Using Laughing Gas for Labor

How Nitrous Oxide for Labor Is Making a Comeback

Labor gas mask

Nitrous oxide is a pain relief method that is reemerging in the United States as a way for birthing people to help 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.

Laughing gas has become less popular in the U.S., but elsewhere in the world, laughing gas (often called "called gas and air") is a popular pain relief option for laboring patients, even in home births.

Nitrous oxide is commonly used outside the U.S., and you'll find many references to it in popular culture, such as on television shows like "Call the Midwife."

Here are some of the key points you should know about using laughing gas during labor for pain relief, including what the research has to say about the benefits, side effects, and possible downsides.

Benefits of Using Laughing Gas During Labor

Laughing gas might not be the most popular method of pain relief during labor, but research has shown it can be an effective and appealing option.

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 the women who used the method went on to give birth without any other form of anesthesia.

When each group was asked to rate the method of pain relief they chose, there was variability in terms of effectiveness according to the women who used laughing gas. Still, the laughing gas group reported a higher rate of satisfaction overall compared to the epidural group.

There are many potential benefits to using laughing gas as a pain management tool during your labor, including:

  • It allows for mobility.
  • It does not require additional monitoring.
  • It can be controlled by the patient.
  • It can be quickly and easily stopped by taking off the mask.
  • 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. Some people worry about being able to taste the medication, as you can with other breathing treatments, but nitrous oxide does not have a smell or taste, making it more palatable to the laboring person.

How Is Laughing Gas Given in Labor?

One of the primary benefits of laughing gas is the ease and speed with which it can be given. Most rooms in a hospital are equipped to administer laughing gas. If not, a small wheeled tank can be moved into the room.

Laughing gas is a combination of nitrous 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 treatment as soon as you lower your hand and remove the mask.

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 to when your contraction will begin. You can also rely on those around you, like your doula or labor nurse, for help.

Another benefit of laughing gas is that it is relatively easy to use and requires no special safety equipment (other than the delivery system itself).

Laughing gas can be started very quickly and begins to provide pain relief within a minute—much faster than most medications and other medical forms of pain relief used during labor.

That said, nitrous oxide is also safe to use with other types of pain management during labor, 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.

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.

During Which Stage of Labor Is Laughing Gas Used?

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

Additionally, nitrous oxide does not preclude the use of other forms of analgesia. This is a good attribute if you find that laughing gas alone is not enough to manage your pain as your labor progresses.

The reverse can also be true: 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.

You could use nitrous oxide early in labor while you are trying to decide if you want to have or waiting to have an epidural.

You could also use laughing gas in transition when you may not have time for an epidural or IV medications might be too risky to use.

In the final stages of labor, laughing gas can be used while you are pushing or during delivery of the placenta. 

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

What Are the Side Effects of Laughing Gas for Labor?

Most of the people who use laughing gas for labor report that they are very pleased with the outcomes.

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.

However, another way to look at possible side effects is the way your movement and monitoring during labor might be affected if you use laughing gas.

While you do need to be near the delivery equipment, it is also 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 and still use the laughing gas.

While most hospitals do not place any restrictions on a laboring patient who is using laughing gas, you should still be cautious if you are moving around and changing positions that may be less stable.

An example might be using a birthing ball and nitrous oxide. You would want to use a base to help stabilize the ball or have your partner or doula keep you steady. If you want to try using laughing gas in another birthing setup, such as in the tub, this is a great question to ask when you're on your hospital tour.

Is There Any Reason to Not Use Laughing Gas?

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

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

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

Will Laughing Gas Affect My Baby?

There are no known side effects of laughing gas in newborns. Nitrous oxide readily crosses the placenta and is quickly eliminated by the newborn.

Nitrous oxide is not associated with an increase in fetal distress that can be seen with other medications used for pain during labor. It also does not alter the alertness of the newborn, and therefore, will not affect how the first breastfeeding sessions go for you and your infant.

My Hospital Doesn't Offer Laughing Gas, What Can I Do?

If your hospital does not routinely offer nitrous oxide, ask if it's a possibility during your labor and delivery. In the U.S., the use of laughing gas is still relatively new, so the hospitals where you live might still be in the process of developing guidelines for its use.

If your local hospital or birthing center has not yet started to explore the option, you might try to send a letter to the nurse manager at the labor and delivery unit to ask who you could talk to about making the option a reality.

Certainly, your healthcare provider is someone to talk to about your desire to try laughing gas during your labor. They may be able and willing to offer it in a one-off situation.

Having your doctor as a champion can make a big difference when you're lobbying for more options. Patient-led requests often drive changes to hospital policies. You likely won't be the only patient interested in having the option of using laughing gas during labor. Remember; you'll never know if you don't ask!

A Word From Verywell

Nitrous oxide, or laughing gas, 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 for people who want to use a method that's easy and low-risk.

While it's not as common in the U.S. as it is elsewhere in the world, many providers, hospitals, and birthing centers are willing to allow people to use laughing gas during labor and delivery. It can be used on its own or combined with traditional forms of pain control, like an epidural.

While there are some situations where it's not safe for a person to use, you'll never know if you don't ask. If your local hospital doesn't regularly offer it, ask your doctor or the nurse manager at the birthing center if the option is available.

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