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Nitrous Oxide In Labor and Delivery: Protocol Development and Implementation
Abstract Number: T-18
Abstract Type: Case Report/Case Series
Nitrous oxide has enjoyed resurgence in popularity in recent years as an alternative for labor pain management. Many studies have demonstrated the maternal and neonatal safety of nitrous oxide in labor when compared to parturients having an unmedicated birth. At our institution, The Colorado Institute for Maternal and Fetal Health, we recently implemented nitrous oxide in labor. We are presenting our experience with protocol development and implementation.
We first sent out a questionnaire to the anesthesiology, nursing, obstetric, pediatric, family medicine, neonatology, maternal fetal medicine and midwifery departments to evaluate support and concerns. We found there was 98% support across the groups. We created a multidisciplinary working group that comprised members from most disciplines listed above and met on a weekly basis. For educational and informational purposes, Grand Round presentations were made to the involved departments. Guidelines, patient consent forms, patient education sheets and electronic medical record data collection sets for nursing documentation were created. Capital budget approval was received to purchase two Nitronox™ machines. We provided training in-services to the anesthesiology and nursing departments where we required competency sign-off for all staff. We also obtained approval from our biomedical and facilities department regarding fire codes. Our billing department provided the information required to obtain reimbursement for labor analgesia.
We learned that in order to offer anesthesia gas outside of the operating room, there were fire codes that needed compliance per the National Fire Protection Association Standards for Health Care Facilities (1999). This included, but was not limited to, a sufficient ventilation system for each labor room, adequate emergency electrical outlets and emergency battery powered lighting.
After six weeks of availability of this new program, approximately 20% of our parturients have requested nitrous oxide in labor. Of those, approximately 50% of our parturients convert to an epidural. This is higher than other published studies and may be due to the effect of altitude on partial gas pressures. Nitrous oxide has also been requested for postpartum laceration repairs, retained products of conception and external cephalic versions. We have had 100% reimbursement for our nitrous cases and no patient complaints.
We have successfully implemented a program for use of nitrous oxide in labor at our institution using a multidisciplinary approach. No complications or adverse outcomes have occurred and our maternal satisfaction rate is high.
1. Likis et al. Nitrous oxide for the management of labor pain: a systematic review. Anesthesia & Analgesia. 2014 Jan;118 (1):153-67.
2. Barbieri, RL et al. Nitrous oxide for labor pain. OBG Management. 2014;26 (12):10-12,14.