From the American College of Nurse‐midwives: Nitrous Oxide for Labor Analgesia

Beyond the epidural: Alternatives to neuraxial labor analgesia

Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. Providing safe choices for labor analgesia and support is central to creating a tailored, safe, and effective analgesic treatment plan with high maternal satisfaction. Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.

Non-Neuraxial Labor Analgesia: Options

Although it is the most effective method to treat labor pain, neuraxial analgesia may be undesired, contraindicated, unsuccessful, or unavailable. Providing safe choices for labor pain relief is a central goal of health care providers alike. Consequently, knowledge of the efficacy, clinical implementation, and side effects of various non-neuraxial strategies is needed to provide appropriate options for laboring patients. In addition to nonpharmacologic alternatives, inhaled nitrous oxide and systemic opioids represent two broad classes of non-neuraxial pharmacologic labor analgesia most commonly available. This review summarizes the current published literature for these non-neuraxial labor analgesic options.

Nitrous Oxide Utility in Labor and Birth: A Multipurpose Modality

The use of nitrous oxide (N2O) for labor and birth has very recently emerged as a viable modality in the United States, despite a long history of use in Canada and Europe. Usually associated with dental procedures, there are significant differences between dental and parturition utility, efficacy, and staff exposure. In addition to using it for pain relief and anxiolysis, those centers utilizing it have noted it to be multipurpose and useful for such situations as: external cephalic version, manual removal of placenta, intravenous starts, during placement of urinary catheters and intracervical Foley bulbs. Nitrous oxide has proven to be especially helpful for repair of lacerations under local anesthesia and is a multiuse modality that should be available to women in all birth settings. This article explores the history of N2O use, provides a comparison of obstetrical use to use in the dental industry, examines the contraindications to, and implications for usage, and discusses logistical points of consideration for clinicians working with women using N2O for labor and birth.

A Nurse's Guide to Supporting Physiologic Birth

Physiologic birth promotes the practice of normal labor and birth, in which a woman's innate power is supported and unnecessary interventions are avoided. Nurses are in a unique position to support physiologic birth because they attend almost all births. Several resources are available to assist nurses in promoting physiologic birth, including BirthTOOLS.org, a new online resource developed by the American College of Nurse-Midwives in collaboration with other organizations. By using resources such as BirthTOOLS.org and others, nurses can become familiar with the evidence surrounding physiologic birth and can contribute to improved patient safety and quality of care by supporting physiologic birth. http://dx.doi.org/10.1016/j.nwh.2015.12.009.

Maternal expectations and experiences of labor analgesia with nitrous oxide

BACKGROUND

Although there are various methods for painless delivery such as using entonox gas, most of the people are unfamiliar or concerned about it yet.

OBJECTIVES

The purpose of this study was to assess maternal expectations and experience of labor analgesia with nitrous oxide.

PATIENTS AND METHODS

In a clinical trial study, 98 pregnant women in active phase of delivery were studied randomly in two groups (intervention group = 49, control group = 49) after obtaining written consent. Efficacy, experience satisfaction, and also expectation of pregnant women about entonox gas in two groups were compared, likewise in intervention group before and after using entonox gas.

RESULTS

Most of the pregnant women receiving entonox gas had less labor pain (91.8%), and were satisfied with it (98%). The severity of pain in the most of entonox user was moderate level (46.94%), while for the control group it was severe (55.10%) which was significant, 40.82% of the mother in entonox group had a severe pain and 10.20% had a very severe pain, whereas in the control group (55.10%) of the mother had a severe pain and 26.53% of the had very severe pain (P = 0.004). efficacy of labor pain was in moderate level in most cases. 49% of pregnant women receiving gas described their experience as a good and excellent. 80.9% indicated that they will request the mentioned painless method in the future. The amount of suffering from gas side effects was mild in most patients of intervention group (63%). Expectations of the majority of pregnant women in intervention group (before receiving gas) and control group for painless delivery were weak (65.3%, 40.9%). The percentage of positive expectations had increased after receiving entonox gas (P = 0.01). There was a difference between the expectations of intervention group receiving entonox gas and control group (P = 0.001). Positive expectations were more in intervention group than the control group. Most differences of expectations in intervention group before and after receiving the gas were about higher efficacy (P = 0.001), more satisfaction (P = 0.001), fewer complications (P = 0.001), information about gas as painless delivery method (P = 0.02), and also previous experience of intolerable labor pain (P = 0.04).

CONCLUSIONS

This study has shown that using entonox gas caused less labor pain, favorable expectations and experiences and also more maternal satisfaction.

Nitrous oxide as labor analgesia: clinical implications for nurses

A new interest in self-administered nitrous oxide for labor analgesia has emerged in recent years in the United States. It has been used widely in Europe for decades, with favorable results. The American College of Nurse-Midwives published a position statement in 2010 supporting the practice of self-administered nitrous oxide as an additional analgesia choice for laboring women. Recent literature on this subject has been directed toward midwives, obstetricians and/or anesthesiologists, with little emphasis for labor and delivery nurses. This article presents highlights of nursing care for women using self-administered nitrous oxide during labor and birth.