As baby's birth nears, you've surely got a lot of questions on your mind. Likely one of the biggest — especially if this is your first baby — is how you'll manage labor pain. Maybe you've looked into the epidural or a spinal block or Demerol, or even a drug-free birth.
And in doing your research, you might have also come across a pain relief option that sounds a little funny: laughing gas.
Also known as nitrous oxide, this inhaled gas is more commonly associated with getting cavities filled than pushing out a baby. In the U.S., nitrous oxide used to be common during labor — but it was often used in conjunction with narcotic painkillers, causing complications. Today, although doctors rarely turn to the narcotics that caused the problems, only about an estimated 1 percent of women in the U.S. use nitrous oxide during labor. That said, in countries including the UK, Australia and Canada, more than half of women rely on nitrous oxide throughout labor to take the edge off of pain and anxiety. And in the US, more large hospital systems — such as Vanderbilt University Medical Center — have begun offering nitrous oxide to women. So why do some people in the U.S. say laughing gas should be available more widely? And what should you know if you're considering it as an option?
What is nitrous oxide?
Nitrous oxide is a clear, colorless gas that's usually mixed 50/50 with oxygen for laboring moms. When breathed in, it leads to slight feelings of euphoria, relaxation and detachment from your current situation. In small doses — like what dentists use to help patients relax during a cavity filling — nitrous oxide is considered an analgesic, or pain relief. At much higher doses — sometimes used in operating rooms in combination with other drugs — the gas can be an anesthetic, meaning it leads to loss of consciousness.
How does laughing gas work during labor?
Unlike an epidural, laughing gas won't completely numb any parts of the body. And it won't significantly relieve pain, like narcotics do. Laughing gas is more often described as a disassociation from pain: You might still feel pain, but you won't be as bothered or anxious about it.
There's not much you need to do to prepare for laughing gas — it's fine to eat and drink like usual up until labor. You won't have to wait for an anesthesiologist to set you up (like you do with an epidural); a trained nurse can show you how to breathe through the mask. When and how much of the drug you take is up to you, since you'll be holding the mask and can remove it to breathe regular air whenever you want.
Benefits of Nitrous Oxide
In places where nitrous oxide is frequently used in labor and delivery wards, practitioners report that it helps women by both easing pain and lessening anxiety. Laughing gas can:
Help you to relax and stay in position while a doctor is setting up an epidural (which can cause discomfort and/or anxiety, since it involves putting a small tube into the spinal column).
Ease needle phobia if you're uneasy about having an IV placed.
Offer a small amount of pain relief during the most painful stages of labor and pushing if you aren't using other pain-relief medications (practitioners often recommend taking a breath of the gas about 30 seconds before a contraction starts to get the maximum effectiveness).
Help you to relax and concentrate on your brand new baby while your practitioner inspects the perineum or sews up tears after labor.
Nitrous Oxide vs. Other Pain Relief Options
A few benefits of the epidural versus other pain relief options:
It's quick to start: Unlike some pain relief techniques, you'll begin feeling the effects of the drug after taking just a few breaths.
You can stop at any time: Similarly, if you aren't enjoying the effects or don't feel it's helping you anymore, simply breathing regular air for a few minutes makes the effects disappear.
There are usually fewer side effects. Compared to narcotics or epidurals, since the drug is so short-lasting, most people experience fewer side effects — it doesn't cause drowsiness or cloudy thinking after it's worn off, for instance.
Possible Risks
Experts generally agree that, for most people, a small amount of nitrous oxide is relatively safe. The side effects are similar to those from narcotics, though they're shorter-lasting. Some women feel dizzy or nauseous while they're breathing the gas until a few minutes after they stop.
Although research is still ongoing, past studies have found nitrous oxide has no effects on the health of a baby at birth or a newborn's alertness or ability to breastfeed. That said, researchers who scoured the literature in 2012 found 58 studies on the use of nitrous oxide in labor, but only six were conducted in the U.S., and most were considered poor quality studies because they included too few women or didn't use standardized methods. In addition, there aren't many studies on long-term effects. This lack of research has made some clinicians hesitant to use the gas, especially since other well-studied options for pain relief already exist.
Who Can't Use Laughing Gas During Labor
If you have any of the following conditions, your doctor likely won't recommend nitrous oxide:
Severe vitamin B12 deficiency (the gas can lower B12 levels, so if they're already very low, that can be dangerous)
Musculoskeletal disease (you need to be able to hold the nitrous air mask yourself)
Collapsed lungs or past gastric bypass surgery (these can lead to air pockets in your body, which nitrous oxide can enter and cause to expand even more)
Is It For You?
Just as every pregnancy is different, every birth is unique, too — and moms have a variety of ideas about how they want their experience to go down. You may, for instance, want to feel as little pain as possible; or it might be more important to experience all the sensations of labor, including pain. If you're looking for pain relief that's faster-acting and has fewer side effects than narcotics or an epidural, laughing gas might help you get through labor.
Even if you think you want to try nitrous oxide, you'll have to ask your healthcare practitioner whether it's an option — it's still only offered for birth at a few hospitals and birthing centers around the country, although the numbers are growing. Labor and delivery wards need special equipment that can mix nitrous oxide with oxygen (and it's different equipment than what's used in dentist's offices because it's a slightly different ratio of laughing gas to oxygen), as well as training and protocols for their nurses.
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