In the polarized landscape of parenting, it often seems there's no such thing as a middle ground. Parenting books and blogs portray parenthood as a minefield of divisive choices: Breast vs. bottle, cloth vs. disposable, sling vs. stroller. The first of many fraught decisions a mother faces—one she makes before she's even a mom—is the choice between "natural" (unmedicated) and pain-free (anesthetized) childbirth. As expectant women quickly learn, either choice comes with a caricature: You can forgo the drugs and be a smug, crunchy masochist, or you can accept them and be a selfish, epidural-dependent wimp.
But part of the reason the childbirth debate has become so polarized is the dearth of any middle ground between full-on epidural anesthesia and nothing at all. (Unless you count breathing exercises as a pain-control measure.) Lately, though, a number of midwives have been pushing for a third way. They are advocating that more delivery rooms offer nitrous oxide, the inhaled anesthetic more commonly known as laughing gas, familiar to many of us from dental procedures (and, perhaps, ill-advised experiments with Reddi-wip cans).Why are midwives—a group that in this country is usually associated with natural childbirth—leading the charge to bring a new drug to laboring women?
Nitrous oxide has a lot going for it. Unlike the epidural, which offers complete pain relief but renders a woman immobile from the waist down, nitrous oxide merely blunts pain. But it also lets a laboring woman walk, perch on a birthing ball, whatever. It's comparatively cheap, and it's fast-acting, offering relief in less than a minute. Perhaps most key from midwives' point of view, it is easily administered by the laboring woman herself. She grabs the mask when she knows a contraction is coming. She stops as the contraction ends. In other words, she is empowered to manage her own pain.
What nitrous oxide isn't is new. The gas was first used on laboring moms in the 1880s and came into more widespread use in the 1930s, when a series of technical advances in Great Britain made it easier for laboring women to self-administer through a mask. Nitrous is still used widely in other countries' delivery rooms: According to data parsed by nurse-midwife and former Centers for Disease Control and Prevention epidemiologist Judith Rooks, well over half of laboring women sampled in the United Kingdom use nitrous oxide today. In other places, including Finland and the Canadian province of British Columbia, close to half of women use it.
Why don't we have it here? As the Associated Press has reported, only a handful of American hospital delivery rooms still offer nitrous to laboring women. It was more widely available in this country from the '30s through the '50s, says pediatrician Mark Sloan, author of Birth Day, but several factors blunted its popularity. For some reason, Sloan says, the idea of women self-administering nitrous oxide didn't catch on here the way it did in England, where midwives started towing nitrous around with them to home births. In the United States, by contrast, hospital deliveries were the norm, and doctors and nurses were told to deliver nitrous by holding a mask over a laboring woman's face with each contraction. When, in the '50s and '60s two rival inhalational anesthetics came along, both of them less time-consuming to administer, they elbowed nitrous oxide out of the way. It later turned out these rivals were dangerous, but just when nitrous might have been poised to make a comeback, the epidural arrived on the scene.
So what about epidurals? For their intended purpose—obliterating pain—they're pretty great. However, they also render a laboring woman unable to walk or even pee, leaving her hooked up to a machine in a prone position. And there are other issues. William Camann, head of obstetric anesthesia at the Brigham & Women's Hospital in Boston and co-author of Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth, says that while recent research offers no evidence that epidurals increase the C-section rate (as natural childbirth advocates sometimes claim), they can slow labor, which may or may not increase interventions like vacuum extraction. And if for some women being numb below the waist is a godsend, it can make others feel like spectators, separating them from the experience of an ancient, sacred act.