Maggie McCullough was pregnant with her first child when she and her husband, Travis, decided to try a different kind of pain relief during labor.
“I wanted to go a more natural route,” said McCullough, 25, who gave birth to daughter Everly on Nov. 4. “My mom always did, and I think that influenced my decision a little bit.”
During the couple’s prenatal classes at Billings Clinic, taught by Jessica Halgren, a childbirth educator and labor and delivery nurse, they heard about a new alternative at the Billings hospital: nitrous oxide.
It’s not that nitrous oxide use is new. The odorless, colorless gas (also called “laughing gas”) is probably more associated with dentists’ offices in the United States, although it is the No. 1 pain option in labor and delivery rooms in countries such as the United Kingdom and Australia.
Halgren, in an interview with McCullough, said she’d first heard about it at a conference.
“I was so excited that it was being used in the U.S. and I thought ‘why don’t we have that here?’ ” she said. “So I talked to our managers here and vendors, seeing how it would work.”
Eventually, a decision was made to add the anesthetic gas as an option at Billings Clinic. It became available to patients in the fall, and since its introduction it has been used by 34 patients for an average of 94 minutes per person.
According to the American Society of Anesthesiologists, nitrous oxide is an inhaled anesthetic gas that helps reduce anxiety and makes patients less aware of pain. But it does not eliminate pain.
Halgren sees some advantages to it over other options, including epidurals now used by 85 percent of clinic patients. Nationally, epidurals are used by 89 percent of women in labor.
Nitrous oxide gives women in labor more mobility, Halgren said, unlike epidurals that require a laboring woman to remain lying down, positioned on her side.
When McCullough was in labor, the baby’s back was facing her back. That can cause a lot of back labor, Halgren said, and can make delivery more difficult.
“Being able to still move encourages the baby to rotate to the anterior position, which makes it much easier for delivery and relives back pressure,” she said.
An epidural blocks pain from below a woman’s breast down to her toes. That may make it difficult for her to feel contractions or feel the urge to push, Halgren said.
“Sometimes it can take longer since you don’t have the sensation to respond to your body and push spontaneously,” she said, explaining that at that point, nurses often coach patients about when to push.
Use of nitrous oxide is a much lower-cost option than an epidural. And unlike the use of a narcotic that could depress a baby’s respiratory function after birth, nitrous oxide “is in and out of the mother’s system in a couple of minutes,” Halgren said.
“That’s why the mom controls it,” she said. “It’s safe, and if she’s getting too sedated, the mask will fall from her face and in a couple of minutes she’ll feel back to normal.”
People who have used nitrous oxide for a dental procedure may remember a slight feeling of euphoria. That’s because the mixture of gases is 70-30 (30 percent oxygen), while it’s a 50-50 blend for women in labor.
“The biggest thing I hear from people is, ‘I feel more relaxed,’ ” Halgren said. “And that, we know, is super important in labor, so mom can focus on her breathing skills and her body to relax so she’s not fighting contractions.”
The ASA cited one study in which 60 percent of the women who used nitrous oxide ultimately decided to opt for an epidural. It showed that the level of pain before and after use of the gas remained the same.
The good news is nitrous oxide gives expectant parents one more option for them to consider during labor and delivery, Halgren said.
At Billings Clinic, McCullough was one of the first patients to use the gas. She opted to let that be her way of dealing with the pain throughout the delivery.
McCullough's labor began at 10 p.m. on Nov. 3. She and Travis went to the hospital the next day, at 1 p.m., and she began using the gas sometime after that.
“I would take a good breath full of the nitrous oxide,” she said. “I wouldn’t say it took away any of the pain; it definitely was still there. But it made it so I could focus on my breathing and get through the contractions, so the pain didn’t overtake me.”
She figured she used the gas for “maybe a half hour or so, and it definitely really got me through that really hard part of labor.” Everly was born at 4:58 p.m.
Halgren, who wasn’t present for McCullough’s labor, said nitrous oxide is generally most effective when it’s used during active labor before a woman enters into transition. It gives her a chance to experiment with the gas, to see what’s most effective for her before she gets to that more intense stage.
In Halgren's conversations with expectant parents, she said she’s seeing increased interest in its use.
“I think culturally people are looking for that option with less intervention and being able to experience more of birth and have an active role in labor,” she said.