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Self-administered Relief

Holyoke Medical Center's Birthing Center

Ads Nitrous Oxide As Sedation Choice

Ginny and Ginny Nitrous

Ginny Miller, certified nurse midwife with Holyoke Midwifery Care, left, and Virginia Thomas, registered nurse manager of Holyoke Medical Center Birrthing Center, look over the nitrous oxide sedation machine.(Foto por John Suchocki | The Republican)

Marta Nitrous

January 8, 2014 - Northampton - Staff photo by Michael S. Gordon - Marta Martinez with 18-day-old Kai Alexander Martinez-Peron.


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Click here to see ABC 40/Fox 6 Video.

By Kathryn Roy

Holyoke Medical Center, through its Birthing Center, has become the first hospital in the state — and one of the first in the United States — to offer the once more commonly used nitrous oxide as an inhaled sedation choice to help relieve pain during labor.

Commonly known as laughing gas, nitrous oxide has been used for labor pain management in Europe for decades. Patients of The Birthing Center can choose nitrous oxide to help alleviate labor pain at any point in their labor.

Ginny Miller, certified nurse midwife with Holyoke Medical Center’s Midwifery Care, said new technology made this option more easily accessible.

“It was used in this country till about the 1970s, and then when epidurals (regional anesthesia given through injection in or around the spine) became more available, and the machinery (for nitrous oxide) was not being made anymore to the concentrations you need for labor and delivery, it went out of favor,” Miller said. “Now, there’s a new company that makes the equipment.”

The nitrous oxide mixture, which is 50 percent nitrous oxide and 50 percent oxygen, is self-administered by the patient through a mask that goes over her face.

“The woman controls it herself, so she can use as much or as little as she needs,” Miller said. “You can move from nitrous oxide to an IV narcotic to an epidural, or some women only need a little to get through part of labor.”

It’s not as strong as a narcotic, but it does give them a sensation of relief from the pain, Miller said.

“For some women, it’s not going to be enough, but for some, this may be all they need,” she said. “They can be more mobile and they don’t need to be confined to bed.”

Miller said women can also use the nitrous oxide earlier in their labor than they would typically get an epidural. It can also be used during repair of a laceration or manual removal of the placenta.

Women who are interested in trying nitrous oxide are given a brief training session on how to use it.

“They need to be taught when to start it,” Miller said. “You want to start a little bit before the contraction starts, and then you breathe through the contraction through the mask. The effect of it wears off in seconds.”

Virginia Thomas, registered nurse manager of The Birthing Center, spearheaded the hospital’s effort to bring in nitrous oxide for laboring women.

“We have patients who do not have the option to get an epidural, and they don’t have some of the choices that some other women have,” Thomas said. “For those women, it’s such a phenomenal option. It’s so exciting to make this happen.”

Women who have had back surgery, certain back conditions, fear of needles, weight issues and other conditions are not ideal candidates for epidurals and spinal pain medications.

“There are some that want as little intervention as possible,” Thomas said. “This allows for more control in their labor, so they’re more involved in the whole birth process.”

Thomas said pregnant women will learn about the new nitrous oxide option when they visit with their providers.

“When women come in during labor, we always talk to them about pain management options,” she said. “We try to have the patient involved as possible in the birth plan so they can have the birth experience that they want.”

Marta Martinez, of Northampton, was one of the first patients to use nitrous oxide when her son, Kai Alexander Martinez-Peron, was born Dec. 20.

Martinez, who is an acupuncturist and Chinese herbalist, said she’s been aware of the use of nitrous oxide in the U.K. for a long time, and was anxious to try it. (Viewers of the PBS’ popular English drama, “Call the Midwife,” would be familiar with its introduction during an episode of the show that is set in the 1950s.)

“For me, as a healthcare practitioner, I felt like it was the best alternative as far as not having my legs numb, for example, with an epidural, or having a certain level of anxiety because of pain if I went completely without pain relief,” she said.

Martinez said she only used nitrous oxide as a means to alleviate her pain, and only during the pushing phase of her labor.

“It helped me ride the pain in such a way that I could be 100 percent present for the birth of my son, while at the same time, I felt aware and conscious of my own body as the process of labor was taking place,” she said. “I could still feel the pain, but the pain was workable; I could work with it.”

For now, other Western Massachusetts hospitals haven’t jumped on board with nitrous oxide for laboring women. At Baystate Medical Center in Springfield, Dr. Andrew Healy, medical director of obstetrics, said they have been doing research on nitrous oxide.

“We’re going to review the risks and benefits and decide whether to move forward or not,” Healy said.

Baystate, like other medical center, offers a variety of pain relief and birth plan options.

“We have patients who come in and use absolutely no pain control,” he said. “We have patients who use doulas (professional birth support attendees) to get through labor. We have patients who use IV medications and patients who get an epidural, so we offer the whole spectrum.”

Healy said some popular pain relief options may not be ideal for some patients or some situations. For example, if a patient is uncomfortable and is having trouble keeping still, an epidural is not the best option. In late-stage labor, there is a concern that IV medications could affect the baby as he or she is born. While spinal pain medications offer quick relief, setting up for spinal administration could take too long for the woman who is about to give birth.

“It’s pretty rare that a patient is told she has missed the window for an epidural or a spinal,” Healy said.

Healy agreed that certain medical conditions and other factors can have an effect on what pain management option is ideal for a specific patient.

He said while new developments in pain control don’t happen every day, healthcare professionals at Baystate are always reviewing published data.

“We are always looking at whether we are doing things the best we can or if there are changes we need to make,” he said. “Or, ‘Is this something we should be offering?’ We’re always trying to stay at the top of the curve as far as quality of care and providing for our patients.”

Healy said the hospital has committees that constantly review what the hospital offers its patients.

“We want to make it the best experience they can have, but we also want to make sure it’s a safe experience for mother and the baby,” he said.

Thomas said Holyoke Medical Center is glad to be able to offer laboring women something new to add to their experience.

“This isn’t going to be for everybody, but it will be one more option,” she said.




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