Most people are familiar with nitrous oxide, otherwise known as laughing gas. However, you may associate it with the dentist and be unaware that it can be used in other settings. In fact, nitrous oxide in labor and delivery is gaining popularity and availability in the U.S. Let’s learn more about this option, discuss the pros and cons, and help you decide if it might be an option to ask your health care providers about.
About Nitrous Oxide
Nitrous oxide (N2O) is a nonflammable, colorless, tasteless, odorless gas (1). (While generally considered tasteless and odorless, many people report that it has a sweet or “bubble gum” sensation when inhaled.) When used in labor, it is a mix of 50% nitrous and 50% oxygen (2). In high concentrations, it’s a weak anesthetic. In low doses, as used in labor, it can make a person feel more relaxed and less anxious.
Nitrous oxide doesn’t eliminate pain or take away the sensation of a contraction, the way something like an epidural can. Instead, women report that it makes them notice the pain less or care less about it (3). By relieving anxiety, nitrous oxide can help increase moms tolerance of pain (4).
How Common is Nitrous Oxide in Labor?
Nitrous oxide is commonly used as a labor analgesic in many Western countries, but is used much less frequently in the U.S. (1) This doesn’t mean that it’s a new technology, though; it is old and proven. Usage was common in the U.S. starting in the mid-1900s. But when epidurals became popular in the 1970s, use of nitrous oxide decreased and most labor and delivery units eventually stopped offering it. Over the last decade, though, the number of hospitals and birth centers that offer nitrous has greatly increased.
Other countries with high-quality healthcare offer nitrous as a routine part of obstetric care. The U.K., Canada, Australia, and Scandanavia offer it as an option in 50-60% of births (2). In these countries, birth tends to be less medical, with more births occurring at home or in birth centers, attended by midwives. Nitrous oxide, then, has been a good, low cost, portable option for easing the pain of labor without removing a woman from the physical experience as much as an epidural can.
How is Nitrous Oxide Used in Labor?
The use of nitrous oxide in labor is simple and keeps the laboring woman in control. Mom self-administers it by holding a mask over her nose and mouth and breathing deeply (2). She can use it as she feels the need; it takes effect within 30 to 50 seconds of beginning inhalation. And, it clears from your system within 30 seconds of stopping.
Nitrous in the Dentist vs Labor
If you’ve ever had nitrous oxide at the dentist and felt detached, you may find that your experience during labor is different. There are two ways that the use differs between dentist and labor usage. First, the nitrous used for labor is a 50/50 mix that can’t be changed, while dentists use a system they can adjust, and can go as high as a 70/30 mix (2).
Secondly, the gas a dentist uses is a continuous flow system with a mask strapped to the face. In labor, the gas only flows to mom when she holds the mask to her face (it is never strapped on) and inhales; a valve ensures that only inhaling with the mask on releases the gas. This allows the patient to control when she wants pain relief and prevents her from getting too much. If she starts to get drowsy from it, her hand and the mask will fall away from her face (3).
Is it Safe?
American Society of Anesthesiologists
Nitrous oxide has a long history of use in labor and is widely considered safe for both mother and baby (1). Let’s look at what some medical associations have to say about it. According to the chair of obstetric anesthesia for the American Society of Anesthesiologists, “It is very, very safe, and is probably the most commonly used anesthetic in history. The low concentrations that we use in labor make it very safe and the self-administration makes it really safe for moms. And while there aren’t specific studies for babies, the volume of worldwide use for labor gives tons of experiential data that it’s safe for babies (2).”
Two midwife associations agree. According to the Journal of Midwifery & Women’s Health, “Nitrous oxide labor analgesia is safe for the mother, fetus, and [baby] and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of…oxytocin, and has no adverse effects on the normal…progress of labor.” And the American College of Nurse-Midwives (ACNM) says that, “Research has supported the reasonable [use], safety, and unique and beneficial qualities of N2O as an analgesic for labor and its use as a widely accepted component of quality maternity care.” (5)
American College of Obstetrics and Gynecologists
It is worth noting that the American College of Obstetrics and Gynecologists (ACOG) has not released a statement in support of nitrous oxide. Their current position states: “ACOG is reviewing this issue, but at this time does not have guidelines or recommendations on the use of nitrous oxide during labor” (3). This does not mean that they oppose its use, but that they haven’t yet created guidelines for its use.
Nitrous Oxide Pros
If you find that you need or want medicinal help through labor, there are many reasons why nitrous oxide might be a good option to consider.
- It is widely considered safe for mom and baby.
- The release of oxytocin, uterine activity, and labor progress are not disrupted
- Baby’s heart rate or infant alertness are not affected during the early bonding period between mother and newborn.
- It does not affect breastfeeding.
- Many women find it helps them relax and decreases their perception of labor pain.
- It does not require an IV or urinary catheter, so it does not limit mobility. A woman can still move around, walk, sit on a birthing ball, use a tub, etc.
- Because it is self-administered, a woman is in charge of how much to use or if she wants to stop using it.
- Mom can use nitrous during any stage of labor.
- There are no lingering side effects.
- It is usually much cheaper than other options. (See below for more about that, because this isn’t always the case.)
- A doctor, midwife, or nurse can set up and monitor the use of nitrous, because it isn’t technically anesthesia. That means you don’t have to wait for an anesthesiologist to be available or pay a consult fee for one.
- If you tend to feel anxious, nitrous may help ease your anxiety.
- It can help you avoid an epidural or narcotic pain medication if you’d prefer not to use them (2, 3, 4, 5, 6).
Nitrous Oxide Cons
As with any medication, there are potential downsides to using nitrous oxide. Let’s look at the cons.
- Mom may experience minor side effects such as dizziness, nausea, and/or drowsiness.
- It can be slightly dissociative, or make women feel a little disconnected. Some women don’t like that feeling.
- It may be daunting or cumbersome to hold a mask over your face while riding through contractions or pushing (1, 3, 4).
When Nitrous Oxide Isn’t an Option
The good thing about nitrous oxide is that if you don’t like the way it feels, you can stop and it clears from your system nearly instantly. (3) However, while it’s safe for almost everyone, there are some reasons why a person wouldn’t be able to use it:
- If you have COPD (severe chronic obstructive pulmonary disease) or any severe upper airway obstruction. (This does not include mild asthma.)
- In the case of a vitamin B12 deficiency.
- If you have an MTHFR gene mutation.
- Having a musculoskeletal disease or any impairment that keeps you from holding the mask yourself.
- If you have collapsed lungs, past gastric bypass surgery, or recent inner ear surgery (4, 7).
What About the Cost?
Cost usually falls into the “pro” list, but in certain cases, could be a “con.” The flat fee is common billing in the U.S. and the average is $100 to $500. In some cases, the hospital may code the use of nitrous as anesthesia, in which case the bill could be significantly higher.
It’s worth noting that there isn’t a standard way to bill nitrous oxide for labor at this point. So, it’s a good idea to contact your hospital or birth center ahead of time to find out how they bill it if you think you might want to use it.
Some women breathe, walk, use bathtubs, etc to cope with labor pain. Some women choose epidurals or narcotics. And, in increasingly more places in the U.S., nitrous oxide is an option that falls somewhere in between. Nitrous oxide isn’t the right choice for everyone, and won’t replace existing options. It is simply another option that a laboring woman may have at her disposal to help cope with the challenges of labor and delivery. If you think nitrous oxide might be something you’d like to consider for your labor, talk to your doctor or midwife about the options in your birth facility.
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1. Collins, M., Starr, S., Bishop, J., & Baysinger, C. (2012). Nitrous oxide for labor analgesia: Expanding analgesic options for women in the United States. Retrieved July 24, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594866/
2. Baird, S. (2020, April 16). The Rise of Laughing Gas in the Delivery Room. Retrieved July 24, 2020, from https://www.nytimes.com/2020/04/15/parenting/pregnancy/nitrous-oxide-laughing-gas-labor.html
3. Szalinski, C. (2014, January 06). Laughing Gas in the Delivery Room? Yes, Please. Retrieved July 24, 2020, from https://slate.com/human-interest/2014/01/laughing-gas-for-labor-could-nitrous-oxide-be-the-next-big-thing-in-american-childbirth.html
4. Nitrous oxide for labor: Seriously, don’t laugh before you read this: Your Pregnancy Matters: UT Southwestern Medical Center. (n.d.). Retrieved July 24, 2020, from https://utswmed.org/medblog/nitrous-oxide-labor/
5. Nitrous Oxide During Labor: Benefits and Risks. (2019, October 13). Retrieved July 24, 2020, from https://americanpregnancy.org/labor-and-birth/nitrous-oxide-labor/
6. 5 FAQ about laughing gas for pain relief during labor and delivery. (n.d.). Retrieved July 24, 2020, from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-faq-about-laughing-gas-for-pain-relief
7. 11, R., & From the What to Expect editorial team and Heidi Murkoff. (2015, October 15). Laughing Gas (Nitrous Oxide) for Pain Relief During Labor. Retrieved July 24, 2020, from https://www.whattoexpect.com/pregnancy/laughing-gas-nitrous-oxide-labor