give me nitrous oxide when I was pregnant with my 2nd one. The midwifes are crazy.

    • AmaryllisZ

      NO made me more panicked than normal (quite a feat), but I couldn’t express it, so then I started panicking about that, too. I ended up passing out and coming to in an ambulance with a heartrate over 200 and blood pressure in the stroke zone. Over a small filling.

      I cannot imagine condemning women in labor to that experience.

      • Lena

        While not near as bad as your experience, I’ve noticed a panicky feeling with NO, as well. It’s really strange. I’d feel it start working, my body and mind start to relax, and that relaxing freaks me out and I get really tense and need the dentist to stop.

        • thepragmatist

          The only time I did it I was convinced I was going to die right then. It really did feel like the way I imagine it would feel to die. Like my brain was being starved of oxygen and was just shriveling and dying. Gah.

          • R T

            I felt the same way!

      • R T

        NO made me lose my mind when I was 8 or so and getting a stubborn baby tooth pulled FINALLY! Anyway, the doctor gave it to me and I very quickly decided he was trying to kill me and jumped out of the chair and ran screaming around the room! My mom could hear me all the way in the waiting room and swears some already nervous people left due to my screams! A nurse and the dentist chased me around the room while I spun around the chair just out of their reach! They had to get my mom to talk me out from under a table! I HATE it so much! It gave me no pain relief, made me paranoid delusional and made me feel like I couldn’t breath!

  • Amy Tuteur, MD

    Nitrous has the added “benefit” of being relatively ineffective at eliminating pain, while an epidural is highly effective. Wouldn’t want women to miss out on all of the pain, would we?

    • Anj Fabian

      Some of the more horrible birth stories I’ve read had women frantically huffing nitrous in a desperate attempt to alleviate the pain.

      It didn’t work. One woman reported being both in agony and so out of it that she was hallucinating. It sounded dreadful.

    • Zornorph

      It’s what you get for making us eat of the forbidden fruit!

  • moto_librarian

    Wow. My hospital started offering nitrous about three years ago because the nurse-midwifery practice was advocating for its availability. It was actually my backup plan for pain relief in case I came in to dilated for an epidural with my second. I can’t believe that they are promoting a medication that definitely crosses the placenta and can drug the baby when epidural anesthesia is readily available!

    My aunt told me that when she was doing her clinicals in nursing school, she found a nitrous mask in a closet. She had no idea what it would be used for, and the nurse who was working with her explained that nitrous was one of the main options for pain relief in labor prior to the epidural. When I told my aunt that nitrous was making a comeback, she couldn’t believe it.

  • Allie P

    Isn’t that “twilight sleep?” Why must we go backward in time?

    • moto_librarian

      I just can’t wrap my head around this. Given the emphasis on being “present” during birth, I just can’t understand why midwives would prefer nitrous over an epidural. I was completely mentally present during the birth of my second thanks to the epidural, with the added bonus of having zero pain during delivery.

      • siri dennis

        It’s not the midwife’s preference that counts; it’s the mother’s. This is how it normally goes: Woman arrives in labour, is asked if she would like something to relieve it. Maybe offer a warm bath to help her relax once her obs have been done and a CTG strip obtained. Maybe offer a couple of paracetamol, plus a sedative if she is very tired and labouring overnight. Next, offer Entonox; full explanation given, assistance given with using it etc. She may or may not like it. Offer pethidine; again, her choice entirely. As labour progresses, she may decide she’d like an epidural, and the midwife is bound by law, policy, guidelines and common decency to act on the woman’s wish. Occasionally, labour is so far advanced that it really is too late; you can’t sit still on the edge of the bed with a baby emerging from your body.

        Sometimes the anaesthetist will arrive, take one look at the scenario, catch the midwife’s eye and signal their intention to retreat as the woman is clearly pushing. The whole point of having a team is to work together to ensure the best possible outcome for all clients. Why is that so hard to understand? What possible motive could a UK midwife have for providing poor practice? She receives her salary regardless of how often she consults a doctor, so has nothing to gain from being obstructive.

        Plus, clients can sue many years later if they choose, si it’s in the midwife’s own interest to give good, safe care. Yes, there are rubbish midwives, just as there are rubbish obstetricians. (I have yet to meet a rubbish anaesthetist; I really love and admire anaesthetists, they are amazing). Yes, Furness General is a horrible example of systemic and individual failings; however, if you look up Bristol Heart Scandal or James Witheart, you’ll see that these things can happen anywhere, and to any type of professional. In Furness, term babies died needlessly

        • siri dennis

          Cont’d: In Bristol, many more babies and children died. Yes, they were very sick children who needed surgery to survive. Yes, it’s not possible to pinpoint how many died ‘needlessly’, but it was accepted at the time that there were unnecessary deaths, and that the setting wasn’t safe. The only one of the three surgeons who wasn’t struck off, just disciplined, admitted that he would expect high mortality rates while a surgeon is learning a new technique (in this case, arterial switch). What do you think the odds are that the parents were told this when giving consent? ‘I’ve never performed this surgery before, this is my very first one, I’ll be doing it alone, and there is a very high risk your child could die’.

    • Amy M

      No that was scopolamine. (or however you spell it.) My understanding is that Twilight Sleep definitely impaired memory, but did not actually dull pain, which is why women were tied down when given it. I’ve never had NO, but I hear it actually does decrease pain, and doesn’t remove all memory of the event the way Twilight Sleep did.

      Personally, I was very happy with the epidural and none of the doctors, or nurses involved with the birth of my children seemed to have any issues with me having it either.

  • Anj Fabian

    Some of this is also true of pethidine. The dosing part isn’t true, but pethidine is sedating and does pass to the baby.

    (It’s also an opiate.)

    • moto_librarian

      But midwives hate pethidine, dontcha know? This level of hypocrisy is stunning, even for midwives.

      • Anj Fabian

        In the NHS systems, they sure don’t hate pethidine. I see it offered fairly freely. There are some restrictions to pethidine use, but it is far more readily available than an epidural.

        The major restrictions on pethidine is timing of use. It wears off relatively quickly, so it’s a short term pain relief. It’s not supposed to be used near or during the pushing stage so it means that the most painful part of labor is going to be without pain relief.

        Unless you have an epidural…

        • AlexisRT

          There is a reduction in the availability of pethidine in NHS units, IIRC. It was pushed fairly heavily when I had my first but AIUI several units near where I gave birth have now banned it. I do not understand why it remains so popular since it doesn’t work well at all. If anything I’d rank nitrous over pethidine. The nitrous wears off quickly; if you don’t like it, it’s gone.

          • Wren

            That is one of the benefits I hear for nitrous. If it’s horrible for you, it’s quick to try out and quick to get out of your system. IM narcotics last longer and you just have to ride them out at that point.