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Peterborough

Birthing new options

Monadnock Community Hospital: Nitrous oxide now available in Peterborough maternity ward

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.

    Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States. Purchase photo reprints at Photo Finder »

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.

    Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States. Purchase photo reprints at Photo Finder »

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.

    Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States. Purchase photo reprints at Photo Finder »

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.

    Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States. Purchase photo reprints at Photo Finder »

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.

    Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States. Purchase photo reprints at Photo Finder »

  • Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit.

    Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit. Purchase photo reprints at Photo Finder »

  • Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit.

    Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit. Purchase photo reprints at Photo Finder »

  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.
  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.
  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.
  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.
  • Melinda Treadwell hold her newborn daughter, Margo, at Monadnock Community Hospital, where Treadwell used nitrous oxide to control pain during delivery, a method rarely used in the United States.
  • Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit.
  • Monadnock Community Hospital is introducing the use of nitrous oxide as a pain relief option in its birthing unit.

For more than 20 years, women giving birth in Canada, western Europe and Australia have had the option of using nitrous oxide to help them cope with pain during labor. But in the United States, where nitrous oxide is frequently used in dental offices, it has not been available in delivery rooms. But that’s about to change, and Monadnock Community Hospital in Peterborough is leading the way, the first hospital in New England and one of just a few in the country that has nitrous oxide equipment in its maternity unit.

“No one treatment is right for everybody,” says Dr. Fletcher Wilson, the chief of obstetrics at MCH. “The more options available, the better off you’ll be. [Nitrous oxide] is used by the majority of the world. Why aren’t we doing it?”

The hospital recently purchased two Pro Nox nitrous oxide delivery systems, which are relatively new to the U.S. market and have been approved by the Food and Drug Administration. The units, which can be wheeled into a birthing room, include both a mask and a mouthpiece, either of which can be used by the patient to breath in a 50/50 mixture of nitrous oxide and oxygen.

“It’s a patient-controlled medication,” says Elizabeth Kester, RN, the manager of women and children’s health services for the hospital’s Birthing Center. “If they administer it themselves, they can make it more effective.”

Nitrous oxide is not anesthesia, Kester stresses. The woman remains awake and alert. The procedure lessens pain, but does not eliminate it.

Wilson says hospitals in this country have traditionally focused on epidural pain relief, where an anesthetic injected through a catheter will take away pain from the abdomen down.

“It’s successful for pain control, but it’s an invasive option,” Wilson says of epidural anesthesia. “In the U.S., we went in that direction and never looked back. The epidural takes away all pain. A lot of women don’t want that or may not want it until much later in the delivery.”

Wilson says epidural anesthesia is perfectly safe. It’s a higher level of pain intervention, which many women prefer not to use unless necessary.

One of the first women to use nitrous oxide at MCH is Melinda Treadwell of Marlborough, whose daughter Margo was born on Oct. 7.

“It allowed me to go through the intense parts of labor by blunting the pain,” Treadwell said shortly before leaving the hospital. “It made a huge difference, made it a lot more comfortable.”

Treadwell, who was in labor for about 24 hours, said the birthing center team walked her through the process of using the equipment herself. She experienced some nausea, which is one of the disadvantages of nitrous oxide, but she was able to control that by taking smaller breaths or stopping when necessary.

“I know Melinda is sensitive,” said Treadwell’s spouse, Elise Morrissette, who was with her during the labor. “It was a 30-second commitment. She didn’t have to keep doing it.”

Treadwell eventually delivered Margo by Caesarean section, where anesthesia was used. Even at that point, an anesthesiologist administered nitrous oxide as part of her sedation treatment.

“It was not an easy process, but it was wonderful in the end,” Treadwell said. “This was a great team. This hospital is really where we wanted to be.”

Melissa Lake of Keene used nitrous oxide prior to the birth of her daughter, Brynn, who arrived on Oct. 25.

“I didn’t really want an epidural,” she said. “I know they really had good success [with nitrous oxide] in the U.K. I learned about it being available here through the birthing classes at the hospital.”

Lake said she used nitrous oxide for about five hours, starting when her contractions became distracting.

“It was more to help me relax during contractions. I could take as much as I wanted,” she said. “I had to put [the mouthpiece] in. My husband or the nurses couldn’t do it. That helped me get my mind off the contraction.”

Wilson and Kester say the availability of nitrous oxide may encourage women like Treadwell and Lake to choose to deliver their babies at MCH.

“Childbearing-age woman will shop for services,” Wilson says. “People will start to ask. They will choose to go to a hospital that offers options.”

The hospital went through a lengthy internal review process, evaluating the safety of the nitrous oxide procedure, studying the equipment available and preparing to train staff. Research showed that nitrous oxide had no detrimental effects on newborns, who will clear any residual nitrous oxide from their system within their first few breaths. The administration procedure for nitrous oxide will be led by the nursing staff, which means it can quickly be made available to patients.

Wilson and Kester say the two nitrous oxide units and supplies cost about $15,000. Because the procedure is so new is this country, it’s still unclear how the hospital will recoup its costs.

“We haven’t figured out yet how to bill for it,” Wilson says, adding that the hospital is not charging patients directly but is working with insurance providers to determine reimbursement levels.

“The cost to the hospital isn’t huge,” Kester says. “We’re committed to providing every possible safe option.”

Wilson estimates that about 80 percent of the patients in the Birthing Center are now using nitrous oxide.

“Nitrous oxide changes the perception of pain,” he says. “In labor, pain comes and goes. The woman herself knows best and she can administer more nitrous if she needs it. Some women have just used this. Some go on to use an epidural. It’s been a positive experience for us.”

Dave Anderson can be reached at 924-7172, ext. 233 or danderson@ledgertranscript.com. He’s on Twitter at @DaveAndersonMLT.

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