Inquirer delivers well-rounded report on using laughing gas for labor pain–except for two things

Does the story adequately discuss the costs of the intervention?

Satisfactory

The cost of nitrous oxide for use during labor in one facility ($250) is included. It’s also mentioned that most insurance plans won’t cover it.

A bonus that may have been appreciated by readers would have been comparing its price to the two most common approaches for managing labor pain (in the US): epidurals and IV narcotics.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

It’s mentioned:

“Nitrous comes with some caveats. It can cause nausea and dizziness. It also interacts with vitamin B12, so women with a deficiency of the nutrient shouldn’t use the gas … but studies — and generations of use worldwide — have not found complications or long-term problems.”

This is enough for a satisfactory rating. However, we’re left asking: where’s the evidence? Some research findings to support a midwife’s statement in a review that nitrous is “safe for the mother, fetus, and neonate” would be salient for many expecting mothers.

It’s also important to point out that if you Google “nitrous oxide & harms” you will come across a much larger list of harms, some of them quite ominous. But most of these occur in the setting of the prolonged and extensive abuse of recreational nitrous oxide (aka “whippets”). But, presumably, the obstetric use of nitrous — which is a brief exposure to limited doses — would pose much less risk. Mentioning this would help clarify things.

Does the story commit disease-mongering?

Satisfactory

None.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story employs several independent sources. A minor point, but it would have been helpful to hear from a source from one of the countries where using nitrous oxide during labor is far more commonplace, and for an ACOG spokesperson to comment on the lack of guidance on using it during labor.

Although not strictly conflict of interest issues, the article rightly points out two advocacy considerations. First, that many midwives are advocating for nitrous as a low-tech option at a time when labor and delivery are becoming increasingly medicalized. Second, that some hospitals are approaching nitrous as a marketing tool; presumably to position themselves as low-tech-friendly.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story does well to provide relevant historical and cultural context; namely, that the traditional approach to labor pain in the US is biased toward epidural anesthesia, despite the fact that nitrous oxide is a common alternative in other countries.

Given the current opioid epidemic in this country, it may have been timely to mention the extensive use of narcotics in managing labor pain in the US.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It’s mentioned that currently “an estimated 500 U.S. hospitals and birthing centers offer nitrous — up from a handful less than a decade ago.”

Does the story establish the true novelty of the approach?

Satisfactory

It’s well established that obstetric nitrous oxide is widely used in several countries.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story doesn’t appear to rely upon a news release.