Exploring nitrous oxide use for labor analgesia in Nigeria

Despite the fact that many Nigerian women have limited access to pharmacologic methods for pain management during labor,1,2 previous studies have indicated a demand for such options.3–5 Opioids are a frequently offered analgesic method,5,6 but there are associated risks to the fetus with this type of pain management.7 The use of epidurals, another common method of labor analgesia, has not become prevalent in Nigeria due to lack of awareness, lack of resources, expense, and women’s beliefs that it is not necessary and/or it is harmful.3 Nitrous oxide is an alternative labor analgesic that has reduced side effects compared to opioids and offers pain reduction without the loss of body movement and positioning as is seen with epidurals.7 Because Nigerian women have expressed an interest in increased options for labor analgesics, and nitrous oxide aligns with some of their cultural desires,8 offering nitrous oxide could increase maternal satisfaction.9–12 The literature review examines epidurals, opioids, and nitrous oxide for use as labor analgesics, including their mechanisms of action, benefits, and side effects. It also reviews Nigerian cultural beliefs, the advantages and disadvantages of using nitrous oxide in Nigeria, current practice in Nigeria regarding labor analgesia, Nigerian women’s and healthcare providers opinions on analgesia, additional maternal advantages of labor analgesia outside of pain relief, and birthing locations in Nigeria. The study will be an exploratory, descriptive cross-sectional study that will use a questionnaire to obtain data regarding pregnant women’s knowledge of, and attitudes toward, nitrous oxide as an analgesic during childbirth. It will be administered to 270 pregnant women who visit an antenatal clinic at the Primary Health Care facilities in Mushin Local Government Area located in the state of Lagos, Nigeria. Descriptive statistics of the participants will be reported, and the chi-squared test will be used to determine the associations between the demographics and awareness of various analgesic options, cultural acceptability of using nitrous oxide for labor pain management, and the desirability to use nitrous oxide as a labor analgesic. The use of nitrous oxide for labor analgesia could provide Nigerian women with an important option apart from only opioids or epidurals. It could decrease the use of opioids, thus decreasing their associated health risks during labor.3 Additionally, because vaginal deliveries are an important cultural desire of Nigerian women, nitrous oxide could provide a method for pain management during labor that does not lead to increased risk of cesarean section.13,1