RENEE MONTAGNE, HOST:
Today in Your Health, we're going to take a look at nitric oxide - otherwise known as laughing gas - and childbirth, yes, childbirth. Laughing gas has a long history. Since the mid-1800s, it's been used for serious pain relief and sometimes a little comic relief, such as the 1976 movie "The Pink Panther Strikes Again."
(SOUNDBITE OF FILM, "THE PINK PANTHER STRIKES AGAIN")
PETER SELLERS: (As Chief Inspector Clouseau) Nitrous oxide.
HERBERT LOM: (As Dreyfus) What's that?
SELLERS: (As Chief Inspector Clouseau) That is the anesthetic, you know.
LOM: (As Dreyfus) Oh, good.
SELLERS: (As Chief Inspector Clouseau) Yes, it is good, yes.
MONTAGNE: Peter Sellers, posing as a dentist who samples the gas before giving it to his patient. And that's how most of us think that nitrous oxide is used. But this morning we're going to hear from Rhode Island Public Radio's Kristin Gourlay about its use in childbirth.
KRISTIN GOURLAY, BYLINE: Hello, Renee.
MONTAGNE: So you're here to talk to us about laughing gas and childbirth, which is - I have to say, I have never put those two together.
GOURLAY: Yes. It used to be really common, but it actually fell out of favor. And to see it back in use, I visited South County Hospital in North Kingstown, R.I. Amy Marks has just given birth. Her son, Ethan Thomas, is barely a day old. He's snug in the crook of her arm as she receives visitors.
This small hospital in southern Rhode Island has just added nitrous oxide - or laughing gas - to its menu of pain relief options for labor. Marks jumped at the chance to use it because she wanted to avoid an epidural. That's an injection in the spine that blocks feeling below the waist.
AMY MARKS: When the contractions started getting pretty intense, where I was like, oh, this is really bad, I think I might want an epidural. Somebody reminded me, no, remember, you wanted to try the nitrous. I said, oh, yeah. So they brought it in and it really took the edge off.
MONTAGNE: If you've been through labor, you know it hurts. Is taking the edge off really enough? Well, it was for Marks once she got the hang of it.
MARKS: So you're going through the contraction and you're breathing in, breathing out, you know, maybe do five, six breaths and then you get to the peak of the contraction. And I kind of didn't really need anymore. I could bare the rest of the contraction. You know, the contraction went away and I'm just kind of like, giggly, but only for like, you know, 15 to 30 seconds.
GOURLAY: It doesn't obliterate the pain like an epidural.
MARKS: I was, like, I'm just happy. I was, like, really tense and, like, oh, like - and now I was able to relax my body and my mind.
GOURLAY: Breathing in the mixture of 50 percent nitric oxide and 50 percent oxygen produces a kind of temporary euphoria. Up until 2011, only a couple of hospitals in the United States offered nitrous oxide to women in labor. Today, it's in the hundreds. Dr. Michelle Collins teaches nurse-midwifery at Vanderbilt University.
MICHELLE COLLINS: It started in Europe. It's been used in labor and birth for over 75 years.
GOURLAY: But she says it fell out of favor in the U.S. when epidurals became popular around the early 1970s. Now midwives are convincing a new generation of doctors and hospitals the option is safe and women want it.
COLLINS: For some women, the epidural is going to be their number one choice. For other women, they want to be un-medicated and have nothing and that's their choice. For other women, nitrous oxide is a viable choice. So for many of us, it seems somewhat like a menu. And for everything that's safe, it should be on that menu and available to the woman.
GOURLAY: Another advocate, nurse-midwife and epidemiologist Judith Rooks, says the gas is safe because it leaves the body in seconds.
JUDITH ROOKS: It does pass the placenta and go into the fetal circulation. But as soon as the baby takes a breath or two, it's gone.
GOURLAY: What's more, nitrous is cheaper than an epidural by hundreds, sometimes thousands of dollars. For one thing, you don't need an anesthesiologist to administer it. Though hospitals are having a hard time figuring out the billing because it's so new, says Vanderbilt professor Michelle Collins.
COLLINS: Right now there's not a charge code for - particularly for using nitrous oxide for labor and birth. So places are having to sort of write their own page, if you will, as to how to charge for this.
GOURLAY: One insurer in Rhode Island covers it as it would another painkiller. Some hospitals, says Collins, just swipe a patient's credit card or don't charge at all because the gas is so cheap. At a time when giving birth in a hospital has gotten pretty expensive, that might be music to some women's ears.
MONTAGNE: And that was Rhode Island Public Radio reporter Kristin Gourlay. And Kristin is with us now. You know, I did not hear any critics there.
GOURLAY: Well, you're right. There's just a lot of safety data on nitrous and all of it is really pretty good. Some people say, you know, you've got to make sure there's a system for capturing any gas that escapes into the labor and delivery room, you know, so staff don't breathe it in.
Also, women have to be taught how to use it because there's a delay in its effect, you know, you have to anticipate your contractions a little bit and breathe it in about 15 to 30 seconds before. But midwives and some doctors are really trying to make nitrous oxide another common option for women in labor.
MONTAGNE: And you mentioned midwives leading the way here?
GOURLAY: That's right. You know, midwives have always advocated for women to have more control of the experience of giving birth. When epidurals came on the scene, you know, for many years people just saw them as this incredible new option that could give a woman a completely pain-free birth. You know, that was something unimaginable, Renee, a hundred years ago. But epidurals come with a price, you know. For one, you can't move around once you've gotten it. Moving around can actually help speed up labor. Epidurals have been known to slow labor down. Nitrous oxide doesn't have that effect.
So midwives are part of this movement toward a more patient-centered childbirth. I don't just mean, quote, "natural childbirth," where a woman doesn't use any drugs. But, you know, one in which a woman has more options, let's say, and is in more control of the experience of giving birth.
MONTAGNE: We've heard about safety then just now. But how easy is it to use?
GOURLAY: Well, pretty easy. Midwives showed it to me in Amy Marks's hospital room, she's the woman who had just given birth in the piece we just heard. It was just a cart with a couple of gas tanks on it. And nurses just roll it up to the woman's bedside. There's a hose with a breathing mask. And when she wants a little gas, a woman can just pick up the mask and breathe.
MONTAGNE: Kristin Gourlay is a reporter with Rhode Island Public Radio. She's part of a reporting partnership with NPR, local member stations and Kaiser Health News. Thanks very much.
GOURLAY: Thank you so much.
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