In the early 20th century, women used nitrous oxide––“laughing gas”––to ease the pain of labor, but its use declined in favor of more-potent analgesia. Now, a small band of midwives is helping to revive its use in the United States, according to a report from Kaiser Health News.
The laughing gas set-up is on a small cart stocked with two gas tanks. The cart is mobile, so nurses can roll it up to the woman’s bedside. There’s a hose with a breathing mask. When a woman wants a little gas, she can just pick up the mask and breathe.
Until 2011, only a few hospitals in the U.S. offered nitrous oxide to women in labor. Today, the number is in the hundreds, according to the two main manufacturers of nitrous oxide systems. One of those manufacturers, Porter Instrument, maker of Nitronox, told Kaiser that nearly 300 hospitals and birth centers use the option for pain management.
In May 2011, the American Society of Anesthesiologists said in a paper that they would like to see more-rigorous studies on its safety and efficacy—much of the research is decades old. They also warned that facilities should have an effective system for capturing any gas that escapes into the air, so those nearby don’t breathe it in.
Nitrous oxide is less expensive than an epidural by hundreds, sometimes thousands, of dollars, according to Dr. Michelle Collins, a professor at the Vanderbilt University School of Nursing. The disposable breathing apparatus may cost about $25, and the cost of the gas alone is about 50 cents an hour. An anesthesiologist does not need to administer it—it can be done by a nurse midwife or other trained medical staff. Hospitals are having a hard time figuring out the billing, however, because it’s so new, Collins said.
“The interesting thing is that there’s not a charge code for this particular use of nitrous oxide in labor,” she said. “So places around the country are being very creative in how they’re approaching the charge portion of it.”
One insurer in Rhode Island covers it as it would another painkiller. Some hospitals, said Collins, just swipe a patient’s credit card or don’t charge at all.
Source: Kaiser Health News; November 8, 2016.