Krystal Holladay thought she was having false labor — she’d been having frequent Braxton Hicks contractions in the final weeks of her third trimester — so she sent her husband, Jeremiah, off to work and put her 8-year-old son on the school bus.
By 7 a.m., she decided that her contractions, which came a minute apart, were real. Holladay lived one hour east of Fort Collins’ UCHealth Poudre Valley Hospital.
Things moved quickly from there. Her father picked her up, along with her 5-year-old daughter, and they rushed to the hospital where Jeremiah met them only minutes after they arrived at 8 a.m.
“There was really no time for an epidural,” said Jennifer Sedmak, a registered nurse at PVH’s Birthing Center and Holladay’s delivery nurse.
Holladay was eight centimeters dilated; delivery was imminent. And by then, Holladay was reporting her pain at a 12 to 15 on a scale of one to 10. Her doctor asked if she’d like to try UCHealth’s new pain management tool: laughing gas.
Laughing gas, or nitrous oxide, is a nonflammable and odorless gas. Many people know about it from dentists, who use it for minimal sedation. Nitrous brings on a relaxed state that allows people to respond normally to verbal commands. And though it can impair cognition, it doesn’t affect breathing or heart functions.
“It’s not a pain reliever but an anxiolytic, or what we tell people is that it gives them the I-don’t-care factor,” said Nicky Barber, a women’s care charge nurse at UCHealth Medical Center of the Rockies. “So their pain may still be at a seven — they just don’t care that it’s at a seven.”
On Feb. 1 – the day Holladay arrived at PVH — UCHealth began offering nitrous oxide gas as an option for pain management during labor and after birth at both PVH and MCR.
It is a primary aim of UCHealth to allow patients free choice and autonomy in selecting the best form of labor pain management for their particular situation, Barber said.
“We wanted to give our moms-to-be another safe, effective option to choose from,” she said. “Ultimately, we want our moms to decide what’s best for them and what they feel most comfortable with, and we’re here to support that choice.”
Holladay was the first UCHealth patient in northern Colorado to opt for the new pain management option. Outside PVH and MCR, no other northern Colorado hospital offers this option.
“I could still feel everything, but on a scale from one to 10, my pain was at a 12 or 15, and when I started using the gas it took it down to a seven during my contractions,” Holladay said. “It’s not an epidural by any means, but I sure was glad that it was here.”
“I think this was the perfect situation for using nitrous,” added Sedmak, who’s worked in the labor and delivery unit for 17 years. “Krystal was able to use the nitrous through the delivery — through the hard pushing — and was able to control that herself.”
When used in labor or for therapeutic use immediately after birth, the gas is inhaled intermittently at a lower concentration than the dose provided at a dentist’s office. It is most effective when inhaled about 60 to 90 seconds before a contraction, at which time the patient holds the mask to their face, continues to breathe normally, and removes the mask when the contraction is finished. The gas goes to work in as little as 30 seconds and is out of one’s system after a few breaths.
Patients can expect to feel pain relief as well as a “don’t care” factor, euphoria and/or decreased anxiety. Holladay said she felt a bit tired but still in control.
“It didn’t make her goofy,” Jeremiah recalled. “At first I thought she was falling asleep, but then I realized she was just relaxing.”
Sheyenne Holladay was born at 8:45 a.m. Feb. 1, weighing 7 pounds, 3 ounces, and measuring 19.75 inches long.
Extensive research has shown that nitrous oxide during delivery has no ill effect on fetal outcomes. Nor does the gas hamper the woman’s ability to push during labor. Another benefit is that women can be up and moving around or in water when using nitrous, which isn’t always an option with other methods of pain control.
“I feel like my body is more sore without an epidural, but I feel better overall,” said Holladay, who used an epidural during the deliveries of her first two children.
Jeremiah said he noticed a difference this time around.
“Don’t get me wrong, I saw my wife in pain. It is delivery after all, but as an alternative to an epidural, I feel it’s a good option,” he said. “My wife was my wife after (delivery), where before I could tell she was drugged.”
Patients who want to use nitrous to manage pain during or immediately following delivery cannot be under the influence of any other drugs or alcohol, and there is a specific timeline nurses must follow before providing nitrous if the patient has been given other medications, such as Fentanyl. There are other uncommon conditions, too — such as vitamin B12 deficiency — that make nitrous an inadvisable option.
Barber said that PVH and MCR also have approved the use of nitrous for painful procedures, including the manual turn of a baby in the uterus, also known as an external cephalic version.
Nitrous oxide is also an option for delivery and after birth at UCHealth University of Colorado Hospital in Aurora. UCH began to offer nitrous for labor and delivery patients in 2014 – the first hospital in Colorado to do so.