Safety and Risk of Nitrous Dioxide During Labor Essay

Nitrous Oxide is a chemical compound with the formula N­2O and is an oxide of Nitrogen. This gas is commonly referred to as ‘sweet air’ or ‘laughing gas.’ Inhaling it has a euphoric effect, and this was the motivation behind its use as an analgesia. Since the inception of N­2­­O analgesia use in the management of pain during labor, studies have been conducted to ascertain the various effects it has, other than the analgesic property. In the United States, the reported use of N­2O as a labor analgesia is a minimal 1%. This is the motivation for this review. It is an analysis of the factors that have led to the decreased, to almost nil use of N­2O analgesia during labor.
When used in high doses, N­2O is a weak anesthetic but, in low doses, it is an analgesic. Safety and Risk of Nitrous Dioxide During Labor Essay. The low dose use of N­2O is achieved by using it in 50/50 combination with oxygen gas. When the50% N­2O is in Oxygen, the mixture is referred to as Entonox. Concerns that have been advanced are in relation to the effect that Entonox has on labor, and birth. Studies have also indicated that N­2O analgesia during labor affects breastfeeding and the wellbeing of both mother and neonate. There are also possible occupational risks that this method presents to persons who care for mothers during labor.
Reviews on the occupational risks and the safety of N­2O labor analgesia have also been carried out. It is essential for a nurse to be well aware of the risks linked to this method in order to practice safety precaution. This knowledge also makes it possible for the nurse to provide the mother with proper care during labor.
The use of N­2O was recommended earlier, due to its low blood-gas solubility coefficient. The value of 0.47 is indicative of its ability to rapidly equilibrate with blood. When used during labor to manage pain, N­2O is used intermittently, targeting the peak pain during contractions. The parturient can be trained on how to effectively time peak contraction pain. To attain the near-maximum effect of Entonox, approximately ten breaths are required. The intermittent use ensures that there is a minimal accumulation of N­2O in blood during, and after use

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This review of the safety and risks of nitrous oxide (N(2) O) labor analgesia presents results of a search for evidence of its effects on labor, the mother, the fetus, the neonate, breastfeeding, and maternal-infant bonding. Concerns about apoptotic damage to the brains of immature mammals exposed to high doses of N(2) O during late gestation, possible cardiovascular risks from hyperhomocysteinemia caused by N(2) O, a hypothesis that children exposed to N(2) O during birth are more likely to become addicted to amphetamine drugs as adults, and possible occupational risks for those who provide care to women using N(2) O/O(2) labor analgesia are discussed in detail. Safety and Risk of Nitrous Dioxide During Labor Essay.

Methods: Research relevant to the 4 special concerns and to the effects of N(2) O analgesia on labor and the mother-child dyad were examined in depth. Three recent reviews of the biologic, toxicologic, anesthetic, analgesic, and anxiolytic effects of N(2) O; 3 reviews of the safety of 50% N(2) O/oxygen (O(2) ) in providing analgesia in a variety of health care settings; and a 2002 systematic review of N(2) O/O(2) labor analgesia were used.

Results: Nitrous oxide analgesia is safe for mothers, neonates, and those who care for women during childbirth if the N(2) O is delivered as a 50% blend with O(2) , is self-administered, and good occupational hygiene is practiced. Because of the strong correlation between dose and harm from exposure to N(2) O, concerns based on effects of long exposure to high anesthetic-level doses of N(2) O have only tenuous, hypothetical pertinence to the safety of N(2) O/O(2) labor analgesia.

Discussion: Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.

Labor and childbirth can be a very frightening and anxious time in a woman’s life. Pain
is considered a normal, natural and expected part of childbirth and for that reason, it is vitally
important to provide women access to different approaches to pain management. Healthcare
professionals must be aware of all the options available to women for pain management because
it is crucial that women feel they have a choice in what they use for their body. While every
woman will experience pain differently, they should be able to have a choice of which measures
they use to cope with the pain and demands of labor and they should understand the basic
physiology behind why they are experiencing pain. “Pain is defined as ‘an unpleasant sensation
caused by noxious stimulation of the sensory nerve endings’ or ‘as a state in which an individual
experiences and reports the presence of severe discomfort or an uncomfortable sensation”
(Lennon, 2018, p.637). Safety and Risk of Nitrous Dioxide During Labor Essay.
The pain women experience during labor and childbirth is caused by a combination of
physical and psychological factors. Physiologically, the feedback system that exists between
your hormones, endorphins and pain receptors enable your body to continue to release oxytocin.
Oxytocin is the hormone that “initiates uterine contractions and cervical dilation, and allows the
fetus to enter the pelvis, causing distention and stretching of the pelvic floor and vagina”
(Lennon, 2018, p.637). The result of all the influences is a sensation of pain. The psychological
component of pain during labor is the way in which the woman perceives the pain and
discomfort. Perceptions of pain are influenced by many external factors such as culture,
background, expectations, experience, fatigue, fear and anxiety (Lennon, 2018). In addition to
understanding the physiology behind the pain, women must understand the options available to
them to help manage that pain.
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NITROUS OXIDE AS PAIN RELIEF FOR WOMEN IN LABOR
There are both pharmacologic and non-pharmacologic pain relief measures that van be
taken in order to reduce pain and improve comfort of laboring women. Often, a combination of
pharmacologic and non-pharmacologic methods is effective at reducing and relieving pain and
discomfort. There are many methods of pain relief for women in labor. They are generally
considered to be in one of two major classes; analgesics and anesthetics. An analgesic is a drug
that relieves pain but still allows for function and movement of muscle. An anesthetic relieves
pain by decreasing sensation, so you cannot feel anything, including pain. Safety and Risk of Nitrous Dioxide During Labor Essay. Furthermore, pain
relieving drugs for labor can be classified into systemic, regional or local. “Systemic
medications affect the entire body. Local medications affect only a small area of the body.
Regional medications affect a region of the body, like the region below the waist” (American
College of Obstetricians and Gynecologists (ACOG), 2017). Opioids are the most common form
of systemic analgesics used during labor and they are typically given through an IV. Opioids can
depress breathing and heart rate in both mother and fetus and can cause drowsiness, nausea and
itching. “An epidural block is the most common type of pain relief used for childbirth in the
United States” (ACOG, 2017). The epidural is an example of regional anesthesia used in
pregnant women. Side effects of an epidural when an opioid is used include nausea, itching,
changes in breathing and drowsiness. Other side effects of an epidural can include fever,
headache, decreased blood pressure and soreness. Local anesthetics are used in specific body
areas and are often used for repair of an episiotomy or other tissues after birth. For local
anesthetics, the medication is injected into the nerves and causes numbness and reduced
sensation, so pain is not felt.
“Nitrous oxide is a tasteless and odorless gas used as a labor analgesic in some hospitals”
(ACOG, 2017). Nitrous oxide, more commonly known as laughing gas, is most well-known for
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NITROUS OXIDE AS PAIN RELIEF FOR WOMEN IN LABOR
its use in the dental field however it is becoming increasingly popular as a tool for women to
manage their labor pains. In high doses, such as in the dental field, nitrous oxide acts as an
anesthetic. In lower doses, it acts as an anxiolytic, which helps to reduce anxiety and an
analgesic which helps to reduce pain (Collins, 2015). Historically, nitrous oxide was used in the
United States for labor pain management but never to a large extent.  Safety and Risk of Nitrous Dioxide During Labor Essay.Currently, nitrous oxide is
not widely used in the United States, however it is used in a vast majority of other welldeveloped countries especially in Europe. “Inhaled N2O for labor analgesia has remained
popular throughout Europe, with reported use in up to 60% of laboring women” (Collins, Fiore,
Boudreau & Hewer, 2018, p. 72). In the United States, nitrous oxide has been used less
commonly and most women choose opioid or other methods of pain management. “From 1975
to 1985, N2O was used in about 6% of laboring patients in the United States, with numbers
diminishing greatly in the late 1980s” (Collins, Fiore, Boudreau & Hewer, 2018, p. 72). With
the new research and knowledge we have today about nitrous oxide and its uses as labor
analgesia, there is a growing interest from women and a number of hospitals in the United States
have begun to offer it to laboring women (Collins, Fiore, Boudreau & Hewer, 2018, p. 72).
Although it is not a very well-known method of pain management, there are many midwives,
physicians and healthcare professionals who strongly support it implementation into hospitals in
America.
According to the Journal of Midwifery & Women’s Health, “Nitrous oxide labor
analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers.Safety and Risk of Nitrous Dioxide During Labor Essay.  It is
simple to administer, does not interfere with the release and function of endogenous oxytocin,
and has no adverse effects on the normal physiology and progress of labor” (Rooks, 2011, p.
557). The mode of action of nitrous oxide is not clear, but we do know that it “works by
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NITROUS OXIDE AS PAIN RELIEF FOR WOMEN IN LABOR
increasing the release of endorphins, corticotropins and dopamine that are produced in the
mother’s brain” (Stewart & Collins, 2012, p.402). This means that nitrous oxide works by
increasing the release of natural opioids from the brain without having to introduce outside
medications or synthetic drugs into the body. Nitrous oxide could revolutionize pain
management. Unlike epidurals that can disrupt progress of labor and opioid analgesics that can
have detrimental effects on the mother and fetus as well as the outcome, nitrous oxide is a safe
and effective way to help women cope with the pain of childbirth. It also does not disrupt fetal
alertness in utero which can lead to better outcomes and potentially higher APGAR scores after
birth. In the United States, many women are limited to having to choose opioids and other drug
agents given through epidural because there is a lack of alternative option, nitrous oxide could
give women another choice.
One of the most commonly used brands of medical nitrous oxide in areas outside of the
United States is Entonox. Entonox is a combination of 50% nitrous oxide and 50% oxygen that
can be used in a hospital setting during labor. “Entonox has never been approved by the US
Food and Drug Administration (FDA) for use in the United States; the only delivery apparatus
used for this purpose in the United States is Nitronox” (Collins, Starr, Bishop, & Baysinger,
2012, p. e127). Nitronox is a delivery system that, “combines 50% N2O and 50% oxygen in a
set concentration that cannot be altered” (Collins, Starr, Bishop, & Baysinger, 2012, p. e127). Safety and Risk of Nitrous Dioxide During Labor Essay. In
order to protect healthcare workers who may face exposure to abnormally high concentrations of
nitrous oxide for extended periods of time, “scavenging equipment is set up through wall suction
to remove exhaled nitrous oxide from the environment to decrease occupational exposure”
(Houser, Debuty & Beal, 2018, p. 15). Entonox is typically self-administered either
intermittently or continuously. This allows the woman the freedom to decide when she wants to
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NITROUS OXIDE AS PAIN RELIEF FOR WOMEN IN LABOR
use the analgesic and when she wants to stop using it to try something different. Entonox can
provide independence for the laboring woman and it allows freedom to move around the room
unlike an epidural or other pain relief methods. Nitrous oxide also has a very quick onset of 30-
50 seconds and if the woman wishes to discontinue use, it can easily be reversed by simply
breathing normal room air for around 5 minutes instead of breathing into the mask.
Overall, there are many advantages and benefits to using nitrous oxide for pain
management in labor and women in the United States and around the world deserve to have as
many options as possible to choose from to ensure that they feel comfortable and satisfied with
their pain management regimen. Women in labor should have bodily autonomy and be able to
have help in relieving their pain in a way that works with what they want in their birth plans and
what their expectations are for labor and childbirth.
Significance in Nursing
Pain is one of the most common problems that nurses have to manage during their care of
patients. Whether the patient is in pain from a surgery or cancer, a broken bone or delivering a
baby, pain remains at the center of patient problems. Patients in all areas of nursing experience
pain and it is crucial to find ways to manage that pain effectively and efficiently. Safety and Risk of Nitrous Dioxide During Labor Essay. Pain isconsidered as the fifth vital sign which indicates that it is a vitally important part of nursing care.
Although it is seen as a normal body process to feel pain, it can greatly hinder healing, progress
and overall well-being. “Chronic pain can lead to a chronic stress reaction that causes an
increase in blood pressure and heart rate. This stress reaction can lead to harmful health effects,
such as a reduced ability to fight off illnesses and diseases” (Cleveland Clinic, 2017). For that
reason, this topic is incredibly important. Women in labor experience pain and discomfort
through all stages of labor and after birth. As nurses, it is our responsibility to help patients cope
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with the pain they are experiencing and provide them with the most comfort and support that we
can. Safety and Risk of Nitrous Dioxide During Labor Essay.