Using Laughing Gas for Labor

How Nitrous Oxide for Labor Is Making a Comeback

Woman using laughing gas to ease pain in labor
istockphoto

Nitrous oxide is a pain relief method that is regaining popularity in the United States as another option for helping to control pain in labor. You may have heard about "laughing gas" as something used to help relax you while at the dentist—nitrous oxide is the same medication.

While laughing gas for labor is not commonly used in America, elsewhere in the world laughing gas (often also called "gas and air") is a popular childbirth pain relief option, even in home births. Many women report satisfaction with this pain relief method. However, it is not as effective as using an epidural.

Here are key points to consider when weighing whether to use laughing gas during labor for pain relief, including what the research has to say about the benefits, side effects, and possible downsides.

Overview

The primary benefits of laughing gas are the ease and speed with which it can be given and the fact that it can be self-administered. Most rooms in a hospital are equipped to administer laughing gas. If not, a small tank can be wheeled into the room. The equipment used to provide laughing gas is set to deliver 50% oxygen and 50% nitrous oxide. It cannot be altered or adjusted. For safety reasons, the gas is also non-flammable.

Laughing gas is a combination of nitrous oxide and oxygen that can be self-delivered through a face mask.

As you have a contraction, you lift the mask to your face and breathe normally. You stop getting the benefits of the medicine as soon as you remove the mask. For this reason, it is recommended that you start to breathe in the nitrous oxide about thirty seconds before your contraction begins. Your goal is for the concentration of the medication to reach peak levels at about the same time as the peak of your contractions.

Every person's pain levels and tolerance will be different during labor, so you might need to go through a few contractions before you figure out the perfect way to time your laughing gas for optimum pain management. You can use a fetal monitor as a guide for when your contraction will begin. You can also rely on those around you, like your doula or labor nurse, for help.

Potential Benefits

Potential benefits to using laughing gas as a pain management tool during your labor include the following:

  • It allows for mobility.
  • It can be controlled by the patient.
  • It can be quickly and easily stopped by taking off the mask.
  • It does not require additional monitoring.
  • It has fewer side effects than traditional pain relief methods used during labor, like epidural anesthesia or intravenous (IV) medications like Demerol or Stadol.
  • It is tasteless and odorless, making it palatable to the laboring person.

As noted above, the big benefits of laughing gas are that it is relatively easy to use and requires no special safety equipment (other than the delivery system itself), and can be started very quickly, providing pain relief within a minute—much faster than most other pain relief options used during labor.

Laughing gas is also available for all stages of labor. This makes it a great choice for when pain relief is needed at the last minute, particularly when you need it to work quickly.

That said, nitrous oxide is also safe to use with other types of labor pain management, including an epidural. In fact, laughing gas can provide a bridge in the time between a request for an epidural and when an anesthesiologist is available. Plus, laughing gas can be helpful if you feel that epidural anesthesia isn’t managing your pain adequately. Some practitioners use nitrous oxide when administering an epidural to reduce anxiety and tension during the procedure.

While you do need to be near the delivery equipment, it is usually portable. Laughing gas will not make you numb, so you have complete freedom of movement and will be able to assume positions that are comfortable for you.

Laughing gas can also be helpful in the repair phase of delivery, during manual exploration of the uterus, or other medical procedures, during which time there can be increased pain (especially if you haven't had an epidural).

Why Choose It?

Research confirms that laughing gas is nearly as effective at controlling pain as epidural, but multiple studies show that it can be an efficient and appealing option. In fact, in one study, given a choice between an epidural and laughing gas, about 20% of the laboring patients chose laughing gas. Of note, 60% of those who used the gas went on to give birth without any other form of anesthesia.

When patients were asked to rate the effectiveness of the pain relief method they chose, the ratings for laughing gas varied. Still, the laughing gas group reported a higher rate of satisfaction overall compared to the epidural group.

Other studies have also shown that many women report being satisfied with choosing laughing gas for labor pain, even if they didn't find the pain relief itself to be sufficient. Not enough research has been done to establish why those women would find it satisfactory in the absence of pain relief.

However, it may have to do with a stigma some people have around using an epidural, which may make them more motivated to embrace another pain control option even if it doesn't provide total relief.

Potential Side Effects

No medication is completely free of side effects, but this doesn’t mean that everyone will experience them. Side effects like nausea, vomiting, dizziness, and drowsiness can occur with laughing gas but are usually mild, short-lived, and go away as soon as you stop using the gas. Serious side effects are not common.

Nitrous oxide as a method of pain relief does not appear to alter the outcomes of labor (for example, increasing the need for a cesarean section or assisted delivery) compared to interventions like forceps or vacuum extractions. It also does not seem to have an effect on the length of labor, either.

While you are usually free to move around and change positions while using laughing gas, you'll want to be cautious of any effects on your balance. For example, extra care should be taken if you plan to use a birthing ball and nitrous oxide. You would want to use a base to help stabilize the ball and/or have your partner or doula keep you steady.

Contraindications

There are several contraindications for using nitrous oxide. Your doctor or midwife may not allow you to use laughing gas during labor if:

  • You are critically ill (this includes having severe heart or lung disease, pneumothorax, small bowel obstruction, or pulmonary hypotension)
  • You have a severe psychiatric disorder
  • You have a vitamin B12 deficiency
  • You have had recent inner ear surgery, certain kinds of surgery on your eyes, or certain surgeries on your head or neck

Nitrous oxide is also not used for other medical purposes during the first trimester of pregnancy, as it can have an effect on folate metabolism (which is very important in early pregnancy).

Effect on the Baby

Laughing gas doesn't cause any known side effects in newborns. Nitrous oxide readily crosses the placenta and is quickly eliminated by the newborn.

Nitrous oxide is not associated with the increase in fetal distress that may be seen with some other medications used for pain during labor. It also does not alter the alertness of the newborn, so it will not affect how the first breastfeeding sessions go for you and your infant if you choose to breastfeed.

A Word From Verywell

Nitrous oxide might not be the first pain management method that comes to mind when you think about labor and delivery, but it can be a great option, especially if you would prefer to avoid an epidural. Additionally, laughing gas can be used on its own or combined with other forms of pain control to provide help with discomfort while you wait for the more potent pain relief to kick in. The point is, it's always ideal to have more options when it comes to dealing with labor pain.

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