Steve Calvin M.D. on pregnancy care, health care reform, and innovation

The discomfort of birth is no laughing matter.

My wife Cindy describes the discomfort of labor as “pain with a purpose”.    Dealing with that pain is one of the biggest challenges that mothers face at the end of pregnancy.  Many mothers think that the only pain management options are the two extremes of just gritting their teeth or of requesting an immediate epidural block.  In a birth center the pain management strategies don’t include epidural blocks or injected narcotics but they do include position changes, massage, coaching encouragement and the very helpful warm water soak in a birthing tub.   Sometimes these are not enough.  It would be helpful to have a safe option that fills in the gap before moving to the hospital and the (sometimes absolutely necessary) use of needles and drugs.

Nitrous oxide, popularly known as laughing gas, is that option.  Most know nitrous oxide from the higher doses used for dental procedures but it is widely used for labor pain in many other countries and a few locations in the U.S.  During birth it is self-administered by mask in a 50:50 nitrous oxide/oxygen mix.   It is safe for mother and baby, FDA approved and very effective for the mothers who just need to take the edge off the pain.  It has rapid onset and is gone within minutes.  We started to use nitrous oxide this month and it quickly led to three local TV stories and then a great story on the national Today Show.  The links are below.

Many of us believe that one factor in the rise in cesarean section rates is maternal anxiety.   Uncontrolled pain (or even its anticipation) is a cause of some of that anxiety.  Nitrous oxide is a good option for some of these mothers.  I personally think that another factor in the rise of cesarean sections is healthcare provider anxiety.  Our midwife team is a very calm and capable bunch so they don’t need the nitrous oxide but during my career I have worked in settings where some of the physicians and nurses could have used a couple of puffs.


Is non-profit status essential for healthcare organizations?

A young attorney colleague and I co-wrote a commentary in the January 4, 2014 issue of the Minneapolis Star Tribune.  In it we constructively critique the virtual non-profit healthcare monopoly that we have in Minnesota:

We hope to encourage discussion of how the current system could be improved.  We are finding that the midwife-led team based approach of the BirthBundleTM is a great option.  2015 will see expansion of our model and we are excited to partner with a non-profit payer (UCare) on a pilot program.  More later.