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Friday, September 17, 2010

 

Nitrous oxide

Content warning: this post discusses a bad birth experience. If you've had a bad birth experience and are prone to flashbacks, take note. To quote the Birth Trauma Association: It is estimated that, in the UK alone, this may result in 10,000 women a year developing Post Traumatic Stress Disorder (PTSD). Also, as many as 200,000 more women may feel traumatised by childbirth and develop some of the symptoms of PTSD. If you're one of those - and I'm one of those too - you may prefer to skip it.

I've added this warning late in the day after a commenter requested it. To anyone I distressed before the warning went up, my deepest apologies.



Drugs being one of those things that writers often like to write about, here's a post about something that happened to me lately. To wit, at around the mid-point of my 40-hour labour, I was given gas and air.

Now, you're supposed to take gas and air only during the contractions, but contractions are a natural process and induction ain't, so what I got was constant pain, and the only way to get rid of it was to keep taking the gas until I was finally given an epidural about twenty-four hours after the induction began. The second day of labour, the medical staff tried to stop me inhaling the gas so constantly (to my deep fear and distress, as life without it was pretty much beyond my exhausted endurance by that point) but at two in the morning, the night shift midwife simply put a tank of gas in my room and left me to it, so I spent a lot of time high. And as the pain came back unless I knocked myself out completely, I mean really seriously high.

Interesting experience. And one that I hope I won't have to repeat.

This is the way gas and air works: you inhale it, and feel a little drunk and fuzzy after a couple of breaths. It doesn't numb you out very thoroughly, though, unless you keep on inhaling. Then what happens is that you climb and climb until you hit a dizzy plateau where suddenly your whole body is high. Pain vanishes (with reservations), and so do the edges of your body unless you consciously start looking for them. The closest normal sensation is that of having a limb fall asleep: nitrous oxide gives you full-body-and-mind pins and needles.

Which I, at least, experienced as a kind of white noise, a ringing in my ears that got into my mind - but also as racing thoughts. Gas and air is supposed to relax you, so it may take other people differently, but I found my mind going haywire. Now, I'd had gas and air before, at the dentist's as a child, and the effects were a little different - it made me giggly rather than racy - so body chemistry and the emotional state you bring in presumably have a lot to do with it. In the hospital I was stressed out, to put it mildly, so my scrambling brain might well have been reacting to that. In any case, here's how it went:

The brain, as I've said before, is a rationalising organ, and faced with this fuzziness, my brain tried to make sense of things. Possibly the racing thoughts were a measure of just how hard it was having to struggle, because the effects were as follows:

1. A sense of frantically trying to work something out.

2. A tendency to leap from one 'insight' to the next: no sooner did I feel like I had worked something out than my mind would decide that yes, that was all very well, but really that signified this - which was all very well, but really this signified that...

3. A preoccupation with infinity.

4. A tendency to manufacture false memories of childhood and earlier life.

I'm fairly sure, for example, that I never colour-coded my homework by scribbling in certain boxes with a brown pencil when I was eight, but my brain was very bound up in that 'memory' for a while, particularly the scribbling sensation (which I think was a way of expressing how buzzy my nerve endings felt). I don't think I used to end comprehension questions with the phrase 'of the people' and abbreviate 'people' to 'ppl', nor to write sentences that referred to things being 'of the people of the people', which I'd write like a mathematical notation - ppl to the power of ppl. I don't think I used to visualise a blue sky seen through a narrow car windscreen at the end of a tunnel when I was falling asleep as a child either, but my brain 'remembered' it vividly - to the point where I'm honestly not sure if that was a real memory or not. Meditation became a subject that occupied me: I did have some interesting experiences at meditation classes in my late teens and early twenties, but whether they were the same as the thoughts about mindfulness I was having on the gas or not, I really don't know. My brain was, I think, making stuff up and insisting that it was not only true, but somehow significant, key experiences, even some kind of guide as to the real nature of life or myself.

At the same time, thoughts tended to spiral off very quickly into a kind of recursive superlative. I got the idea in my head that when I was a child, I'd had the thought that you could feel something so strongly that the only way to express the feeling (either physical or mental) was to trail off halfway through naming it and scream instead. My brain supplied a written notation for this which my keyboard can't mimic: substitute a dot for an asterisk, and the word 'mindfulness', for instance (which I kept obsessing over) would be written 'mindfuln*****'. Every thought I had, I quickly finished by writing it out in my mind as an infini***** version of itself, and then sped on, trying to work out the next thing.

Underneath all this gibber was another attempt at working something out: I wanted to work out what effects the gas had on me, and whether any of these sleeting thoughts were either useful insights or curious symptoms. Gas and air tends to make you forget everything that's happened more than a few seconds ago unless you concentrate, but I was concentrating. I wanted to tell my husband what the effects were. I figured he'd find them interesting. While I was going round and round with my fizzing infinities, I was also trying to balance these insights by asking myself what I knew to be true, and the fact that I loved my husband was one of them. I couldn't remember him very clearly, nor slow down my spinning brain enough to actually recall what love felt like, but I knew it was a fact. (In retrospect, a fact probably best expressed by the fact that I was holding on to the plan of talking to him later as a way to steady myself while my brain was going crazy.)*

So anyway, there I was, on my own at two in the morning, counting the minutes until eight o'clock when the hospital would let my husband back onto the ward - and I stopped checking my phone in discouragement after I found that what seemed to me a long period of time had actually resulted in me checking the darn thing twice inside of a minute. My brain was trying to juggle philosophical insights, but my philosophy has always been that no esoteric insight is worth anything if it detaches you from reality. So at intervals, I returned to reality to give my thoughts some ballast. I knew I was in labour, and that I'd agreed to an induction I didn't want for the safety of the baby, and that I'd agreed to take gas and air that I didn't particularly want because I couldn't deal with the pain -

- and crash, my body would find the pain it had previously lost in the fuzz.

The gas, you see, didn't actually get rid of the pain. It just filled my brain with so much static that most of the time I couldn't see it. But every now and again my circling thoughts would come back to the point where I decided to check reality and sort of remembered how to do it, and when that happened, I found that reality contained a lot of pain.

So I'd gasp at the gas again, deliberately sending my thoughts back out running, because, in one of those recursive chains of logic that kept unpeeling in my skull anyway, it seemed the only way to deal with the pain was to forget that I was supposed to be dealing with it. But of course, having forgotten, I kept forgetting that reality was something I'd regret checking, and then check it again.

And round and round I went, until I passed out. (And woke up long enough to be sick on the floor. Then passed out again, and woke up with a sore throat from breathing dry gas for hours.)

In short, the effects of the gas were exciting in their way, but there was something horrible about them, a kind of pay-your-soul price. In order to get away from the pain, I had to cut loose from my anchors and allow myself to go into a slightly crazed state of mind. And if I tried to order it, I was punished by a return of the pain. Nitrous oxide is a jealous analgesic.

In vino veritas, perhaps? Did the gas reveal elements of myself that are usually submerged? I think I was wrestling with about three different layers of identity: an adult woman trying to maintain balance on what was really important to her, a young woman reaching after spiritual insights, and a little girl who wanted to get praised for doing her homework. None of these except perhaps the first were any kind of mother identity - a medicalised birth doesn't help put you in that frame of mind at all, and neither does being out of your skull, and it was only when my son actually appeared, twenty-four hours later, that I started getting my head around it. In the meantime, the gas kept shunting my brain back into the past, into pre-pregnancy identities - or at least, into false versions of them.

Did I learn anything from the experience? While my brain was trying to have profound insights at a rate of knots, I think the main things I actually learned were - well, not so much lessons learned as opinions re-confirmed. I don't drink or use drugs, and the nitrous oxide experience reminded me why: I don't enjoy the sensation of an alien force taking control of my perceptions. I'm sceptical of anyone who says they've had a spiritual revelation on drugs, and the nitrous oxide gave me an example of that: I felt like I was reaching for insights, but the gas confirmed that it's possible to have the sensation of insight without any actual insight to back it up, because most of the thoughts I had were pretty much garble, or just ways of saying 'Wow, I feel kind of buzzy' and 'Yeah, trying to stay coherent here.' Talking to my husband is one of my ways of coping with stressful situations, and I dealt with the stress of the gas (plus being left alone in early labour all night) by thinking of what I might say to him later.

These were all things I knew, and the gas just gave me a graphic demonstration of them: I didn't take out anything I didn't bring in. The main new thing I learned was that if I ever get up the courage to have another child, I should go in with a written set of requests about pain relief - because, while I was actually able to understand and reply to questions better than I would have been on alcohol, I gave the impression of being drunk past comprehension. It took me a bit of time to double-check I was clear on everything, but nitrous oxide did not completely knock out the rational part of my mind any more than it knocked out the pain: it just buried them under an avalanche of mental chatter, and given the right effort, they could be dredged up. So the main thing I learned was pretty much 'How nitrous oxide affects me'. Not a very deep revelation, but hey, I always thought that if you want depth, you might as well stay sober.

Having said all that, without the nitrous oxide, I don't even want to imagine what that night would have been like. And if I were a woman in a poorer country, I wouldn't have had to imagine it, because proper medical care wouldn't have been available to me. I'm currently soliciting donations to The Center For Reproductive Rights, which campaigns to give pregnant women access to legal and medical support; if you can afford a charitable donation right now, please give them a thought.



*It probably says something about our relationship that when he was allowed back into the hospital next morning and I was given gas again, I was dizzily trying to explain its effects to him while I could still remember them as a way of coping with the stress and pain - while he coped with the stress of seeing his wife in this condition by listening sympathetically, patting me on the back, and also taking out his iPhone to record what I was saying, in the hopes I might find it interesting to hear later. A big reason we married each other was that we've always enjoyed conversing.

This is what he records me as saying: '...to indicate that it had reached the sort of infinite level ... extension ... or possibly the highest level of sensation ... like, so pleasant you'd scream, so angry you'd scream - which is like, "Don't do that, agghhh..." [this is me quietly demonstrating 'so angry you'd scream', not actually telling someone not to do something], sort of white noise of excessive anything ... [inaudible] produces a sensation of white noise in the brain [inaudible] ... for example, it tries to spell things, but can't be bothered it just sort of spells, like, the first syllable and then goes dot dot dot dot dot dot dot dot dot, but not on the bottom, at the top, to indicate that there's white noise going on...'

He also notes that I told him my brain had invented a word, the definition of which was 'a unit of quantity, in which the quantity is infinity', sort of an equivalent to 'score' or 'dozen'. The word was 'plenchment'. Don't ask me.

I don't sound trippy on the recording, and I certainly don't sound insightful. I sound exhausted.

Comments:
Great to read you again.

Your post sparked a number of thoughts/responses from me. I'll start with just two.


First, I think/suspect that much of the "medicalized birth" "modern medicine needs to get in touch with the wisdom of the ancients" crowd have never felt (or been with someone feelings) the type of pain that can go on for so long and at such an intensity that the person suffering the pain dies. Pain exhausts the human body. I heard a lecture on medical history (unfortunately I can't source it here) that claimed that two things were involved in the major drop in death from childbirth in England: hygiene and chloroform. The first reduced the amount of illness from infection and the second prevented women from collapsing from pain induced exhaustion.

Most women I know who have given birth fall into one of two categories: either they had almost pain free birth or they were so drugged they have no real memory of the pain. Reading your description of the process gives me insight into why pain-killers made such a difference to women giving birth.

Second I'm interested in whether you ever went through a stage where you couldn't remember what it was not to feel pain. I have felt pain (extended pain) where I could no longer remember not feeling pain. It is as if the pain became the entire world and I was engulfed within it. I did not feel pain I lived in a universe in which there was nothing other than pain. You talked about how your response to pain and Gareth's response to your response speaks greatly to who your both are and how you relate -- the only way I could deal with the pain was to reason it through and prove to myself logically that even though I could summon up no memories of not feeling pain I did have memories of doing things that could not be done while feeling the pain I was feeling. My only way of getting through the pain was my reasoning that the pain could not be infinite and all encompassing and therefore each moment I spent in pain brought me a moment closes to not being in pain.

Oh, and it sounds like you are doing the mother thing right. Clean the nappies, fill the tummy, get ride of the gas. Start again.
 
Second I'm interested in whether you ever went through a stage where you couldn't remember what it was not to feel pain.

I went through a stage where the memory was far distant. It was at that stage where I decided I'd never have another child. (A decision I may or may not review, but I was very clear on it at the time.) It wasn't just that I'd been labouring all day; I'd had round ligament pain, hand pain, a knee knacked from the extra weight, back pain and general pregnancy strain for weeks previously - so I actually hadn't had a period of no pain for a very long time. I hadn't been comfortable for months. It all piled up.

And yeah, that was exhausting; the weight of it pressed on me more and more as time went on. For about ten or twelve hours I managed all right doing breathing exercises and hypnotherapy stuff, backed up with a TENS machine, but I simply wore out. If I'd had rest periods, which you're supposed to in normal childbirth, I probably could have kept on top of it, but the constancy was just too much to cope with. It's probably relevant that the pain got worse, and I ran out of ability to cope with it, after Gareth got sent home for the night; that took away my anchor, and being in pain alone is way scarier than being in pain with someone you trust around.

Was it in an article you linked to that someone pointed out women campaigned for childbirth pain relief before they campaigned for the vote? Because that's something I now understand.

I'm not sure if I quite forgot what not-being-in-pain was like, It wasn't a question I thought to ask myself; I was more focused on how much longer it would be before eight o'clock came and Gareth would be back, and on how and whether I could get through that time. What I can say is this: prior to the induction, I supported the right to voluntary euthanasia out of intellectual conviction, but I found it hard to imagine anyone choosing death over a life in constant pain. Now, I get it.
 
First, I think/suspect that much of the "medicalized birth" "modern medicine needs to get in touch with the wisdom of the ancients" crowd have never felt (or been with someone feelings) the type of pain that can go on for so long and at such an intensity that the person suffering the pain dies.

Yeah. Nice if it works for you, but I did all the preparation and it didn't work for me, so I'm a bit pissed off with it right now. One of the things about it is this: people like to say that childbirth was designed by millions of years of evolution, as if that proves it should be easy - but you know what else was designed by millions of years of evolution? Male spiders that get eaten after passing on their sperm. Female spiders that get eaten by their young. Male angler fish that latch onto a female and waste away into nothing but a pair of testes. Passing on your genes and then dying.

Evolution doesn't have a personality, and it certainly doesn't have any sympathy. It's about passing on your genes; it isn't about passing on your genes comfortably.
 
Kit, I know that there were a lot of interesting points in this post here about perception and reality and artificial consciousness or whatever...

...but I couldn't get to them because I kept thinking OMG OMG OMG you POOR thing and then having flashbacks to my own horrible birth experiences and hyperventilating and then brain shutdown.

All of which is to say, you have my profound sympathies, and you might want to put some "Trigger Warnings" at the top of this post.

-- hapax
 
Do you mean the hospital staff wouldn't allow your husband to stay with you overnight? That's confusing, because it sounds like he would have comforted you quite a bit. Do you know why he had to leave?
I'm sorry nitrous oxide produced such anguish for you. It sounds like a bad LSD trip. The gas worked wonders for me; I often joke that the only reason I want another child is for more of the hospital drugs.
 
Sorry, hapax. And sorry for your bad experiences. Point well taken: you're absolutely right, and I should have thought of that. My only excuse is that I wrote this when I was still in the first flush of postnatal freakout, so thank you for catching me out.

Do you know why he had to leave?

Visiting hours were from eight till ten. Ten o'clock passed.

They said they might turn a blind eye, but that he really should go home and get some sleep so he could support me in labour. The fact that I was in labour seemed not to register with them. Nor the fact that it's intimidating to be in pain and dependent on hospital staff, so relying on their blind eye and going against their advice can be difficult when you're in too much pain to think straight.

Birth partners were allowed to stay round the clock in the labour ward, but with an induction, you don't get moved into the labour ward till you've dilated enough. Till then you wait in a different ward, and they talk visiting hours.
 
Hi! I found your post while searching for certain N2O experiences. I have some insight from the "drug user" side; since that's not your thing, I'll keep it brief.

The N2O experience is definitely strongly mindset-based. Those recursive, self-referential thoughts can yield insight if you are calm, but they can feel feverish if you are not.

I do agree that you don't take out what you don't bring in. But, as an analogy, you can bring in jars of acrylic paint and bring out a painting. Sometimes drugs can help you rearrange what you brought in, in a desirable way.

N2O is known to increase both ideation and suggestibility, so your experience of forming false, but convincing, memories is quite "normal". One learns to recognize and adjust for these rather quickly.

I think I've said enough. I personally have found value in N2O and other drugs, but I'm not here to be an apologist or pusher - I just wanted to provide a different view that might give you some additional context for your experiences.

Thanks for reading.
 
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