Nitrous oxide, a.k.a. laughing gas has been used as a form of pain relief since the late 1900’s, although you’re more likely to see it at the dentist’s office than a birth center. Epidurals are the pain relief of choice in the U.S. but that may be changing. Laughing gas has been widely available for laboring women in other countries, and it’s finally making its way to hospitals and birth centers here in the United States.
What is laughing gas, exactly?
When used in labor, laughing gas is usually referred to as nitrous oxide or just nitrous. You may have heard British women refer to it as “gas and air” (Call the Midwife, anyone?), but it’s the same mpixture by many names: 50% N2O (nitrous oxide) and 50% O2 (oxygen). It’s just like the laughing gas that you may have been given to take the edge off during an unpleasant procedure at the dentist.
Nitrous is an inhaled analgesic, meaning a pain relief drug that you breathe in rather than take orally or inject intravenously. It works by decreasing the sensation of pain and interfering with your body’s stress response to reduce anxiety.
In 2011 the American College of Nurse Midwives published a position statement on laughing gas. They stated that that there is enough research to support the reasonable safety and efficacy of nitrous oxide during labor, recommended that midwives be trained to administer nitrous, and suggested that mamas-to-be should be educated about it as an option during childbirth. (Read their updated 2015 statement.)
“Nitrous oxide’s comeback [as pain relief during labor] has really accelerated in the last 5 years. My experience since its resurgence has been amazing! I’m so glad that this has been made available to my patients,” says certified nurse midwife Cynthia Mason who practices in Illinois.
Because nitrous oxide offers relief from pain and anxiety that is low cost with low risks to mama and baby, it appeals to women who desire a low intervention, natural birth but who need a little extra help coping with the pain and anxiety of labor.
How does nitrous oxide work during labor?
Nitrous oxide works by increasing endorphins, dopamine, and other natural opioids in the brain while also decreasing the release of cortisol.
In other words, it releases the happy, yummy hormones in your body while also stopping anxiety and stress hormones. This may be one reason why many mamas report particularly positive experiences with nitrous oxide in reducing their anxiety during labor.
(Read more about women’s experiences with nitrous oxide below.)
How does laughing gas compare to other pain relief?
Nitrous oxide is unique among other labor pain medications (epidurals, spinals, and narcotics) in the following ways:
- When you inhale nitrous oxide, less 1% of the gas is metabolized by your body. It is not stored in the body, and more than 99% leaves the body as you exhale. It does not cross the placenta.
- Nitrous oxide has no effects on the natural, physiological progression of labor.
- It does not interfere with the body’s natural ability to produce oxytocin and endorphins.
- It does not affect breastfeeding.
- It does not interfere with baby’s alertness immediately following birth and during the “magic hour” of bonding between mama and baby.
- It does not increase the risk of neonatal resuscitation.
- The amount of gas inhaled is completely controlled by the patient. The gas is inhaled and exhaled through the same mask and the patient is the only person who can hold their mask. As nurse midwife Cynthia Mason explains, “Many of my clients like this feeling of control and autonomy; they are in control of how much or how little of the gas that is received.”
- Little to no extensive fetal monitoring is required with nitrous oxide and a minimal amount of additional monitoring of the laboring mama is required.
- The laboring mama is free to move around after using nitrous. She does not need an IV, nor will she be tethered to a continuous monitor.
- Use of nitrous oxide can be stopped quickly. It leaves the body within minutes, and the laboring mama can easily choose another pain relief aid or none at all, if she desires.
Is nitrous oxide safe? What are potential side effects?
“Out of the pharmacologic pain relief options, nitrous oxide has the best safety profile for the baby,” explains Cynthia.
While it may sound like a dream pain reliever, it’s important to know that there can be side effects.
Commonly reported effects in laboring women include: detachment, dizziness, euphoria, fatigue, hallucinations, hazy memory of events, headache, nightmares, pleasure, relaxation, sedation, and a sense of warmth. Of course every woman experiences labor and labor pain differently, so intensity and type of side effects vary from women to women.
Among women who reported having unpleasant experiences with nitrous oxide during labor, the most common complaint was nausea, dizziness, and vomiting.
Research does show negative effects on patients who used nitrous oxide for anesthesia rather than analgesia. In high doses, nitrous can be used to bring patients to a lightly unconscious state. For this reason, analgesic nitrous oxide (that is, nitrous used as pain relief) should always be mixed with at least 50% oxygen.
Can anyone use laughing gas during labor?
It turns out that women with low vitamin b12 levels experience increased depletion in after using nitrous oxide as an analgesic. For this reason, women who have low levels of vitamin b12 are recommended against using nitrous oxide for pain relief.
Women who may fall into this category include:
- Vegans (This is because meat is the most common source of b12.)
- Crohn’s Disease sufferers, or others with similar nutrient absorption issues
- Those with MTHFR gene mutation
Of course, it’s always best to consult with your midwife or doctor if you think this risk might apply to you. There are blood tests that can determine if you have a deficiency. Sometimes, it can be easily resolved with supplements or injections.
If nitrous is safe for women giving birth, how come my pregnant dentist can’t administer it to her patients?
Thankfully, laws exist in this country that seek to limit health care workers’ occupational exposure to certain chemicals. Research has shown that repeated, long-term exposure to high doses of N2O could threaten the reproductive health of women.
Proper ventilation in hospitals as well as the introduction of scavenging equipment has greatly reduced healthcare workers’ prolonged exposure to N2O. (Scavenging refers to equipment that provides negative pressure, capturing the patient’s exhalations and sucking them out of the room.)
All research to date has shown that when used in a mixture with 50% O2 with proper scavenging equipment provided, nitrous oxide is safe for women during labor (source).
What to expect if you choose laughing gas during labor
Hospitals and birthing centers that offer nitrous oxide for pain relief during labor will have staff trained on the safe usage and administration of the gas. If you decide to use nitrous during labor, you can expect it to go something like this:
- Your midwife or doctor will inform you on the risks and side effects of using nitrous oxide.
- He or she will instruct you on how to hold the mask over your nose and mouth to create a seal. Only you will be able to hold the mask and control the flow of nitrous.
- You will begin inhaling the gas 30 seconds before a contraction starts; you’ll likely feel the full effect of the nitrous about 50 seconds after you first inhale, so coordinating your breaths with your contractions is key. It may take several contractions before you get the hang of this.*
- Exhale completely into the mask to help with scavenging of the gas. This is to keep too much N2O from escaping into the room. You may be instructed to exhale into the mask for several breaths after you stop inhaling the nitrous.
- When the mask is removed (always by you), the nitrous leaves your body within minutes.
- Continue normal breathing between contractions, or when you take the mask off.
*Note: While it might seem easier to use the gas continuously (nonstop during and between contractions) rather than to attempt to time your inhalations to your contractions, you may experience less dizziness and nausea with intermittent use.
What other natural mamas say about laughing gas in labor
We asked our natural mamas on Facebook to tell their stories of laughing gas during labor. We were thrilled to see how many of you responded! Here are a few of the highs (and lows) of laughing gas experiences.
On that particular hazy feeling:
“I, my sister, and my best friend all used to in our most recent labors and we all thought it was amazing! It doesn’t ‘take away’ the pain per say, but it does something that makes you relax and embrace the burn of each contraction, helps you to ‘not care’ about the labor pains. I felt totally in control the whole time I was using it. I used it through transition and pushing, so probably for about an hour or so.” – Stephanie C.
“I used it during my first labour and thought it gave me something to focus on-maybe a placebo effect could have worked just as well…tasted a bit funny and made me less aware of the pain. The second pregnancy they only allowed it during labour not pushing which sucked. Third pregnancy I swear it wasn’t working, took huge breathes, didn’t feel any different head wise but the nurses took one look at me and said it’s working!” – Gillian V.
“I used it when I started to push. It just gave me an euphoric high. Took the edge off. It didn’t offer me much in pain relief but it did help to calm my nerves.” – Savana P.
On reducing anxiety:
“I used it during my last labor. I had severe anxiety from the labor before that. That labor was 19 hours of active back labor. It was grueling. So I was offered it this time. I waited until I started to panic from the pain. The mask helped me relax enough to focus on my breathing. I was able to sit on a ball and focus on breathing per every couple bounces. As soon as it was time to push, I took it off and was able to calmly deliver the baby. This labor was 4 hours. I really believe it was the biggest help to me for anxiety, which helped me to relax and focus.” – Melody L.
“I used it in transition but didn’t like it while pushing. It helped me get through the last cm or so! I would definitely use it again i felt I needed a little relief. My husband even said he could tell it helped me relax!” – Jessica P.
“I did with my second birth! Game. Changer. I was able to relax through contractions and it made my second birth an absolutely amazing experience, especially because I came into it with a lot of anxiety. My first labor and delivery was extremely long (28+ hours of active labor, plus 3 hours of pushing) and all pain-meds-free. It was awful. Going into my second birth knowing nitrous was an option eased my anxiety and helped me tremendously to relax my entire body as I contracted and pushed.” – Jenn B.
On unpleasant side effects:
“I was desperate for relief so I tried to breathe it in as fast and as hard as I could – of course- I felt like I was hyperventilating and it left me feeling like I couldn’t breathe.” – Mya B.
“Even though it did take the edge off, it made me very dizzy…. I do not plan on using it this time around.” – Bryanna T.
“Used gas with my first but it wasn’t for long. I hated the feeling of losing control of my body. I felt drunk and sick at the same time.” – Ana S.
“I did but it just made me super dizzy! I gave up after a few tries.” – Amanda R.
On helping with a natural birth plan:
“This made all the difference for me! I was in labor for 45 hours due to a posterior cervix that kept me from fully dilating. I was exhausted from hours of painful back labor, and ready to give up on my natural birth plan. That’s when my midwife suggested laughing gas. It was fantastic! It helped me breathe through and relax during my back labor contractions. Within an hour, I was fully dilated. It certainly makes you feel a little loopy, but it’s out of your system within seconds. It does not take away the pain, but it takes the edge off. I felt very present. Once I got to the pushing stage, I stopped using it. I felt in full control.” – Brenna
“Once my contractions got quite severe I used it. It did certainly help with the breathing as you could hear the in and out and the tempo was calming. As the pain intensified, they could not increase the dosage. Would I do it again? Absolutely. It helped with my natural birth at age 45 for my first child. Only side effect was it made my mouth very dry.” – Loretta M.
“I had a drug free labor and birth other than using the nitrous when I was 10 cm, getting ready to push. I didn’t really feel it, the labor cloud was stronger than the nitrous! It did provide me with a ritual while getting through some really intense contractions.” – Ashley H.
Did you use nitrous oxide during childbirth and labor?
As a whole, nitrous oxide can be a great option for laboring moms who need pain relief and emotional support but don’t want the risks (and recovery) of other forms of pain relief.
Do you have your own experience with laughing gas during labor to add? Did it take the edge off? Did you have any unpleasant side effects? Share with us in the comments below.