Laughing gas? seriously?

"I loved not having the side effects of an epidural after my delivery but was able to breathe in gas and air while getting stitches!"

- McCulloch February 2014

Nitrous Oxide

Nitrous Oxide for Pain Relief in Labor
Nitrous oxide is offered in many other countries (such as Great Britain, Australia, Canada, the Netherlands) for pain relief in labor. It is extremely safe and quite effective. Nitrous oxide (mixed with 50% oxygen) is a gas that you administer to yourself, so you control when and how you use it.  Here are a number of links you may want to check out for more information about nitrous oxide for pain relief in labor.

Wikinut Blog Post by Dr. Copeland
Australian blog post discussing why nitrous oxide has not been readily available in the U.S., despite its widespread use in many other countries, including Australia.  It focuses on the diversity of viewpoints of pregnant women and the type of birth they want, and that while some women want a completely anesthetized birth, and others want completely unmedicated, there are many who would like something in between, and this is where nitrous oxide can be very helpful. Blog Post by Libby Copeland
This blog post is an introduction to the return of nitrous oxide for laboring women in the U.S., describing it as a "middle ground" option for pain relief.

Laughing Gas For Labor Pain - Why Not?
This older article (2010) by WBUR (an NPR affiliate) questions why nitrous oxide is not offered to laboring women and provides basic information about risks and benefits.

Gas is No Laugh at Vanderbilt
This video discusses how nitrous oxide is being used at Vanderbilt University Hospital, one of the first three hospitals to offer this service in the United States (in modern times, anyway).  A mom is featured on the video who used nitrous oxide in her labor and she discusses her experience.

Laughing Gas at Vanderbilt
This is another great video about the use of nitrous oxide at Vanderbilt, and features the same mother as the previous video, but from a different interview.

Laughing Gas Bringing Smiles to More Women in Labor
This article and video feature Judith Bishop, CNM, a midwife at University of California at San Francisco Hospital, the first U.S. hospital to reintroduce nitrous oxide for laboring women.  Because it was published in 2011, some of the information is out-of-date (for example, it says the equipment to provide nitrous oxide in labor is not available, but it is now).

Entonox (gas and air)
In England, nitrous oxide is often referred to as "gas and air" or by the brand name of it's equipment supplier "Entonox."  This site provides basic information for moms-to-be in Britain about the nitrous oxide that is available to all laboring mothers in that country.

Nitrous Oxide Returns for Labor Pain Management
This article from Ob.Gyn.News  June of 2013 features a video Judith Bishop, CNM (a pioneer in the rebirth of nitrous oxide) from UCSF.  She discusses why a few hospitals are reviving the use of nitrous oxide for labor, and how nitrous oxide fills a gap in the available pain relief options for laboring women.

ACNM's Position Statement
The American College of Nurse-Midwives has endorsed the safety of nitrous oxide for use in labor, and they recommend it be available to all appropriate laboring women.

Nitrous Oxide as Labor Analgesia - Clinical Implications for Nurses (pdf)
This very comprehensive article is a little technical, but still very readable.  It covers all aspects of nitrous oxide use in labor, including which women are candidates for nitrous oxide, history of use, safety, side effects, effectiveness, and many other issues.  If you have the time, this is a great article.

Cochrane Library: Pain Relief for Women in Labor
Cochrane Systematic Reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions in maternity care.  This link will download a file (but it is safe, don't worry) with the Cochrane Library's information on various types of pain relief in labor.  The Abstract and Plain Language Summary will probably be most helpful, but if you really want the scientific nitty-gritty, the rest of the 160 pages of this report should give you all you ever wanted to know. In this review, nitrous oxide in labor is referred to as "inhaled analgesia."

Cochrane Library: Press Release on Use of Nitrous Oxide in Labor
And here, in a nutshell, is what the Cochrane Library has to say about the use of nitrous oxide in labor.

For the more scientifically inclined, here are some articles about using nitrous oxide in labor from medical journals:

Nitrous Oxide for Labor Analgesia: Expanding Analgesic Options for Women in the United States
Michelle R. Collins, PhD, CNM, Sarah A. Starr, MD, Judith T. Bishop, MSN, CNM, Curtis L. Baysinger, MD Reviews in Obstetrics and Gynecology, Vol 5 No. 3/4 2012.

Abstract: Nitrous oxide (N2O) is a commonly used labor analgesic in many Western countries, but is used infrequently in the United States.  The University of California at San Francisco has been offering N2O for labor analgesia for more than 30 years.  Vanderbilt University Medical Center recently began offering N2O as an option for pain relief in laboring women.  Many women report that N2O provides effective pain relief during labor and argue that it should be made more widely available in the United States.  This article discusses the use of N2O for pain management during labor, including its history, properties, clinical indications, and use and environmental safety issues.  Practical issues regarding implementation of N2O service in a medical center setting are also discussed.

Safety and Risks of Nitrous Oxide Labor Analgesia: A Review
Judith P. Rooks, CNM MPH MS. Journal of Midwifery and Women's Health, Vol 56, No 6, November/December 2011. Discussion: Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.

Maternal Expectations and Experiences of Labor Analgesia With Nitrous Oxide
Hajar Pasha, Iranian Red Crescent Medical Journal, 2012 December; 14(12): 792–797.  This study out of Iran is believed to be the first randomized study of the effectiveness of nitrous oxide labor analgesia. In the study, 98 women in active labor were randomized into two groups, one which was allowed the use of nitrous oxide during labor, and the other which was not (control).  The translation into English makes the study itself difficult to read, but here are the main conclusions:

  • 91.8% of laboring women receiving nitrous oxide gas had less labor pain, and 98% were satisfied with it.

  • In the two groups, mother's rated their pain as follows:

Pain Rating
Nitrous Group
Non-Nitrous Group
Moderate or less
Very Severe

  • 49% of women receiving nitrous oxide described their experience as a Good or Excellent, and 80.9% indicated they will request it again in a future delivery.
  • Side effects were mild in most patients (63%).