Laugh through labor? Nitrous oxide makes comeback

A “retro” form of pain control is making a comeback in the United States: nitrous oxide, often known as laughing gas.

Nitrous oxide was used to ease the pain of labor since the early 1900s. It fell out of favor in the United States as alternative pain relief methods were developed and culture shifted to women becoming less involved during the birthing process. However, it continued to be used in other countries. In fact, 60 percent of women in the United Kingdom, 48 percent in Finland and 43 percent in Canada give birth with the help of nitrous oxide.

A movement to revive its use in the U.S. began a few years ago as women sought to take a more involved role in labor. Our team added nitrous oxide as a pain control option for labor in 2014. It’s proved very popular, with about one-third of patients in our midwifery practice using it during labor.

About 1/3 of our pregnant patients use nitrous oxide as a pain control method. via @MedStarWHC

Does using nitrous oxide mean you’ll laugh your way through labor? Not quite, but it can take the edge off enough to keep going if you don’t want to use another pain relief method, such as an epidural. Let’s talk about how nitrous oxide works during labor, as well as its benefits and potential side effects.  

How nitrous oxide works as pain control during labor

First of all, this is not the laughing gas you get at your dentist’s office. It’s a much lower concentration –  50 percent nitrous oxide and 50 percent oxygen. Because of this, women who use it during labor rarely act loopy or experience memory loss afterward.  

Nitrous oxide doesn’t actually reduce pain, but instead seems to alter the way women perceive pain. My patients tell me that they still feel their contractions, but they just don’t care about them anymore.  

Some women don’t even realize they’re reaping the benefits of nitrous oxide, telling us later, “I don’t think it did anything.” But their partners and care team often have a different perspective, noting something along the lines of, “Well, it certainly seemed to help!”  

Nitrous oxide is absorbed through the lungs as you inhale and excreted shortly after as you exhale. Just before a contraction, you hold the mask to your face and breath in and out. You should feel the effects of the gas in less than a minute. Once you put the mask down, the effects wear off after a few breaths of room air.  

Only a woman in labor can hold the mask. Your partner, nurse, doctor or midwife is not allowed to help. This is a safety precaution to prevent you from breathing in too much nitrous oxide. You’ll drop the mask if you become over-sedated and begin to breathe room oxygen, resolving the symptoms.  

Benefits to using laughing gas during labor

I think one of the biggest pluses to nitrous oxide is the sense of autonomy that it gives women in labor. You decide when you need the gas and how long you need it.  

But there are additional benefits to nitrous oxide compared with other forms of pain relief such as an epidural.

  • Maintain mobility: Nitrous oxide doesn’t numb a part of your body like an epidural or tie you to an IV or catheter, so with help from your support team you can still move and reposition easily.
  • Low long-term commitment: Once you get an epidural or pain-relieving drug through an IV, you’re in it for the long haul – or until the drugs wear off. Not so with nitrous oxide. If you don’t like it or find it isn’t working for you, you can stop and try something else.  

Nitrous oxide has few side effects, but some women report feeling nauseated, dizzy or drowsy.  

If you’re interested in midwifery care, join our practice for a monthly meet-and-greet at 6 p.m. on the second Wednesday of every month in the Medical Affairs conference room 121 A/B located in the Physicians Office Building.  

Who can use nitrous oxide during labor successfully

Very few women can’t use nitrous oxide. But it’s not recommended for women who have:

  • A severe vitamin B12 deficiency, because the gas can further lower those levels.
  • Had a collapsed lung or certain surgeries that can create air pockets in the body where the nitrous oxide can enter and expand.  

Some women find nitrous oxide doesn’t provide what they need. I’ve found that women are more likely to be successful with nitrous oxide, meaning they don’t require an alternative pain relief method such as an epidural, if they start using it after they are about  5 to 6 cm dilated. It’s may not be as effective if you have a lot of labor left in front of you.  

If you’re exhausted, remember that nitrous oxide is an active form of pain control – you must hold the mask yourself. You may be disappointed to find it doesn’t give you the rest you’re hoping for.  

However, most of our patients are happy with their nitrous oxide experience. In fact, a February 2017 study published in Anesthesia & Analgesia showed women who used nitrous oxide alone were more likely to indicate high satisfaction compared with women who got an epidural.  

A nitrous oxide program requires the coordination and partnership of everyone who works with pregnant patients: Ob/Gyns, midwives, anesthesiologists, neonatologists and nurses. I think it’s a testament to our team’s progressive and women-centered approach to care that we are able to offer nitrous here.  

I also take to heart that other regional hospitals have taken notice of our nitrous oxide program, calling us for advice to start their own. And I hope in the future that this pain control option is available to more women in labor in the District and the rest of the country.  

Loral Patchen, MA, MSN, CNM

Loral Patchen lives in Washington, D.C., with her husband, a native of Colombia, and their teenage daughter. She is an avid cyclist and enjoys hiking with her dog, Stella. Most weekends between March and November she may be found in her garden.

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