Midwives oppose the use of drugs in labor … unless they can administer them

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

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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.

All the pious wailing about the effects of epidurals are nothing more than hypocrisy.

“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.

 

This piece first appeared in December 2013.

  • Mattie

    Just a question on terms, when you refer to nitrous oxide are you talking about entenox (gas and air) which is a mix of 50% Nitrous oxide and 50% oxygen, or just nitrous oxide?

    • Sue

      Nitrous oxide can’t be used on it’s own – because we need at least as much oxygen as in normal air, which is 21%.

      Standard “entonox” in a pre-mix is 50% nitrous with 50% air, but nitrous oxide can also be given via a gas blender, up to 70% with 30% oxygen.

      • Mattie

        Thanks 🙂

  • Chi

    OT: Apparently the District Health Board for the area I live in is having antenatal class instructors ask their former students (of which I’m one) to fill out a questionnaire about breastfeeding experiences and why you started/stopped.

    According to the person posting the survey, breastfeeding rates in our area are ‘low’ (whatever that means) and the DHB is asking these questions in order to try and get breastfeeding rates up.

    This is a HUGE trigger for me as it’s not just some random lactivists on the internet being hostile, this is right in my back yard. My first instinct is to reply to her with something along the lines of “Who cares if breastfeeding rates are low? As long as babies are loved and nourished, what does it matter?”

    Yeah feeling a little hostile.

    Oh here are the questions they’re asking if anyone cares lol:

    BREASTFEEDING EXPERIENCES
    What made you decide to breastfeed?

    What made you decide not to breastfeed?

    What made you stop once you had started breastfeeding?

    How easy was it to find help when you needed it?

    Who did you contact?

    Are you likely to breastfeed with subsequent children?

    • Dr Kitty

      Just be honest.
      The party line is that women stop breastfeeding because they aren’t supported, or don’t feel confident.
      So anything that says “I tried, with lots of support, but any purported benefits just weren’t worth the time and effort and pain involved” is worthwhile.

      Or tell them BF was triggering, or you had DMER, or your meds weren’t compatible with BF or whatever.

      It doesn’t matter what the rates are, women need individualised information about how they can best feed their infant, based on their unique circumstances and pregetences. THAT should be the goal.

      • Chi

        Oh I am totally pinching that bit about women needing individualized information based on circumstances and preferences.

      • Chi

        Oh and yeah it was triggering. Not in a PTSD kind of way, but in a ‘dangerous slide down into PPD’ way. Plus I developed Reynauds and vasospasm, complete with shooting pains all the way from my nipples to the back of my rib cage.

    • Who?

      I think it’s entirely fair enough-and constructive-to respond only in the comments section, saying the most important thing is that the baby gets fed, and breast or bottle or some combo makes no difference.

      Also fair enough to point out that parents who bottlefeed might also benefit from some support, as might their babies.

    • BeatriceC

      I think things like this miss the fact that even the same woman can have entirely different experiences with different kids. Each of my three living children had vastly different experiences. My first took a while to get the hang of it and me, being a redhead with fair skin, had a miserable time. I combo fed for a while, then exclusively BF’d for a few months, then started introducing solids. He self-weaned around 13 months. The second was a pro from the first time he was put to the breast (there were a few weeks of TPM and tube feeding due to prematurity), but I got pregnant really soon and my body couldn’t handle both, so he got switched to formula. The third never got the hang of it (born at 24 weeks, it was a long time before he could be put to the breast), but my body thought I’d delivered a football team and I could pump 20 ounces in a 10 minute sitting, so he ate EBM from a bottle.

      On the other hand, I think that maybe if women shared individual reasons, people who make surveys like this might realize there’s no one size fits all approach, and quit being quite so stupid about it.

    • The Computer Ate My Nym

      I’d be tempted to answer…creatively and see what they made of it. Things like, Q: What made you stop? A: It just got awkward when the kid started high school. Q: How easy was it to find help? A: Extremely easy. I just sat outside with the baby and every third stranger gave me “help” with how to raise the baby. That sort of thing. See if they caught on or not. But I suppose that wouldn’t be right.

    • Frankly, when faced with questionnaires like that, I tend to lie, just to skew the statistics. And I bet a lot of others do, too.

      • SporkParade

        I suspect this is an Israeli thing. My husband does this when called by political pollsters.

  • omgd

    You forgot to mention that nitrous oxide increases the incidence of nausea/vomiting.

  • Dr Kitty

    OT: If only my son wasn’t thriving, he might have been baby John Snow ( a local extras agency is looking for a brown eyed, black haired newborn boy for an unnamed role, but GOT is shooting).
    But #2 is 2lbs too heavy and has gone from 9th centile at birth to 50th centile now, so I doubt he’d make a believable newborn…

    • Amazed

      Hey, Jon Snow’s exact age is a subject of many discussions! Don’t lose hope!

      • Dr Kitty

        It looks very much like the TV show is going with the obvious theory as to his parentage.

        My dad does a bit of extras work (he’s retired, why not) but GOT kept asking for nudity and people willing to have a falcon eat a bit of meat off their face, and my mother is NOT OK with that….

        • Elizabeth A

          Is it weird that the nudity would bug me (personally) way less than the falcon thing? Being naked can be cold and uncomfy. Falcons are not precision instruments.

  • CanDoc

    To be a scientific purist, let’s consider the evidence:

    1) Desaturation can happen in labour but doesn’t appear to be associated with the intermittent use of nitrous oxide (which is how it is used in labour – for contractions, but not between): http://onlinelibrary.wiley.com/store/10.1111/j.1365-2044.1996.tb07790.x/asset/j.1365-2044.1996.tb07790.x.pdf;jsessionid=0952A7D30AB9068BAFD0F0855319B353.f01t03?v=1&t=ii4iq2xw&s=58bf75934c9219bcb95e5ca01af7af6d9f057b8d

    2) Although it crosses the placenta, nitrous oxide also crosses BACK out across the placenta as maternal levels rapidly drop following contractions as maternal levels drop, with no apparently fetal sedation reported following delivery in multiple studies. http://www.ajog.org/article/S0002-9378(02)70186-5/abstract


    Although I very much appreciate the irony that midwives seem to only approve of analgesics that THEY are allowed to administer, anesthetists and most of the scientific community would agree that nitrous oxide IS in fact (marginally) safer than epidural analgesia for labour, albeit drastically less effective.

  • Sue

    Here is the illogic of the approach:

    1. We know nitrous oxide has some analgesic and sedative properties, but nobody else uses it on its own for very severe pain.
    2. We know that labour isn’t really a “pain” anyway – it;s just “tightening”.
    3. So, if you beg for something to relieve your not-real agonising pain, we’ll give you something that doesn’t really relieve it.
    4. AND, we do this because we are caring and WITH WOMEN, as opposed to those greedy OBs and anesthesiologists, who just want to make money and are all Big Pharma shills anyway.

  • CharlotteB

    I do wish there was something you could get for pain relief if there’s no time for an epidural. My labor was so fast that there was no way I was getting meds, which really really sucked.

    I did get fentanyl afterwards, but that made me dizzy and nauseous. They gave me something that made me feel better.

    One of my friends was offered lots and lots of painkillers after labor (due to tearing), and I was not, which kinda bummed me out at the time. I mean, I’m glad I only needed tylenol, but I didn’t believe that it would do anything.

  • guest

    I never knew that nitrous crossed the placenta so easily. I did wish it was available in the US, because it sounded like more fun than an epidural, for sure (the needle in the back thing freaked me out). Now I won’t support broadening its use in the US. I had an epidural and it was lovely. I was pretty fogged out after that, but it was probably the combination of magnesium and being up all night.

    • CanDoc

      Disagree – I support increasing access to a VARIETY of analgesic options. Our labour and delivery unit uses epidurals, narcotics (fentanyl) and nitrous oxide for labour… all are different and all are useful in different situations. For women who CAN’T get an epidural for medical reasons (e.g. low platelets) or in the 10-15% of women in whom an epidural is not sufficiently effective (still experiencing severe pain), nitrous oxide is excellent.

      • guest

        Exactly what are you disagreeing with? All I said is that *I* now won’t support the broadening of its use. That’s a factual statement, not an opinion you can disagree with. You can do what you like, but there’s nothing in my comment to disagree with.

        • Wren

          Actually, disagreeing with an opinion is perfectly acceptable. It’s not just in scientific issues but everywhere. I don’t where the idea that opinions are somehow sacred and cannot be disagreed with. You stated an opinion, CanDoc stated an opposing opinion with reasons. That is largely how discussions work.

  • Jen

    Out of interest – is there pain relief offered to women in the US who are waiting on their epidural (which could take some time to organise)?

    • guest

      I don’t know about generally, but I wasn’t offered anything other than an epidural at any point during my pregnancy or labor.

    • sony2282

      I usually offer some IV Fentanyl is they are desperate but we usually have an anesthesiologist in the room within 15 minutes so it’s usually not a problem.

    • Michele

      I know they gave me something that let me sleep for a little while with my first but I don’t remember what it was. I had been trying to avoid an epidural because at that point I still thought they potentially had downsides for the baby and the hospital-run birth class I had taken had emphasized the disadvantages of epidurals.

    • StephanieA

      We usually offer IV pain medication- could be morphine, Nubian, stadol, fentanyl, etc. The problem is that these cross the placenta and make baby lethargic so we can’t give them if mom is too close to delivery.

  • namaste863
    • Kelly

      I would not bond with my kids if I had to sleep with them. I can’t even sleep with my babies in my room. I need sleep in order to function properly.

      • crazy grad mama

        THIS. It’s not a coincidence that my PPD was worst when my son was sleeping the least.

        • Kelly

          I could feel my PPD flair up when I was getting little sleep after the last one. Once I got a long nap, I felt like a new person.

    • Gene

      One practical question. My kids tend to go to bed around 7-8pm every night. I don’t go to bed until 10pm. Can I still bond if my kiddo sleeps alone for those 2-3 hours? Or must my spouse and I go to bed at that time as well?

      Sorry! I’d rather a less bonded child than one who dies from mechanical suffocation.

      • Inmara

        You’re such a cruel person, depriving your children from your precious presence which should be 24/7, otherwise you’re not gonna be properly bonded and attached! /sarcasm off

        Seriously, are this “researcher” not aware of infant sleep patterns which are about 14-16 hours of sleep every day? I understand that one could choose to bedshare with colicky newborn or cluster feeding infant for the sake of sleep and sanity but until 3 years? Madness.

      • momofone

        You absolutely will not be able to bond, and since you’re asking, I’m guessing you’ve already screwed this up. The good news is that your spouse is completely irrelevant in the whole scheme of things, so s/he can go to bed at any time (kids don’t bond with the superfluous parent anyway!).

      • guest

        Please tell me you’re kidding about worrying you won’t bond with your kid if you don’t co-sleep.

        • Gene

          Oh god no, I hate co-sleeping. I’ve pronounced too many babies dead after they were found dead in an adult bed.

      • Mel

        My rationale for avoiding co-sleeping: most common cause of death for multiple birth calves born alive is maternal crushing. The dam gets tired and lays on top of a calf. Humans are very different, but I wouldn’t sleep well withdreams of smushed calves in my head…

    • Angharad

      His sample size of 16 whole babies surely is sufficient to draw broad conclusions.

      • Green Fish

        You’re right.
        “… studied the sleeping patterns of 16 infants for the research.”
        “Just six babies in the research group had a quiet night’s sleep on their own.”
        So 6 of 16 were sleeping well on their own?
        (In which case I’d ask how big the comparison group was.)
        Or were the 16 further divided into babies sleeping in their cots and those that don’t?
        his doesn’t seem to be very conclusive either way.

    • Megan

      “Dr Bergman warned that a lack of sleep at this stage could cause behavioural problems for the child in later life.”

      Well then thank God I stopped cosleeping. We all sleep more now. Oh wait…Different babies don’t prefer different things?

      • Blue Chocobo

        I think of the saying about giving a fish vs giving a line and teaching to fish.

        The sooner your baby learns how to fall asleep without an elaborate routine or extensive assistance, the more sleep they will get overall (which is important for brain development). The more you have to do it for them, the less sleep everyone gets.

        Does that mean every baby can learn to do it themselves at an early age? No. Babies are individual and each will have inherent strengths and struggles, hitting some milestones earlier and some later. All skills need opportunity for practice, though. Don’t create a parental habit of denying that opportunity.

    • mabelcruet

      From the safety point of view, planned co-sleeping isn’t the problem. In my region, I’m the pathologist who looks at babies who die of SIDS (except we don’t call it SIDs anymore, the preferred term in the UK is SUDI-sudden unexpected death in infancy). The profile of ‘typical’ SUDIs is changing-we audit all infant deaths and 70% of our SIDS/SUDI cases are babies who are co-sleeping with a parent or parents who had been drinking alcohol or taking illicit drugs on the night the baby died. Usually, the co-sleeping fatal episode was spontaneous-drunk parent comes to bed, picks up baby for a cuddle then falls asleep-a common scenario is mum or dad holding the baby to their chest, then the baby rolls off and ends up face down on the mattress, or rolls between the side of the parent and the back of the sofa.

      Parents who carefully plan their co-sleeping are far less at risk. But from a public health angle, its difficult to get across that it is safe in some circumstances if you do XYZ, but not safe if you do ABC, so the public health message is a blanket ‘do not sleep with baby’ as that is far more straightforward.

      Its got to the stage where if we have a case where the baby was in their own cot when they died, we usually find a cause of death, and if a baby dies in bed with parents, 70% of cases have parents were intoxicated one way or another.

  • MarieD

    Really interesting. I’m in Australia, and gas and air is used extremely extensively in our maternity hospitals (along with other forms of pain relief like pethadine and epidurals). While agreeing with this article in terms of the hypocrisy of midwives demonising epidurals while wanting the ability to administer gas and air, I’m more interested in the question of the safety of gas and air – can any other doctors/anaesthetists who work in countries where gas and air is widely used chime in?

    I had a planned c-section and I have a massive, awful, truly terrible fear of needles, so obviously the whole IV and CSE (combined spinal/epidural) process was really very awful for me. I had a brilliant anaesthetist who could not have been kinder or more helpful to help me get through this so we could get on with the important bit of meeting my baby. I had gas in the OR prior to getting my IV and then again prior to inserting my spinal/epidural. It got me relaxed enough to get the job done and I was very thankful for it. It also made the local anaesthetic injection into my back painless, which was a pleasant surprise. By the time they had laid me down on the operating table all noticeable effects from the gas were gone.

    Obviously I have no experience of labour, and friends who’ve used it have varying accounts of whether it was helpful and how it made them feel. Some loved it and it worked a dream, others hated the sensation. But I think it’s great to have as an option for women. If I’d laboured, I’d definitely have been keen to try it first before deciding if I wanted an epidural. As long as the provision of gas doesn’t limit women’s access to other options like epidurals, surely it’s a good thing?

    Anyway, would love to hear other opinions of those in the know about the safety – there’s certainly no hesitation in offering it to women here in Australia, and I wasn’t made aware of any serious risks to babies.

    • Sue

      I’ve written about this below, Marie. WHere I work, in Emergency Medicine in Aus, nitrous oxide (with oxygen) is used a lot for procedural sedation, especially for kids. It’s also used in mixed inhalational anaesthetics. It’s great for things that are both scary and painful – as you said.

      I also agree with Dr Amy about the irony, and it;s not very effective for very severe pain, but it’s been used millions of times, over decades, during labor, in Aus and UK.

      • MarieD

        Thankyou Sue, appreciate the feedback. It’s really interesting reading through these comments seeing the differences in opinion!

        • Sue

          Yes, it is interesting. Related to familiarity of use, I guess.

    • CanDoc

      Yes. We use nitrous oxide extensively in our L&D unit. The research is clear that although nitrous CAN be sedating, in fact, with the intermittent use we see in labour and delivery, there appears to be NO increase in sedation of newborns. Sedation is much more profound with high narcotic use in labour.
      (From a personal standpoint, I received fentanyl and nitrous oxide through my own second labour, and was very happy with it… although in retrospect and epidural would probably have been even better…)

      • MarieD

        Thankyou.

  • E F

    Does anyone have citations for epidurals not crossing the placental barrier, and nitrous crossing it? I’m not challenging this, I just like to cite sources when I discuss this with people, and most of what I’m finding with Google is either op-ed pieces, garbage blogs, or pamphlets from hospitals.

    • Karen in SC

      Click on the blog The Adequate Mother on the blog roll and search for her posts on epidurals. Also she posted on this thread; she is an anesthesiologist.

    • Daleth

      The other thing to remember is that crossing the placenta usually isn’t even an issue for epidurals (or spinal blocks), because the medication is injected into the fluid around the spine (the “epidural space”) and stays there–it doesn’t get into the blood stream unless a nearby blood vessel is nicked during the insertion process, and even then my understanding is that it only gets into the blood in trace amounts.

      The medication is, in other words, sitting there right next to mom’s spine, numbing it directly. It’s not even IN the blood so it normally doesn’t even have the opportunity to cross the placenta.

      • Angharad

        Possibly dumb question: how does the epidural medication leave the epidural space? Is it just gradually absorbed into the bloodstream over a period of several hours? Or absorbed into some other system so it can be eliminated?

      • The Computer Ate My Nym

        The other point about an epidural is that, because it is administered right on the relevant nerves, the dose of medication needed is much lower than if it were given intravenously. So even when some gets into the blood stream (and hence, potentially, to the fetus), the amount is so small that it’s not pharmacologically significant.

        • Roadstergal

          That’s the clever bit. Putting a small amount right where it’s needed, so the local concentration is high while the systemic exposure is negligible. You just can’t compare it to any of the alternatives that involve getting systemic exposure high enough to have the local effect…

      • Sony2282

        Technically it eventually gets metabolized down and then crosses the blood-brain barrier and gets into the bloodstream. The amount that crosses over is miniscual (sorry I don’t have an exact amount/percent) because it’s been broken down so much by that point. So in reality it’s not any amount that causes sedation in mother or baby. NICU/pediatricians I work with never care or ask if mother had an epidural vs they do ask about narcotic use.

        • Daleth

          How long does it take to metabolize? Does that even happen before the average childbirth is over?

  • Jen

    I tried gas during my first labour but quickly gave up because you have to time your breathing and I didn’t want to have to think during a contraction. So I moved on to pethidine which worked really well for me, took the edge off the contractions and relaxed me, which was what I was after. It worked so well the first time that I was happy to have it again during my third labour (second labour was too quick for any pain relief).

    I am aware that pethidine can affect the baby and that they can be ‘sleepy’ or have breathing issues, particularly if they are born within two hours of getting the injection. Both times I was just at 4cm after several.hours of contractions on syntocin so we thought we had a while to go and both babies were in my arms 90 minutes later. I didn’t feel out of it for their births and I also didn’t feel sick or vomit – so it was something that worked well for me, I have friends who did feel unwell after getting pethidine.

    • Gene

      We use Demerol / Pethidine in the ED for pain control. It’s mainly for SEVERE pain (sickle cell crisis). It’s also highly addictive and many drug seekers ask for it by name, seeking the high. I give it IV rarely and SubQ (kinda like IM) for known drug seekers (less of the immediate high). It makes even regular people loopy and sleepy. We used to use IV narcotics rarely in L&D but it made sleepy moms and sleepy babies. Much much much safer to use tiny doses of narcotics via epidural as opposed to massive doses IV or IM.

      I have no idea why midwives are pushing something that has so much potential to harm baby when Epidurals just don’t. Oh, wait, because anyone can give a shot, but you need to be a doc to place an epidural. So epidural must be worse…

      • Ash

        meperidine–I’ve seen the ordered for postoperative shivering when patients are in the PACU.

      • Sue

        AUstralian hospital practice has essentially replaced pethidine with either morphine or fentanyl, due to the greater addictive properties and more complex drug denamics of pethidine (so GPs don’t continue it in the community). WHere I work, we no longer stock it.

        It still seems to be used in Labour Wards, though. As are sterile saline injections under the skin, apparently. Whaaa?

        • Jen

          I have a feeling that the other two maternity hospitals in my city offer morphine instead of pethidine. And having had it twice I can definitely see why it’s addictive!

  • BeatriceC

    I was given N2O when I was forced to vaginally deliver twins at 18 weeks because of unstoppable preterm labor. Docs didn’t want to do a c-section, for whatever reason, I don’t know. That stuff just made me loopy and sort of “out of body” feeling, but didn’t help much with pain. Maybe it distracted me from focusing on the fact that I was delivering perfectly healthy fetuses that would die as soon as they were born. That’s sort of a mind-torture in and of itself. I managed to make it to 36 weeks with my second pregnancy (and first living child), and I was so happy to see the anesthesiologist with my epidural that I proposed marriage to her as she walked in the door. My (now ex) husband was rather amused. Third pregnancy was also a late term miscarriage delivered vaginally, though at a different hospital with different doctors (I’d moved to a different state), so I had an epidural. Next two pregnancies* were crash c-sections at 32 and 24 weeks, both with a spinal block, I think. I was awake, but it was different than the epidurals. If those hadn’t been c-sections, I would have definitely preferred the epidural over the N2O. Epidurals are lovely, wonderful things.

    *There were two additional pregnancies that were ectopic. I don’t do pregnancy very well, as we can see quite clearly. I had so many pregnancies because I was deep into the Catholic no birth control party line at the time. I began separating from the church when I decided that tying my tubes to keep me alive for the kids I already had might be a good thing, and I was practically shunned for that decision. I’m atheist now.

    • Amy

      Thank you for sharing. My heart goes out to you. Sounds like you’re in a better place spiritually and practically now.

      • BeatriceC

        Thank you. And yes. My living kids are teenagers, and not without health issues (two of them inherited a bone disease from their father), but I’m much better able to care for them without the Catholic party line that beat into me that all this happened because of some sin I must have committed so it’s all my fault. These days I’m quite happy in spite of major medical issues. We have a good life. My ex isn’t part of my life anymore (his choice), but the current Mr.C. is an awesome man who loves my boys as his own, and we have a wonderful family life.

    • Blue Chocobo

      I am very sorry for your losses, and for any mistreatment you suffered taking difficult steps to avoid further pregnancies.

      As a possible answer as to why doctors avoided a cesarean for an unstoppable and tragically early labor, there are much higher risks for the mother when a cesarean is performed earlier in pregnancy. The part of the uterus where a typical cesarean is cut is not “ready” in the second trimester. The immediate risks (from surgery on a tricky site) and future risks (from a funky scar line) would be very, very high compared to a vaginal delivery of even two very small fetuses.

      • BeatriceC

        Thank you. That explanation actually makes sense. In the 18 years since that day, I’ve never actually had any doctor, or anybody else, explain why vaginal delivery was preferable. Given that I would go on to have so many more very difficult pregnancies, the doctor’s choice was probably the best one. My OB history might be the stuff of doctors’ nightmares, but I am quite grateful for the kids I do have (even if they’re teenagers with bad attitudes at the moment).

        • Blue Chocobo

          Glad to help, and good luck with the teenagers. I’ve heard rumors they do come around eventually.

    • fiftyfifty1

      Yes, Blue Chocobo is exactly right. A second trimester c-section is much riskier than a third trimester c-section. The scar that forms is prone to rupturing during future pregnancies, not just during labor but at any time during the pregnancy. It is a terrible thing to have to vaginally deliver a fetus you know won’t live, but to deliver by CS could mean no future babies.

      • BeatriceC

        You know, for years I asked questions and was never given any answer beyond “it’s just better that way.” Eventually I stopped asking. It’s funny how the likely real answer comes out so many years later in response to a comment on something else entirely. Even when I was so emotional over it, hearing the problems and risks to future pregnancies would have made dealing with the trauma at the time so much easier. I wonder what would have been so difficult to tell me the truth at the time instead of glossing over facts. Facts, even when they are unpleasant, ultimately make difficult situations easier to process.

    • CanDoc

      Oh no! What an awful experience you had. 🙁 I’m glad you have your healthy family now. Agree with others that a cesarean section at 18 weeks is both difficult and dangerous for future pregnancies, but women who deliver vaginally in that situation should still be offered good pain control like narcotics or epidural analgesia. Thank you for sharing your experience as a reminder of what can happen when we’re not diligent about caring for women’s pain relief.

      • BeatriceC

        I guess the doctors at the time held the philosophy that “information overload” would be bad for my emotional state. I can’t imagine any situation where that would be the case. I can imagine bad ways to impart information, but the information itself is important. And adequate pain control is essential. The late term miscarriage with an epidural was far less traumatic. Thinking back, information is part of that pain control. If I understood why things had to be that way I might have been in a different mental state and better able to cope with what was going on. One thing is for certain: N2O was definitely inadequate.

    • Sony2282

      At 18 weeks it would have had to be a vertical incision c-section would put future pregnancies under much higher risk than a transverse incision when the uterus/babies are bigger

  • phascogale

    First suck n the gas with child number had me violently vomiting till I got a metochlopramide injection! Never bothered with it again.

    N2O2:O2 is not so great when you have an issue with B12 deficiency and pernicious anemia either. Does bad things.

    I also hate it when you work at a hospital that offers gas but they don’t have the tubing that extracts the gas rather allowing it to go into the air.

  • crazy grad mama

    Since we’re all sharing our nitrous stories, here’s mine: I got it during a C-section, in addition to my epidural. The latter didn’t fully numb my upper abdomen, so all the “pushing and tugging” was actually major pain. The nitrous took the edge off just enough for me to get through without needing GA (and was obviously better for baby’s and my alertness than GA would’ve been).

  • Allie P

    Totally. Next baby I have, I want to be tripping ovaries. Radical. I just had boring old sober epidurals with the last two.

    • KeeperOfTheBooks

      “Tripping Ovaries” would make a hilariously awesome band name.

  • Tosca

    Obviously anecdotal, but…I had Nitrous with my first baby, and it did NOTHING apart from giving me a momentary (unpleasant) head spin. I also had pethidine, which doped me out but gave very little relief.

    For my second I had a “pushing” epidural. I could feel and move my lower body with no problems, but there was just enough anaesthetic to remove the pain. Had I had a third baby, I would have had another epidural in a heartbeat.

  • SarahSD

    Interesting how on the one hand the rhetoric is all about birthing actively, having agency, being empowered, but on the other hand, at least in my hospital’s birthing center, offering narcotics and laughing gas which make you completely out of it, at least mentally. I knew for a fact that I didn’t want narcotics, since I once had a bad reaction to sedation for oral surgery (hysterical crying and panic). But I remember being very worried that being immobilized by the epidural would interfere with my body’s ability to get the baby out (since that is what I had been taught). On the contrary, it allowed me to rest, finally dilate completely, and push with abandon without having to feel my vagina tear.

    The more I think about it, the more I believe that one of the main NCB logics is to sell the mother the idea that she will be in control. But it’s a bait and switch. Being in control is basically limited to moving your body however you want, and possibly eating. What you exchange this “freedom” for is the limited set of tools and scope of practice that midwives can offer. So the trick is to make the limited set of tools and resources sound like they are what makes it possible to have a good birth.

    • Roadstergal

      Seriously – pain is a huge part of the whole ‘control’ thing. If you’re in pain, it’s harder to think clearly, and the worse the pain, the worse the dissociation. I would put adequate pain control at the top of any plan that involves giving control to the woman. Even if adequate pain relief kept me from walking, I would rather be clear-headed and in bed than walking and out of my mind.

      • SarahSD

        Totally agree. But I can understand how, if you are taught to believe that interventions will interfere with your body doing its thing, you might feel like there is agency in choosing the pain. Add to that pseudo-religious cultural undertones about birth as a rite of passage and the power of positive “affirmations”… I mean, I believed that stuff. And felt guilty about my epidural and interventions I had for a year.

        • Roadstergal

          Ugh, I’m so sorry you were pressured into feeling that way. 🙁

          • SarahSD

            Feeling kind of miffed about “losing control” of my birth for a year and wondering what might have been, then slowly discovering I had been had and starting to see the cracks in the NCB ideology is WAY BETTER than coming to this realization by having my baby be injured or die because of a mistaken, misled faith in natural birth.

          • Roadstergal

            That’s a good perspective.

  • theadequatemother

    http://yorkspace.library.yorku.ca/xmlui/handle/10315/7933

    RCT comparing nitrous to compressed air placebo in labour. Nitrous not superior. Nitrous is a placebo. But hey if the dizziness and vomiting distracts you from the contractions I guess that’s efficacy?

    • Monkey Professor for a Head

      I used N2O when I had my son while I was waiting for the anaesthetist, and I personally didn’t like it. I don’t think it did much for the pain itself, but instead it just made me dissociate a bit, which I found unpleasant in itself. Maybe if I’d been allowed it in early labour when I just needed something to take the edge off it might have been of some use, but it wasn’t useful for severe pain. I used it because after 15+ hours of back labour, much of it severe, I was desperate for anything, but I was so relieved when the anaesthetist arrived.

      My epidural on the other hand was awesome. I was given a PCEA, so was able to top myself up whenever I felt like I needed it, and then ease up as we came closer to pushing. It took away the horrible sacral pressure and I avoided the ring of fire completely, but I could still feel contractions. I had no systemic side effects and still had some movement in my legs. Without being in severe pain, I could rest, relax, eat, talk with my husband. I was in far more control than beforehand. It turned my labour from an awful, distressing experience into quite a nice one.

      Theadequatemother, thank you so much for your blog! I read your posts on epidurals when I was pregnant and I found it so helpful to have someone go through the actual scientific evidence on epidurals without the NCB rhetoric attached.

  • theadequatemother

    At least in fetal and infant rats nitrous causes neuronal apoptosis (that would be brain cell death). I was at an anesthesia conference and talking to some of the SmarTOTS researchers. These are the people being funded by the anesthesia patient safety society and the international anesthesia research society to figure out just how damaging anesthetics are to developing brains. They have issued a tstatement commendation that NO child under TWO YEARS of age should be having ANY elective anesthetics.

    I asked them if anyone was looking at the effect of nitrous in labour on the neonatal brain. They were mostly American and while they thought it was actually an imprtant question, due to the fact that nitrous wasn’t widely used in their institutions they hadn’t thought of it.

    I for one would like to know if nitrous causes fetal and newborn infant neuronal loss. I think we should know the answer before we expand and encourage its use.

    • Sue

      We do know that nitrous oxide has good analgesic properties, which is why it is used in both inhalational anesthesia and procedural sedation.

      On its own (with oxygen, of course), it does seem to be much more widely used in Australia and the UK than in the US.

      Nitrous oxide is very widely used in public hospital labor wards in Australia, and has been for decades. I don’t think the issue is safety, so much as efficacy for very severe pain.

      In Emergency Department practice, for example, Nitrous is commonly used for painful procedures, especially in children. The combined sedation and analgesia is ideal for things like burns dressings, suturing or even inserting IVs, and the onset and offset are very rapid. It’s not sufficient, however, for reducing dislocated shoulders or fractures – both types of pain that are analagous in severity to labour (though much shorter duration, of course).

      The other issue is that the effects on different individuals are highly variable – one person can be literally laughing through a painful procedure, while others feel nauseated.

      It might “take the edge off” moderately severe pain but, as others have said, is unlikely to be useful for prolonged, agonising pain. If it’s all you have, though, it’s what you use.

      • The Bofa on the Sofa

        Read theadequatemoher’s link. Nitrous is no better than placebo in childbirth.

        • theadequatemother

          Also, there was a large population study that showed when nitrous was used for adult anesthesia the risk of death from all causes post op was elevated. We don’t even pipe nitrous into half of our anesthesia machines anymore. Most of our new trainees have NEVER used it!

        • Sue

          Hi, Bofa,

          It’s interesting to see the different attitudes of systems that use nitrous commonly and those that don’t.

          I have no argument with (more than)AdequateMother about the lack of efficacy for labor pain, but I’m arguing that, if there were harmful effects from use during labor, the millions of uses over decades in the UK and Aus would have revealed those harms by now. Unless it’s being argued that Aussie and British kids have subtle neuro-cognitive defects that aren’t shared by their US cousins. That would start a good discussion!

          • The Bofa on the Sofa

            The difference is that, if it were something NCB were against, they would be all about the _potential dangers!!!!!_

            Kind of like the “there’s formaldehyde in vaccines!” claim. There’s no indication that there is any problem, but anti-vaxxers have a conniption over it.

      • theadequatemother

        No we know that nitrous is a WEAK analgesic and no better than placebo for the pain of childbirth. Why give a placebo?

        The population of fetal, neonatal and very young brains (< 2 yrs old) that seem to be at the greatest risk for neuronal death after anesthetics is different that the populations h are talking about in the ED. If damage occurs and is clinically significant it will likely show up on neuropsych testing as things like difficulty with higher order processing so no you would t just "notice it" necessarily in the population. But whatever clearly the anesthesia patient safety society and IARS are just a bunch of ninnies.

        • The Bofa on the Sofa

          It’s pretty clear that if midwives were not allowed to give nitrous, the NCB crowd would be howling about how dangerous it is

        • Sue

          I take your point about inadequate effect, but, considering nitrous has been used in literally MILLIONS of laboring women for decades, across the UK and AUs, don’t you think we would have seen a population effect by now?

          I’m not arguing it’s effective for labor pain, but I haven’t seen evidence that it’s dangerous.

  • Wren

    I had a bit of nitrous with both of mine during labour and found it helpful. Not as good as the spinal I had for my C-section, but helpful. I also had it when the danged local just would not take after my second when I was getting the 3 stitches I needed. I was given the choice of nitrous or a third injection of the local. I went for nitrous. It made me a little loopy for a minute or two, but that was it. That baby breastfed like she’d been doing it for a year right from birth, so I’m pretty sure it didn’t affect breastfeeding from my side.
    I know some people do react badly to it, but I thought it was a pretty short reaction if they did, unlike the other pain relief options.

  • RMY

    I think the less effective pain management options are seen as less bad because they are pain a necessary ingredient in childbirth. If it’s too much only the mildest method to make it tolerable is okay.

  • Amazed

    Yeah, yeah, doctors are the bad guys here but no worry, girls, we’re just like doctors! We prescribe medicines to relieve labour pains, just like the bad guys do! Ain’t we wonderful?

  • Here’s a question though, my last labor I was not a candidate for an epidural, and came in too far along for narcotics. Would nitrous oxide have been a good choice for me. Or do risks still out weigh the benefits?

    • araikwao

      In Aus you could have had nitrous. I think part of the placebo effect is relates to having the mask to grab onto, and to concentrate on using it effectively. (Sorry, unrelated speculation!)

      • phascogale

        I think you’ll find there are plenty of circumstances where the midwife has turned the nitrous to 0% and the women are just sucking on air. But its working as they have a focus – their breathing.

  • mabelcruet

    As a medical student many years ago, the obstetric registrar (middle grade doc) let us try nitrous oxide under supervision so that we could experience its effect. It’s probably not quite the same if you’re not actually labour but I was extremely carefree and giggly, couldn’t concentrate, could hear him speaking but could make no sense at all of what was happening. It was only for a couple of minutes, literally he only let us take a couple of breaths, but it was a very peculiar feeling, completely conscious but completely out of it and certainly not capable of making any important decisions. And then the midwife on the ward complained that he had put us in danger as it was such a dangerous drug!

    • Clorinda Madsen

      If it messes with your decision making processes, then add in the pain of labor, and the woman is completely at the mercy of the provider. In the hospital, there are checks and balances that help make sure somebody isn’t taken advantage of, or if they were, they have recourse. What will a mom laboring at home have to make sure she isn’t taken (more) advantage of by the midwife?

      • mabelcruet

        I remember very clearly thinking it was like being drunk-not hopelessly comatose drunk, but that stage where you haven’t any anything to drink for months and the first glass of wine goes right to your head and you get all giddy and giggly very quickly. And as soon as you stop breathing, you sober up. So yes, I definitely wouldn’t have been in a fit state to make decisions. Maybe being in pain counteracts some of the giddiness and labouring women don’t get the same ‘drunk’ response?

        Having said that, I was once asked to speak to an elderly woman who had lost her baby in the 1960s. The baby had a post mortem examination but no one had ever discussed the result with her, and she was now worried about dying and never knowing. She had gone into labour very prematurely and the only treatment available was alcohol-it was used as a smooth muscle relaxant to stop contractions. She said she was being given it intravenously for days and so had no memory of having her baby or seeing him after delivery. I felt so sorry for her.

      • KeeperOfTheBooks

        Frankly, and I do not mean this to be at all insensitive, it sounds a bit like one of the date rape drugs.
        I WANT to be conscious and as in control of my faculties as possible when giving birth and having various peoples’ hands in my vagina, thankyouverymuch. Don’t get me wrong: I trust my OB completely. But I don’t think it’s asking very much to want to be aware of what the hell is going on, and I suspect if asked, he’d agree 110% with that.

    • Eater of Worlds

      This is why I get nitrous for dental procedures. I have a massive phobia from trauma, and to get my cavities taken care of it’s either nitrous and a cart load of benzos or general anesthesia. Nitrous and benzos are cheaper and faster for me and the nitrous is enough to push me over the edge into the land of not caring to get my teeth done. It’s definitely not given to me for pain.

      • Nick Sanders

        Maybe if you’d remember to brush after every planet, you wouldn’t have cavities.

        • Bombshellrisa

          Oil pulling. Brushing your teeth with the evil fluoride is how big dental gets your money anyway, so just oil pull with some sesame oil every morning.

          • Nick Sanders

            Sesame oil? Goodness gracious, that’d be quite the experience.

          • Bombshellrisa

            Yeah, I can’t imagine that swishing and holding a mouthful of sesame oil is a magical elixir and destroyer of toxins but it’s something that I have seen suggested on Facebook again and again.

          • Nick Sanders

            Do these people have no tastebuds or something? Total anosmia? How on earth does anyone manage that?

          • KeeperOfTheBooks

            They may subscribe to the “the fouler it tastes, the better it is for you” school of thought. (The exception being, of course, elderberry syrup, because magic killer of flu is tasty.)

          • Nick Sanders

            Kroger used to carry elderberry jam, but the stopped several years ago. I really miss it.

          • KeeperOfTheBooks

            Have you tried their international food section? There’s usually a small selection of more British food there; it’s where I can reliably find stuff like lemon curd, for example.

          • Nick Sanders

            The brand they carried was a domestic one. I just looked online, and it seems it’s no longer in production, which makes me sad.

          • Liz Leyden

            I’ve only heard of oil pulling with coconut oil.

          • Bombshellrisa

            The friend who posts about it always posts the same thing about sesame oil, she read about it on earth clinic dot com. There is a lot of debate about sesame vs coconut because sesame is supposed to be so inflammatory with its omega 6 content.

        • Eater of Worlds

          It’s the critters, man. They get stuck between my teeth and floss doesn’t dislodge them.

  • Rita Rippetoe

    I’ve had NO for dental work; never heard of it used for labor. Dental work is passive–just stay still til the doctor is done. But I can’t imagine using NO and being all woozy while trying to deliver a baby. I’ve heard the effects described as “you still feel the pain, you just don’t care.” This works for me psychologically if the pain is just a side effect of the necessary things the dentist is doing to my body. But in labor the additional worry is that pain may mean something is wrong with the baby. Can’t imagine that being a comfortable situation.

    • EmbraceYourInnerCrone

      And apparently it makes some people vomit which I can tell you from experience is NOT something you want to be doing when you are in labor if you can avoid it. One thing my child birth class teacher was very truthful about was that a LOT of people vomit during transition, so if you think you are in early labor keep your intake to clear liquids like water, 7up, Jello(not RED or Purple!) clear broth, popsicles, etc.

      I wish i had listened because the baked potato was not pleasant on the return journey…

      • Inmara

        Re: vomiting – there is a joke that if you drink heavily you should eat either rice cereal or beetroot. The first comes out easily, the latter – beautifully 😀

        • Roadstergal

          I’m going to refer back to that Campbell’s beer, bacon, and cheese soup I posted an image of a few days ago – I have a hunch it looks _exactly_ the same coming up as it does coming out of the can.

    • The Bofa on the Sofa

      I’ve had NO for dental work

      I sure hope not!

      You might have had N2O, though…

      NO: Nitric oxide – nasty stuff
      N2O: Nitrous oxide – laughing gas

      Of course, a popular use of N2O these days is for autoerotic asphyxiation.

      • theadequatemother

        Maybe she had NO for acute right heart failure in the setting of pulmonary hypertension. I wouldn’t call it nasty stuff. It’s a great pharmacological agent in the appropriate circumstances.

        • The Bofa on the Sofa

          Yeah, it’s great for erectile disfunction and angina. Don’t breath it though.

          • theadequatemother

            We usually put it into the breathing circuit.

      • Nick Sanders

        Either way, better than NO2. Now that’s some extra nasty stuff.

  • namaste863

    And here I thought that according to NCB dogma, the experience of pain led to a more satisfying, transformative overall childbirth experience. If they honestly believe that, why bother using pain relief at all? Personally, I don’t get the whole thing. Life will grant plenty of opportunities for personal growth all on its own.

    • Megan

      Agreed. And nitrous alters perception. Not as long acting as twilight sedation for childbirth but not that different really when you think about it.

    • MaineJen

      Yeah, why would midwives be “clamoring” to use this stuff if all women need to endure the pain of labor is “support?” I call BS.

      • Megan

        Because women aren’t stupid and they want pain relief. The efforts of midwives to say they don’t need it is only to convince women that they don’t need a hospital or Doctor, where reliable pain relief can be found. BS, indeed.

  • MaineJen

    Yikes…I would rather be fully conscious, thanks! Epidural for me.

    I did try Nubain at a certain point during labor #1…it didn’t do much for pain but made me dizzy/sleepy. I’d be scared to take nitrous.

    • Megan

      Yeah Nubain didn’t do much for my pain either but it helped me sleep a few hours I guess…

    • Zoey

      They gave me Fentanyl in my first labour (because I wanted to avoid an epidural) and it made me as high as a kite. I remember still feeling the pain, but not caring at all and saying and doing strange things. Then it depressed my breathing so much I had to be put on oxygen.

      Not doing that again.

  • StThomas

    When I was an SHO in Obstetrics in gynaecology in a Scottish Hospital, a lot of patients use it and found it beneficial. I have never in 23 years of being a doctor come across anyone coming to harm from it, nor heard of such a thing.

    • Green Fish

      Kudos to you for following up on your patients and checking them for learning disabilities and other signs of neurological damage over the years to see whether placenta crossing anesthetics during birth have adverse effects.
      Or how did you find out that none came to harm?

      While research certainly is not 100% conclusive at this point in time, this study might be an interesting read concerning the effects of anesthesia for children:
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729550/

      • StThomas

        From the abstract on your link “Exposure to anesthesia was a significant risk factor for the later
        development of LD in children receiving multiple, but not single
        anesthetics. We cannot determine whether anesthesia itself may
        contribute to LD, or whether the need for anesthesia is a marker for
        other unidentified factors that contribute to LD.” So I don’t think that I can draw any conclusion from this that can be applied to Entonox. “Gas and air” as it is colloquially known, is a common analgesic for labour in the UK. The effects are brief, rarely lasting more than a few seconds and taken at the crescendo of pain in a contraction. It is certainly less debilitating to the baby than diamorphine, which I often saw used. It is immediately available when an epidural takes a few contractions to set up. Probably most women in labour get it in Britain. My mum certainly did and I managed to get a medical degree. :-).
        There is a place for an effective, convenient , rapidly and briefly active analgesic in labour, which does not seem to do any harm. Dr Tuteur seems to be excercised by theoretical risks rather than long term evidence of effective uncontroversial use without problems, which is unusual for her. I’ll take that bit “without problems” back if you can find any counterexamples; evidence of significant risk in normal use.

        • Amy Tuteur, MD

          I’m not bothered by theoretical risks; I’m bothered by hypocrisy.

          • StThomas

            Fair enough; I confess that I read your post, and looked at the bits I disagreed with more than the bits I did disagree with.

  • Green Fish

    For those who can read German this might be interesting:
    http://www.lachgas-lehrbuch.de/Geburtshilfe/Lachgas_Schmerztherapie_Geburt_DGAI_DGGG_28-10-2014.pdf

    It’s a statement of the German Society for Anaesthesiology and Intensive Care and the German Society for Gynaecology and Obstetrics concerning the use of nitrous, and it’s not positive.
    They say that the analgesic effect of nitrous oxide not measurable, but it is accompanied by significant side-effects. It causes nausea, dizziness and (unpleasant) hallucinations with an incidence of approximately 1%, therefore more research needs to be done into its potential to damage mother, child and staff.
    For the baby they especially fear a possible neurotoxicity as has been shown in tests with animals.

    • theadequatemother

      As an anesthesiologist I agree with the German society on this. And it is NOT because a reduction in epidurals would affect my income at all (it wouldn’t). Nitrous has unpleasant side effects, is not better than placebo in RCT compared to compressed air and may be harmful for the developing brain.

      There is actually no upside…and it also stalls women from getting adequate effective pain relief.

      • araikwao

        The latter *is* an upside to many midwives

      • Sue

        Hi, Adequate. Do you know why nitrous is much more commonly used in the UK and Australia than in the US? I dont work in obstetrics, but I use nitrous for procedural sedation in children in the ED – it is certainly variably tolerated, but it is a very safe drug in this setting.

        For labor pain, it might not be very effective, but haven’t millions of women using it in labor over decades in the UK and Aus demonstrated its safety?

        I agree with Amy;s point in the article, but, if evidence of harm hasn’t emerged after such extensive and prolonged use, I suspect it’s unlikely to emerge now.

        • theadequatemother

          See my comment above regarding the neurotoxic effects. We use a lot of nitrous in Canada. I don’t know why it wasn’t used much or fell out of favour in the US.

          • Blue Chocobo

            I would hazard a guess as to how it fell out of favor in the US-a combination of pushback against twilight sleep (mothers wanted to be “present” for the children’s birth and fathers entered delivery rooms) causing collateral pushback against other options that cause altered mental state, and epidurals are just so much safer, more effective, and modern.

            Just my guess.

  • Azuran

    What gets me the most is all the contradiction and hypocrisy of the thing.
    Labour is not painfull, if you feel pain it’s because you are doing it wrong. Drugs are bad and they affect babies, Epidurals are evil, here, take nitroux oxyde.

    You are post date? Don’t worry, babies know when to be born. Don’t let your doctor scares you with his higher rate of stillbirth. Don’t let them induce your labor, it will start a cascade of intervention. Here, take castor oil instead.

  • Bugsy

    Really interesting…I had nitrous with #2 when it was taking too long for the anesthesiologist to get there (and then when I was dilating too quickly for my beloved epidural to take effect). I’m truthfully not sure it did anything for pain relief, but I was desperate. It definitely left me feeling completely off for a while following his birth.

    The risks were never mentioned to me.

    • Sarah

      I found it completely bloody useless. The vomiting was a slight distraction from the pain, I suppose, but not sure it was an improvement. The risks were never mentioned to me either, whereas they were with the anaesthesia for my section.

  • Sarah

    I agree with most of this post, but since I always point this out if someone questions whether other interventions might impair breastfeeding, in the interests of balance- plenty of women wouldn’t give a damn if nitrous oxide was detrimental to bf. Personally I care much more about the fact that it made me throw up.

    As you were.