CU Nursing - Spring/Summer 2020 - 31

RESEARCH

Women are in charge of nitrous oxide intake
during labor, inhaling puffs through a mask
whenever they feel the need.
Research and Scholarship Symposium
session. "Now it's coming back as a
possible options."
Nodine and Jessica Anderson, DNP,
CNM, director of CU Nursing's
Midwifery Services, shared research
findings on the analgesic. The
Anschutz Medical Campus helped
form and now houses a multi-institutional database, collecting 237
data points on nitrous oxide use
during labor over three years.
Less potent than the dentist's version,
nitrous oxide in the birthing room
contains 50% nitrous oxide and 50%
oxygen, a mixture too weak to cause
anesthetic effects. Instead, the colorless, non-flammable gas eases laboring moms' pain largely by reducing
their anxiety.

DIVERSE GROUP OPTS FOR
GAS IN CU NURSING STUDY
In their study, Nodine and Anderson
looked at satisfaction rates of the
436 women who chose nitrous
oxide during labor and delivery, the
demographics of the group, and the
predictors of conversion rate to epidurals. Consistent with other similar
academic hospitals, about 10% to 13%
of women opted for the gas.
"It's actually a very diverse group of
women who choose to use nitrous
oxide at the University of Colorado
Hospital," Nodine said. Women are in
charge of nitrous oxide intake during
labor, inhaling puffs through a mask
whenever they feel the need.
Overall, patients were moderately satisfied with the option, which studies
suggest are safe for mom and baby,
Nodine said. "Side effects were rare

and not life-threatening, and
APGAR scores were good (the
scale used in rating the health
of a newborn)."

STUDY FINDS SPIKE IN
EPIDURAL CONVERSION
WITH INTERVENTION
Also consistent with other studies of similar hospitals, 63% of the
participants converted to epidurals,
Nodine said.
Predictors were medical augmentation (a woman already in labor
receives labor-inducing medication)
and labor induction (a woman not in
labor has labor induced). Both groups
were three times more likely to convert. Women with prior C-sections
seeking a vaginal birth were six times
more likely to convert to epidurals
after nitrous oxide use.
"The thought regarding these findings is that induced and augmented
labors are more likely to take longer,
requiring more support in getting
to the finish line of holding a baby,"
Anderson said.

RESEARCHER: STUDIES SEEK
TO INFORM, SUPPORT CHOICE
Although their studies are important
largely because C-section rates in this
country are high, Anderson noted
that conversion rates do not equal
failure rates.
"Families have different goals for
their experience," she said. "For some,
that is to get an epidural. For others,
it is to avoid an epidural if possible.
Both examples can still benefit from
the use of nitrous oxide."
For instance, women who opt for

epidurals are generally immobile,
and the option of nitrous oxide allows them to be mobile longer before
making that choice, she said.

Nurse midwives
conduct a check
up on a patient.

The researchers are just delving into a
study on high altitude's effects on nitrous oxide, with many of neighboring
intermountain hospitals questioning
if it influences effectiveness of the
gas, Anderson said. Preliminary results suggest that it does.
In the study, women at sea-level
hospitals were more likely to stick
with nitrous oxide, even with higher
rates of side effects, such as nausea
and dizziness. Individuals at altitude
were most likely to convert due to
inadequate pain relief, Anderson said,
explaining that the higher rate of side
effects at sea level suggests that the
nitrous oxide was more effective.
Other CU Nursing studies, including
one that looks at breastfeeding rates
after births with nitrous oxide use,
are also in the works, Anderson said.
"It's important to us as providers to
understand the implications and how
nitrous oxide works so we can counsel
patients appropriately and ultimately
support patients' choices."

Dr. Jessica
Anderson, far
right, checks up
on one of her
patients.

CU Nursing - Spring/Summer 2020

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