While managing the experience of labor and delivery can be a difficult task for any woman, Spokane obstetrician and gynecologist Dr. Lori Smetana says hospitals here and across the nation are working to make things just a little bit easier. 

“Women today have a lot of different options when it comes to planning for labor and delivery,” says Smetana, an obstetrician and gynecologist at OB/GYN Associates of Spokane who serves as Deaconess Hospital’s labor and delivery medical director. 

“Most seem to value a natural approach, with opportunities to create a bond with their newborn as early as possible, and in recent years we’ve really strived to accommodate those desires,” she says.

Smetana, who received her medical degree from the University of Oklahoma College of Medicine, has lived and worked in Spokane for 21 years now. She currently is one of about 44 doctors at Deaconess who specialize in obstetrics and gynecology. 

She says an average day consists of managing clinic patients, making her rounds, and managing labors, as well as performing C-sections.

“I would estimate Deaconess delivers about 1,500 babies each year,” she says. “I personally see about 25 patients per day, so about 400 each month.” 

Smetana says Deaconess’ obstetrics department offers a variety of women’s health care services, including a full range of gynecological care, a Level III neonatal intensive care unit, labor and delivery services, an obstetrics emergency department, and a new birthing center called BirthWise. 

She says one relatively new option included within labor and delivery services is the use of nitrous oxide to help expectant mothers manage pain while delivering. 

“We started offering nitrous oxide in November of 2016,” she says. “Most people will recognize it from their dentist’s office. It’s what’s called an analgesia, pain medicine that brings relief but doesn’t numb like an anesthetic.”

Nitrous oxide, also known as laughing gas, is an inhaled gas commonly used as pain medication in dental work, following trauma, in end of life care, and in childbirth. 

Smetana says nitrous oxide is set up by the hospital’s nursing staff, but the patient is able to self-administer the medication as needed using a gas mask. 

“It can be used in early labor as a bridge to using an epidural, or throughout the entire labor process including delivery of the placenta and postpartum surgical repairs,” she says.  

Smetana says the number of patients who use nitrous oxide as a bridge medication prior to an epidural injection compares pretty equally to the number of patients who choose to use it throughout their delivery.

“It’s important to remember nitrous oxide isn’t a substitute for an epidural,” she says. “Most patients who use it are trying to keep their delivery as natural as possible, and this method allows them to manage pain while staying alert and in control of their motor functions.”

Kevin Maloney, a spokesman for Deaconess, claims the hospital is one of only two in the state to offer nitrous oxide for use in childbirth, and is the first hospital in the Spokane area to do so. 

“At last check, there is only one other hospital in the state that offers this service, the University of Washington Medical Center in Seattle,” he says.

Smetana estimates that since Deaconess began offering nitrous oxide as an option, probably 55 to 60 of her patients have used it during labor and delivery.  

“Prior to instituting it here, it was discussed for a year or so between our anesthesia departments, midwives on our staff, and other hospitals in the state who we knew had experience in using it,” she says. “It was very well thought out.”

While Deaconess is currently the only hospital in Spokane that offers nitrous oxide, Smetana says she anticipates that will change soon. 

“What I’ve heard so far is that this option helps patients feel empowered, and in better control of their delivery experience,” she says. “They also like that they can use the medication as needed.”

She says there is no smell or taste with the gas, and because it enters and leaves the mother’s body through the lungs it doesn’t accumulate in the bloodstream, and there are no known ill effects on the baby. 

“It’s a safe and effective means of helping the mother relax, while decreasing her perception of labor pain,” Smetana says.  

She adds that there are few restrictions on the use of nitrous oxide during labor and delivery.

“One of the only exceptions would be mothers with preeclampsia, who may be on magnesium medications,” she says. “There are also the basic safety precautions, like making sure the mother is the sole user of the medication, and being sure the room is well ventilated to prevent staff or visitors from accidental exposure.” 

Smetana says the hospital’s birthing center, BirthWise, which opened a year and a half ago, is another attractive option for patients who’re looking for a more at-home delivery experience. 

“It really appeals to that niche group of women who would otherwise chose to give birth at home,” she says. 

Smetana says the hospital also offers what’s called a gentle cesarean option for mothers who aren’t able to deliver naturally, but want to feel more included in the traditional delivery experience. 

“For a gentle C-section, we offer a drape with a clear window so the mother is able to see the delivery process,” she says. “After delivery, we emphasize skin to skin contact right away, so while doctors are closing, the mother can begin to bond with her newborn and even breastfeed if she’d like.”

Looking ahead, Smetana says toward the end of the summer she plans to end her private practice at OB/GYN Associates so she can take on an obstetrics hospitalist position at Deaconess. 

 “I’ve decided I’m ready to start slowing down a bit,” she says. “In this new role, I’ll be supporting hospital staff with their patients, so still the same work but at a slower pace.”

Smetana says she plans to stay involved in several leadership committees at the hospital, and will continue in her role as medical director of labor and delivery.