Nitrous Oxide for Pain Relief in Labor

Nitrous oxide, also known as laughing gas, is something many people know about from dental procedures. But you might not know you can use it during labor to help manage pain and discomfort!⁴ Here’s what you need to know about using nitrous oxide for pain relief in labor.

What Is Nitrous Oxide?

Nitrous oxide is a tasteless and odorless gas inhaled through a mask.⁴ It helps manage discomfort throughout the entire body without causing a loss of feeling or loss of muscle control or movement.⁷ Some people may prefer nitrous oxide over intravenous medication, which can make you feel groggy, or an epidural, which typically reduces feeling and can cause loss of muscle control.^4,6

Nitrous oxide does not completely relieve the pain of labor. Instead, it creates diminished pain or a continued awareness of pain without it bothering you.^4,5 I recommend talking to your healthcare providers during your pregnancy about whether this is available at your place of birth, as it is not always offered everywhere. However, in the past few years, it has grown in popularity.⁵

In 2019, it was reported that nitrous oxide for use during labor is offered in at least 150 hospitals and 50 birthing centers in 33 states in the United States.¹ A survey of 2,400 people who gave birth in the U.S. in 2011 and 2012 found that only 6% of them used nitrous oxide during labor.² As a labor, delivery, and postpartum nurse, I have seen many patients successfully use this during labor and birth.

When Can Nitrous Be Used During Labor?

The great part about nitrous is you can use it at any point during labor and birth.⁸ You may even use it postpartum as your care providers repair any perineal tears or lacerations acquired during delivery.¹⁰ And you can start and end it at any time. If you don’t like it or it doesn’t work for you, it’s easy to switch to another medication.⁵

This gas is typically given through a mask held over the nose and mouth of the laboring patient.⁴ The nitrous oxide concentration must not exceed 50%.⁵ With some practice, you’ll want to time the start of inhalation of nitrous oxide with your contractions. You should start inhaling about 30 to 45 seconds before your contraction begins for maximum pain management. This way, the drug peaks at the same time your contraction is peaking because it takes about 60 seconds for the nitrous oxide to work.^4,11,12

It is also flexible because if you want to use it for one very painful contraction and perhaps not the next contraction, you can control when you do and do not inhale the gas.^4,5 This allows you to be a bit more mobile and flexible in your positions and movements. Some patients report that nitrous oxide not only helps with pain and discomfort but anxiety as well.^3,4

Overall, nitrous is inexpensive and simple to use.^8,9 Plus, one research article found that nitrous oxide “has not been shown to increase bad health outcomes for mothers or newborns.”⁹ Over the next several years, I expect that a lot of research will go into the effectiveness and health outcomes of nitrous. It is becoming a much more popular method of pain management during labor and birth.⁵

Who Can Use Nitrous Oxide?

Some patients report that nitrous is effective and works for them. Others feel it doesn’t reduce the sensation of pain as much as they would like. However, if it’s available to you and you want to try it, don’t be afraid to talk with your care providers! You can always try it. If you don’t like it, you can have another conversation about additional pain management options available to you.

For the most part, the criteria for using nitrous is simple:^5,11

• The mother must be able to safely place the mask on and off her face.
• The mother must be able to obtain a tight seal across the nose and mouth.
• The mom must have adequate B12 levels.
• The mom should have no history of collapsed lungs, gastric bypass surgery, or inner ear surgery.
• The equipment releasing nitrous oxide must use scavenging equipment and have a demand valve.

Aside from some simple vital sign checks and screenings, it’s easy to start using nitrous oxide. There isn’t much of a wait time or medical procedure involved, like with an epidural. During the use of nitrous, your nurses will likely continue to monitor your oxygen saturation, vital signs, physical symptoms, and overall improvement in comfort, if any.

Keep the lines of communication open with your care providers so that they can assess and plan for the next steps. Don’t be ashamed if you don’t like the way you feel or don’t think it is helping after a couple of minutes. Your healthcare providers will gladly offer additional tips and tricks or medications.

Are There Any Risks?

Using nitrous oxide is safe for both you and your baby.⁴ You may experience some side effects with its use — most commonly nausea or vomiting. Due to the sense of detachment, it can cause some people to feel sleepy or dizzy.^4,5 Some patients also feel caught off guard because it is less effective than other forms of pain management. It’s definitely less effective than, say, an epidural!^3,8 However, if you’re looking to get a bit further along in your labor process before being bed-bound by an epidural or looking to cope a bit better with the feelings of pain or anxiety during birth, give it a try!

Overall, nitrous oxide is a great tool to have during your labor and birth. If it’s available to you and you’re willing to try it, then why not? Have a conversation with your healthcare provider. And do some of your own research during your pregnancy. This will allow you to weigh the pros and cons and know additional options and alternatives. If you’re looking to have an unmedicated birth, this might be just the thing you need to help you transition through your labor, the pushing stage, and postpartum!