Getting The Most From Nitrous Oxide
In order to get the most benefit from nitrous oxide, it needs to be used properly. Your midwife will teach you how to use the gas most effectively. If the pain relief is not adequate, and you are using a machine where the strength can be altered, then you should ask your midwife to make it stronger. Remember nitrous oxide is perfectly safe and you will not lose consciousness - even when the machine is adjusted to its strongest setting. However, it is important that you have control over the mask or face-piece yourself. Sometimes partners want to be helpful and hold the mask over your face for you. Always resist this suggestion (politely, of course!). If is far better (and safer) that you decide when you want to use the gas. Otherwise, it can be frightening if someone is holding a mask over your face when you do not want them to. Some people feel claustrophobic, or as if they are suffocating. Only you can determine how you are feeling and only you, therefore, should hold the mask or mouth-piece.
During the pushing stage of labour, the contractions reach their peak more quickly and intensely. The nitrous oxide concentration in the brain may then lag so far behind the peak of the contraction that it seems ineffective. The urge to bear down is often so overwhelming during this stage that it is difficult to use the gas and concentrate on pushing at the same time. For these reasons, it is best to start breathing the gas before the contraction begins. At this stage during the labour, the contractions usually occur at regular intervals and so it is possible to predict to some extent when the next one will begin. Your midwife or partner can time the interval between your contractions and encourage you to start breathing the gas half a minute or so before the next contraction is due. You will then be able to put the gas aside and concentrate on pushing. In this way, the gas will have had an opportunity to achieve an effect at the beginning of a contraction - yet leave you free to push, unencumbered. The relationship between the pain of the contraction and the blood level of nitrous oxide is shown in the graph.
There are other occasions when nitrous oxide can be useful. Some women find vaginal examinations or an induction of labour more comfortable if they breathe the gas for a few minutes beforehand and during the procedure. It is also helpful in relieving stretching pain at the vaginal outlet just before the babys head is crowned. For this reason, nitrous oxide is often useful as a supplement to epidural analgesia (especially low-dose epidurals) if perineal pain persists during this final stage. It may also make delivery of the placenta more comfortable.
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