Advantages of nitrous oxide

Pain relief doesn't necessarily mean taking drugs. Fear - of not knowing what's happening or what to expect - can make pain feel worse than it actually is. Learning to relax can make a big difference, as can feeling in control. Midwives should support women in their choice of using entenox and answer their questions.

Nitrous oxide/entenox are the most common form of pain relief used routinely in both hospital birthing suites and for homebirth. It is basically 50% Nitrous Oxide (laughing gas) and 50% air (oxygen, nitrogen, carbon dioxide etc).

The benefits of gas and air are that although it does cross the placental barrier to the baby the effects are very short lived and therefore there are not known to be any serious side effects with its use for the baby.  The patient holds the mask to her face and breathes the gases into the lungs where it very quickly enters the blood stream. Nitrous Oxide reaches the brain within 15 seconds. 

Nitrous oxide doesn’t stop the pain entirely, but takes the ‘edge’ off the intensity of each contraction. If the mother is relax, she will progress. If she is tense, she will not progress. Entenox helps to relax the muscles, and once the muscles are relaxed, the cervix will open.

What are the disadvantages of gas and air? 

·         It is only a mild painkiller.

·         It may make a person feel light-headed or sick, but it means it works well.

·         It dries out the mouth if you use it for long periods, so water will help.

·         Some hospitals have mobile entenox machines which means a person can mobilize easily and getting into a comfortable position.

It may take a while to get the timing right so that it's effective at the peak of your contractions.

Gas and air is perfectly safe for a labouring woman to use during labour. Although Nitrous Oxide can make the patient drowsy and does pass through the placenta, it is eliminated very quickly by both mother and baby. Research has not found any negative effects to the baby when Nitrous Oxide is used.

History of Entenox/Nitrous Oxide

Childbirth is not easy. Many women suffer during childbirth. Childbirth is meant to be hard, long, and painful – but women are strong  and our bodies are made to handle a lot during this difficult time. Thousands of women have been giving birth in spite of the labour pain. Unfortunately many women do not cope well with labour pain. For some, the pain can be overwhelming.

Several studies had been done on childbirth. Hundreds of women in different countries were interviewed, and all participants said birth contractions were bittersweet, with paradoxial, feelings of love and the challenges of pain culminating in the birth of a child. The description of the pain included burning stinging, cramping, stabbing, hot, heavy, throbbing, tiring, exhausting and intense. The participants of the study also said that giving birth was seen as a difficult, yet empowering experience.

It is for this reason that scientist having been looking for ways to relieve the pain associated with childbirth. The history of childbirth fascinates me and I found it hard to focus on just one detail. I set out to explore the reason behind the development of anesthesia. I came across the birth of Queen Victoria and the birth of her last two babies. I was curious to how and when she changed the mind of the clergy for good.

 

Anaesthetics came into use in the mid-1800 as new chemical compounds were discovered and became available for experiments. Many of the commonly used anaesthetics are simple chemical compounds, and cover a surprising range of substances. The literature shows that the first anaesthetics were discovered when experimenters tried inhaling gases, or the vapours of volatile liquids. It all started with the brilliant mind of Sir James Young Simpson, who was a Scottish obstetrician in the 1800. Simpson had begun using ether to relieve the pain of childbirth, but he was dissatisfied with some of ether's drawbacks, such as its disagreeable smell, the large quantities required, and the lung irritation it caused. Ether was also explosive so and many did not like to use.

It was during this time when a Liverpool chemist, David Waldie, suggested that Simpson try chloroform. On the evening of November 4, 1847, Simpson and two doctor friends inhaled some chloroform and, after feeling very happy and talkative, promptly passed out. They were so impressed with chloroform's potency and rapid effects, that Dr Simpson immediately began using it in his obstetrical practice. Because of this experience the first baby born to a mother who received chloroform for pain was named Anaesthesia.

Unfortunately, the church objected to the use of chloroform, insisting the pain of childbirth was ordained by God, referring to the Bible where God punish Eve somewhere in Genesis. "To the woman He said, "I will greatly increase your pains in childbearing; with pain you will give birth to children." The argument continued until 1853, when Queen Victoria chose to be chloroformed for the birth of her 8^th son Prince Leopold. Dr. John Snow (1813-1858), who administered the chloroform to the queen, became the foremost authority on anesthesia and is recognized today as the world's first professional anesthetist, a pioneer of a new medical specialty.

The queen enjoyed the birth of her son and used it again for her last pregnancy. This event quieted the clergy and made chloroform the most fashionable anesthetic—especially in England —for the next 50 years. Jason Priestly, an English chemist produced nitrous oxide in 1776. He could not use this because of the church but after Queen Victoria used chloroform successfully, it was time to investigate the matter further. However the first medical use seems to have been in the U.S. in 1844, for a tooth extraction.  Nitrous oxide was further investigated by Humphrey Davy in 1800 at the Pneumatic Medical Institution in Bristol.  Humphrey Davy discovered the gas's anesthetic properties when inhaled. Davy’s student, Michael Faraday, showed in1818 that inhalation of ether had the same effect.

In his book on nitrous oxide, Davy recorded that breathing the gas helped to relieve toothache - from which he was suffering at the time - and suggested: "it may probably be used with advantage in surgical operations." But the pain-relieving properties of nitrous oxide were not explored any further until nearly fifty years later. Initially, society was more interested in nitrous oxide as a source of amusement and entertainment. What a waste of valuable time!

So the literature informed us that nitrous oxide was used alone, without any supplementary air or oxygen. In the latter part of the century, it was found that the gas mixture should comprise at least 21% oxygen by volume in order to avoid risks and side effects.  In 1881 nitrous oxide was introduced for pain relief in childbirth. Then in 1911, the American anaesthetist, Arthur Ernest Guedel, described an analgesic technique where patients themselves were allowed to control the administration of a mixture of nitrous oxide and air during childbirth and minor surgery.  In 1933, Dr R J Minnitt invented the gas and air machine which allow labouring women to breathe in a mixture of the nitrous oxide with room air, therefore, achieving a level of pain relieve, but not anaesthetising her to a point of losing consciousness.

In 1961, Michael Tunstall et al described for the first time the medical use of a pre mixed gas consisting of 50% nitrous oxide and 50% oxygen as an analgesic during childbirth. It was found that it was possible to store a homogeneous gas mixture containing up to about 75% nitrous oxide at a pressure of 132 bars, at ambient temperature. This led to the premixed gas patent – and to the entenox product introduced by BOC Medical. The machines used in hospitals today allover the world mix nitrous oxide gas with pure oxygen instead of room air.

Watts. G. (2011). Michael Tunstall. BMJ. Vol. 343:d4977

Callister, L. C., Khalaf, I., Semenic, S., Kartchner, R.,  Vehvilainen-Julkunen, K. (2003). Medscape

 http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/PDF/History/Entonoxdevelopment.pdf

 

Childbirth without interventions

To give birth to a baby is a miracle. Most women dream about this wonderful moment. Giving birth is a natural part of life. Yet, birth is also political and a business. It is a business controlled by powerful people telling women where and how to give birth. Most women give birth in hospitals, with beautiful maternity unit layouts. But these very same beautiful units are built to create interventions. Most pregnant women have no idea what birth is all about and the problems in the hospital system.

Most perinatal nurses or hospital midwives can’t cope with the stresses of an under-resourced and over-medicalised system. I have seen lives placed at risks. Hospitals are short-staffed and underresourced. So it is evident that staff shortages are linked to an increase of medical interventions, the rise in caesarean sections, and, in the worst scenarios, cases where babies had had some degree of oxygen deprivation. Poor birth experience can be linked to women suffering profound birth trauma, and these cases are on the increase. Most perinatal nurses never learn about birthing support but rather about following protocols, guidelines. They know more about documentation and technology instead of supporting the woman during birth.

Medical interventions were meant to assist the process of birth, making it a bit easier for a labouring woman. Unfortunately this has not always been the case. Medical interventions are there to help save the life of a mother and her baby when necessary, here they are seen as a help, but they can be a problem. If an intervention cause an unnecessary cesarean, they’re without a doubt a hindrance.

The majority of the pregnant women I have known and cared for have expressed a desire to give birth naturally. However, what many of us have found to be lacking in today’s society is enough support, education and encouragement to help women achieve the natural birth they hope for. Not only that, labour pain has recently become something that has been seen by some as ‘unnecessary’ or ‘bad’ pain – when it is, in fact, a very useful pain. There is also an epidemic of fear in labour which prevents some women to achieve this.

Today, childbirth has become more of a medical procedure than a natural function of our bodies. Many women who do have a desire for a natural birth are often looking for resources and information on how to achieve that experience. I like the mother advocacy website. The website provides great information to new mothers to help focus on themselves and their need during childbirth. 

Some of the common medical interventions during birth?

• An IV for Fluids
• Epidural Anesthesia
• Electronic Fetal Monitoring
• Pitocin
• Breaking the bag of water
• Episiotomy

Most of which are unnecessary in many of the cases we see them in today, an IV for example. The purpose of an IV could be cut by simply allowing a woman to eat and drink during labor. You'll have more energy during labor if you're not restricted from food or drink. It makes no sense to require you to do extensive and exhausting work with no food or drink. Several studies have shown that there is no need to starve a woman while she is in labour. Offcourse, there are women who need interention but not for the pleasure of a hospital. Many hospitals around the world do not have a problem but I found that the anaesthesiology department’s guideline of not allowing women to eat/drink are more important than those providers in the maternity units.

Most hospitals routinely use IV line birth interventions. Usually they do this because they forbid food (and sometimes drink) during labor. This has negative consequences above and beyond the IV. Having the IV inserted is painful for many women. The cold fluids can cause pain and irritation. The IV pole limits movement. Excess fluids can cause the labouring woman to have to go the bathroom constantly. 

IV lines do not solve this problem. A supportive person, relative, doula or good midwife with a labouring woman will bring comfort and stay with the woman, all the time, not leaving the woman alone during birth. If a woman receive this kind of  support they are more likely to give birth more quickly and easily. They will also use less pain relief than someone without continuous support. I never leave my own labouring woman alone. I stay with them until the baby is born. If they are born in the hospital, I will not let any other person touch them. If they are born at home with me, even better, but my presence as a midiwfe means everything to a woman during childbirth.  The emotional wellbeing of a pregnant woman is of outmost importance. 

“The main concern of those around pregnant women or for people who care for a pregnant woman should be to ensure their emotional wellbeing.” ~ Michel Odent

 http://www.youtube.com/watch?v=ZVvRklrnB1Q&feature=player_embedded#!

Pain in Childbirth

Giving birth is a painful process. For many women childbirth is a frightening experience and it is only natural for a birthing mother to voice her concerns.  Fear is an important factor of childbirth. Even in the scriptures childbirth is portrayed as involving hard labour and pressure. Childbirth is a unique pain at a deeply emotional time for women. The pain in labour is the result of many complex interactions, physiological and psychological, excitatory as well as inhibitory.

We ask the question why there is pain during childbirth. Pain is the psychological, emotional and learnt response to signals induced by noxious stimuli sent from around the body via the spinal cord, to the brain. How we react to them and perceive them is what we feel as pain. But pain in labour is a normal physiological reaction. It is normal to have pain in childbirth and there for a reason for it. In an uneventful pregnancy, labour, pain can be used in a positive manner. But women react against the pain by becoming tense and fighting it. Labour pain is positive pain that will have a positive end-the baby. Labour pain is not like cancer pain that never goes away. Nobody has been in labour forever, so the pain will go away. The pain of each contraction will not be experienced again when it passes.

We know that labour pain is difficult to explain. Labour pain is the result of many complex interactions, physiological and psychological, excitatory as well as inhibitory. Pain during the first stage of labour is due to distention of the lower uterine segment, mechanical dilatation of the cervix and lastly due to stretching of excitatory nociceptive afferents resulting from the contraction of the uterine muscles. The severity of pain parallels with the duration and intensity of contraction. In the second stage additional factors such as traction and pessure on the parietal peritoneum, uterine ligaments, urethra, bladder, rectum, lumbosacral plexus, fascia and muscles of the pelvic floor increase the intensity of pain.

The McGill Questionnaire describes it best. The McGill Pain Questionnaire consists of groupings of words that describe pain. The person rating their pain ranks the words in each grouping. The sensory words most commonly used by mothers to describe the pain during labour are sharp, cramping, aching, throbbing, stabbing, hot, shooting, tight, and heavy. For the emotional affective feelings, the most common words were tiring and exhausting.  

Also each woman has different reactions towards labour pains. Pain relief can come in many forms. Most importantly, a support person who believes in the laboring woman can make a difference. Several studies have shown that good labour support reduce the fear and anxiety during childbirth.

Each woman has different reactions to pain, so pain relief should be individualised and not a routine offer from a list. Most pain relief does not take pain away as completely as the name suggests. It makes pain easier to accept and can help a woman relax and concentrate on the birth if it is used positively. Pain relief can come in many forms. Good nutrition, comfortable position, mobility, and feeling supported-all can be pain relievers.