Boise Doula Pregnancy, Birth, and Postpartum Information and Inspiration, for the Treasure Valley

What You Need to Know About Nitrous Oxide in Labor

12/12/2018

Curious about nitrous oxide as pain relief in labor?

If you are pregnant, sooner or later you will think about how to manage the pain of labor. Some clients know they want to get an epidural, and others would prefer to either forego pain medication entirely, or see how they feel in labor and make a decision in the moment.

Pain management and comfort measures are topics I discuss at length with my clients in our prenatal meetings. When clients want to avoid or delay pain medication, we talk about natural pain relief methods like counter pressure, hydrotherapy, heat therapy, and position changes.

When clients are open to pain medications, but want to avoid or delay an epidural or narcotic medication, nitrous oxide can be a great option.

Nitrous oxide has been used by laboring people in the United Kingdom, Australia and Canada for decades. The ACNM (American College of Nurse-Midwives) supported its use in a 2011 position statement, affirming nitrous oxide as a pain relief option that fits into the midwifery model of care.

While nitrous oxide was once frequently used in United States, in the 1970’s its use declined as epidural analgesia surged in popularity. As of 2017, one report stated that nitrous oxide was available in only around 150 hospitals and 50 birth centers nationwide.

Fortunately for those in the Treasure Valley, both major hospital systems, St. Lukes and St. Alphonsus, offer nitrous oxide, also known simply as “nitrous,” in their labor and delivery rooms.

With all interventions, there are benefits and risks. Here’s what you need to know if you are considering using nitrous oxide in your upcoming birth:

The Benefits of Nitrous Oxide in Labor

It doesn’t affect the normal progress of labor. Often with an epidural, pitocin (artificial oxytocin) is used to compensate for reduced uterine contractions. Nitrous doesn't interfere with the normal course of labor. It can also be used at any stage, from early labor to the pushing stage.
Your movement is not restricted. Although you may have to remain close to the nitrous tanks to utilize the gas, you can labor in any position: standing, squatting, bouncing on a birth ball, on all fours, etc. While you can lie in bed while using nitrous, you aren't limited to the bed as you would be if you were administered an epidural.

You are in control. You administer the nitrous oxide yourself by holding your own mask; when you don’t want it anymore, you remove the mask. With other pain medications, like narcotics and with the epidural, if you have a negative reaction you may have to wait until the medication runs its course through your system, or you may not have the option to discontinue its use until after your baby is born.
Its effects are immediate. As soon as you breathe in the gas (which is actually a 50/50 mixture of nitrous oxide and oxygen), you begin to feel its analgesic (pain relieving) effects. As soon as you remove the mask, the gas dissipates quickly and its analgesic effects stop almost immediately.
It may help you breathe more efficiently. Often people tense up during contractions, and they forget to take the deep breaths which help them more effectively manage their pain. Because you have to take deep breaths into the nitrous mask to get its full effects, you may be better able to regulate your breathing, ensuring you get enough oxygen and helping you to remain calm.
It does not affect infant alertness at birth or interfere with breastfeeding. Pain medications like narcotics and the epidural can cause your baby to be “sleepy” at birth, which can delay the initiation of breastfeeding, or result in lower Apgar scores. These effects are not seen with the use of nitrous oxide.

No drop in blood pressure, so no need for an IV. Epidurals cause a decrease in blood pressure. An IV is required when you get an epidural to help keep blood pressure stable.
No catheterization is required. When you get an epidural, a catheter is inserted into your urethra to catch urine. There is no such need when using nitrous.
No risk of maternal fever. When you get an epidural you are more likely to experience hyperthermia, or a rise in body temperature. Sometimes this manifests as a clinical fever, which can pose risks to the baby.
Continuous fetal monitoring is not required. When you get an epidural or narcotic medication, you will be continuously monitored for signs of fetal distress. (With narcotic medication you can usually revert to intermittent monitoring after a time). While this monitoring is usually external, sometimes internal fetal monitoring becomes necessary. No additional monitoring is required when using nitrous.

The Risks, or Downsides of Nitrous Oxide in Labor

Nausea or vomiting. Some people don’t tolerate the gas well, and find that it makes them feel nauseous. If this occurs, you can discontinue its use and move on to another method of pain management. Know that nausea and vomiting are common symptoms in active labor, whether or not you utilize any pain medication.
Dizziness. Some people experience an uncomfortable dizziness or lightheadedness. You may choose to stop using the nitrous, and this feeling should go away.

Nitrous oxide doesn’t completely eliminate pain. My clients who have used nitrous explain that they can still feel their contractions, but they feel more relaxed when managing them.
You must hold the mask yourself. The laboring person is required to hold the nitrous mask to their own face as a safety measure. If you become too dizzy or faint, the hand holding the mask will naturally fall away from your face, and the nitrous will dissipate. Some people find holding the mask cumbersome or tiring.
Long term effects on fetuses and newborns are unknown. While the use of nitrous oxide has been shown to have no effect on newborn alertness, the long term effects of exposure are unstudied. One study showed neurological dysfunction in rodents when given at high doses, and there have been some concerns about harmful reproductive effects from prolonged exposure in heath care workers.
Certain populations may have negative side effects. Those with Vitamin B12 deficiency, the MTHFR gene mutation, acute asthma or lung disease, or bowel obstruction are at risk for harmful side effects from using nitrous oxide. Consult your care provider if you fall into one of these at-risk groups.

I am a certified labor doula (birth doula) and postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley.
Are you considering using nitrous oxide in labor? Would you like more information about it?

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Copyright 2018

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Visualize Your Positive Birth

8/20/2018

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What will you choose to "see" in labor?

Visualization is a proven tool commonly used by professional athletes, corporate leaders, speakers, and marathon runners that is free, effective, and powerful. It can also be used by anyone birthing a baby, in any setting, in any position, for any type of birth. It's one form of childbirth preparation you can do just about anywhere.

Visualizing a specific action has been shown to activate nervous system responses that are similar to actually performing that action, impacting your heart rate, blood pressure, and hormones. Visualization can help you stay calm and focused in a challenging situation; it can reduce physical symptoms of stress and anxiety and promote feelings of relaxation.

Consider this tool a “mental rehearsal” for your birth. You can visualize the entire process, from imagining yourself feeling the earliest labor signs, to arriving at your birth place, to pushing out your baby and bringing her to your chest. Or, you can focus on just one thing, like your cervix opening up or your baby descending.

Whatever you choose to visualize, keep the following tips in mind:

Practice throughout your pregnancy. You won’t get the benefits of visualization from trying it out once or twice. Make the time to practice your visualization often throughout your pregnancy, so when you are actually in labor, it is familiar to you and easy to go back to when you need it.

Get creative. Some people find it helpful to imagine their actual uterus pushing baby down with each contraction, or to imagine their baby’s head pressing against their actual cervix, thin and ripe.

Others prefer to imagine something more abstract or metaphorical, like a flower opening, or waves crashing. Some may find an image of themselves passing through a barrier representative of “moving through” contractions, and in turn they become an active participant in their labor rather than a passive onlooker. And some choose to visualize something completely unrelated, like their favorite vacation spot, or some other peaceful location.

Personalize your visualization so that it works for you.

Break it down into steps. Whatever you choose to visualize, break it down into small steps. For instance, if imagining a flower opening, you might visualize each petal of the flower slowly unfolding until you can see the center. If imagining ocean waves, visualize the wave building far from shore, gathering momentum until it crests and then falls against the rocks; see the ocean spray, the bubbling foam, maybe even sand crabs scurrying around as the water is pulled back into the sea.

If your visualization can be broken down so it lasts roughly 60-90 seconds— the approximate length of a labor contraction— you will find yourself with a tool you can use to manage each surge.

Write it down. Write down the steps of your visualization to help break it down, and to get a clearer picture in your mind’s eye of what you will “see.” Pay attention to detail; incorporate your other senses, imagining what you might smell or hear if you were actually at the ocean, or in a field, or even in your place of birth.

Incorporate affirmations. Think about how you want to feel as you visualize, and tie this into any birth affirmations you may utilize in labor. You might think of your affirmation, or even speak it aloud, as you work through your visualizations.

As author and speaker Dr. Wayne Dyer says about the power of affirmations,“I use the inner mantra I am, seeing myself as already having arrived at what I’ve placed in my mind.”

During your labor, you might think or say aloud, “I am strong,” “I am open,” “I am calm,” or any number of phrases, while you are actively using your visualization.

You can use visualizations to distract yourself from any pain or discomfort you may experience, even outside of labor. Afraid of needles and about to have blood drawn? Consenting to a cervical check or having your membranes swept? In the OR having your baby by Cesearean? Having an IUD placed?

Go to your visualization to distract your mind from your physical discomfort, and bring you back to a more peaceful state.

I am a certified labor doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
As a doula, I can remind my clients of their visualizations and affirmations and help them have a supportive, positive birth experience.

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Childbirth Prep Done Your Way

7/23/2018

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Your version of childbirth prep might not look like someone else's!

“The aim of education is the knowledge, not of facts, but of values.”
William S. Burroughs

I encourage my clients to take childbirth education classes as they prepare for the birth of their baby. The more you know about the physiology of birth, and what you can expect at each stage of labor, the less fear there is surrounding it.

Where you have your baby can also affect what what you experience— the procedures, care routines, people you will interact with, and what decisions you may have to make, can vary depending on whether you give birth at home, at a birth center, or even at different hospitals.

The amount of information you learn can be overwhelming. In the prenatal meetings with my clients, we sift through this information to find out what pertains to them specifically, based on their goals and how they want to feel during labor and birth. I help them identify what limitations may be present, and how to best work around them. I get to know my clients and their values, and what techniques, both physical and emotional, that will work best for them.

This is where childbirth preparation goes beyond childbirth education.

Preparation for your birth is unique to you. Sometimes, it’s unconventional and maybe even a little strange. I’ll use my own experience as an example: When preparing for the birth of my daughter, I watched every episode I could find of a show on A&E called “I Survived.” The show profiled people from all walks of life who had endured horrible events, like attempted murder, natural disasters, near-death experiences, and trauma, and how they survived those experiences. Their outlook on life was usually gratitude, and a newfound strength. My mindset was that if these people could survive those horrific events, and still have a positive attitude, then I could make it through labor!

That might not be the best form of prep for everyone, and that’s kind of the point. What preparation for birth looks like for me, will likely look totally different for you!

Here are ways others have prepared for their births:

Kim saw a homeopath and chiropractor throughout her pregnancy. She turned a quote she read in a book into her mantra, “Your body was designed to do this.” She used that mantra during labor and has even used it in the years since when doing difficult, physical things.
Susie valued research, and knowing the variables that can occur during labor. She watched TLC’s “A Baby Story” even while trying to get pregnant, and then throughout her pregnancy, to get a sense for the many different scenarios she might encounter when giving birth. She also made sure to tour her hospital so she could see exactly where she would check in, labor, and where she would recover postpartum. She says, “Whenever I felt a kick, or Braxton-Hicks contractions, or the real thing, I could imagine myself in that hospital, doing my breathing, or sitting on the Swiss ball, and getting ready to meet my baby! As a visual learner, that picture in my head was very important.”
Regina, an athlete, tapped back into the mental preparation techniques she would use when she was a professional swimmer by, “visualizing success, a smooth birth process, and birthing in a calm environment." She kept active, doing a lot of walking and squats, especially during the last month of pregnancy. She downloaded a meditation playlist to stay calm and focused during labor, and printed out motivational banners with encouraging phrases to hang in her birth space.
Spring valued humor and practicality in preparing for birth. She read the Girlfriend’s Guide to Pregnancy to get the kind of information a best friend would give, in a format that was more light-hearted, and even irreverent.

What have you used to get through a physically or emotionally challenging time? Laughter? Visualization? Music? The deep breathing you learn in yoga or meditation? Do you value knowing the hard facts?

You can tap into your own experiences, your own strengths, in labor. Use what has worked for you, or what speaks to you, to prepare in a way that is as unique as you are.

I am a certified labor (birth) doula and postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
How can I help you have a more positive birth experience, that is focused on you and your unique needs?

Let's Talk!

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What You Need to Know About Nitrous Oxide in Labor

The Benefits of Nitrous Oxide in Labor

The Risks, or Downsides of Nitrous Oxide in Labor

Visualize Your Positive Birth

Childbirth Prep Done Your Way

Doula Raquel

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