Nitrous Oxide (Laughing Gas) for Pain Relief During Labor

As baby's birth nears, you've surely got a lot of questions on your mind. Likely one of the biggest — especially if this is your first baby — is how you'll manage labor pain. Maybe you've looked into having an epidural or a spinal block or Demerol, or perhaps you're considering an unmedicated birth. And in doing your research, you might have also come across a pain relief option that sounds a little funny: laughing gas.

Also known as nitrous oxide, this inhaled gas is more commonly associated with getting cavities filled than pushing out a baby. In the United States, nitrous oxide used to be common during labor — but at that time it was often used in conjunction with narcotic painkillers, causing complications. After the epidural became the gold standard in the 1970s, the practice all but disappeared in the U.S.

That said, more than 60 percent of women in the UK, and roughly half of women in Australia and Canada, have been found to rely on nitrous oxide throughout labor to take the edge off of pain and anxiety. In the last several years, however, there has been a resurgence of interest in the U.S., and today hundreds of hospitals and birthing centers offer nitrous oxide to laboring women. 

So why do some people in the U.S. say laughing gas should be available more widely? And what should you know if you're considering it as an option?

What is nitrous oxide?

Nitrous oxide is a colorless, odorless gas that's usually mixed 50/50 with oxygen for laboring moms. When breathed in, it reduces anxiety and increases feelings of relaxation and well-being.

In small doses — like what dentists use to help patients relax during a cavity filling or during labor — nitrous oxide is considered an analgesic, or pain relief. At much higher doses — sometimes used in operating rooms in combination with other drugs — the gas can be an anesthetic, meaning it leads to loss of sensation entirely.

How does laughing gas work during labor?

Unlike an epidural, laughing gas won't completely numb any parts of the body. And it won't significantly relieve pain, like narcotics do. Laughing gas is more often described as a disassociation from pain: You might still feel pain, but you won't be as bothered or anxious about it.

There's not much you need to do to prepare for laughing gas — it's fine to eat and drink like usual up until labor. You won't have to wait for an anesthesiologist to set you up (like you do with an epidural); a trained nurse can show you how to breathe through the mask. When and how much of the drug you take is up to you, since you'll be holding the mask to breathe when you need it.

Benefits of nitrous oxide during labor

In places where nitrous oxide is frequently used in labor and delivery wards, practitioners report that it helps women by both easing pain and lessening anxiety. Laughing gas can:

• Help you to relax and stay in position while a doctor is setting up an epidural (which can cause discomfort and/or anxiety, since it involves putting a small tube into the spinal column).
• Ease needle phobia if you're uneasy about having an IV placed.
• Offer a small amount of pain relief during the most painful stages of labor and pushing if you aren't using other pain-relief medications (practitioners often recommend taking a breath of the gas about 30 seconds before a contraction starts to get the maximum effectiveness).
• Help you to relax and concentrate on your brand new baby while your practitioner inspects the perineum or sews up tears after labor.

Possible risks of nitrous oxide during labor

Experts generally agree that, for most people, nitrous oxide in the concentration recommended for labor is relatively safe. The side effects are similar to those from narcotics, though they're shorter-lasting. Some women feel dizzy or nauseous while they're breathing the gas until a few minutes after they stop.

Although research is still ongoing, past studies have found that the amount of nitrous oxide currently used during labor usually given during labor has no effects on the health of a baby at birth or a newborn's alertness or ability to breastfeed. That said, there are some questions about long-term effects and whether it carries risks from crossing the placenta. This lack of research has made some clinicians hesitant to use the gas, especially since other well-studied options for pain relief already exist.

Nitrous oxide vs. an epidural for pain relief during labor

A few benefits of laughing gas versus an epidural and some other pain relief options:

• It's quick to start: Unlike some pain relief techniques, you'll begin feeling the effects of the drug after taking just a few breaths.
• You can move around: Unlike with an epidural, you won’t be hooked up to an IV and monitor, so if you want to walk or sit on a birthing ball, or change your position, you’ll be able to.
• You can stop at any time: Similarly, if you aren't enjoying the effects or don't feel like nitrous oxide is helping you anymore, simply breathing regular air for a few minutes makes the effects disappear.
• There are usually fewer side effects. Compared to narcotics or epidurals, since the drug is so short-lasting, most people experience fewer side effects — it doesn't cause drowsiness or cloudy thinking after it's worn off, for instance.

Is nitrous oxide right for you?

Just as every pregnancy is different, every birth is unique, too — and moms have a variety of ideas about how they want their experience to go down. You may, for instance, want to feel as little pain as possible; or it might be more important to experience all the sensations of labor, including pain. If you're looking for pain relief that's faster-acting and has fewer side effects than narcotics or an epidural, laughing gas might help you get through labor.

However, if you have any of the following conditions, your doctor likely won't recommend nitrous oxide:

• Severe vitamin B12 deficiency (the gas can lower B12 levels, so if they're already very low, that can be dangerous)
• Musculoskeletal disease or any impairment that keeps you from holding that mask yourself
• Collapsed lungs, past gastric bypass or inner ear surgery (these can lead to air pockets in your body, which nitrous oxide can enter and cause to expand even more)

Even if you think you want to try nitrous oxide, you'll have to ask your health-care practitioner whether it's an option — it's still only offered for birth at a few hundred hospitals and birthing centers around the country, although the numbers are growing. Labor and delivery wards need special equipment that can mix nitrous oxide with oxygen (and it's different equipment than what's used in dentist's offices because it's a slightly different ratio of laughing gas to oxygen), as well as training and protocols for their nurses.