Using Nitrous Oxide in Labor
Nitrous oxide analgesia, also known as “laughing gas,” is a safe, effective, and noninvasive form of pain management available at our birth center.
What is nitrous oxide?
Nitrous oxide is a tasteless and odorless gas that can be inhaled for pain relief. In the United States it is most commonly used at the dentist. You may have inhaled it to help you stay relaxed while getting a filling.
Its use during labor is relatively new in this country, but it has been a popular option since the 1930s in countries like Australia, Canada, Finland, and Sweden. In fact, it’s first recorded use during childbirth dates back to 1881!
It has a long and established record of safety and effectiveness, and has the fewest side effects of any of the pain relief medications available for labor.
In some countries, as many as 8 in 10 people use nitrous oxide during labor, and most people who use it say that they were satisfied with the amount of pain relief it provided, and that they would use it again in future labors.
How does nitrous oxide work?
When used for pain relief in labor, the gas given is a mixture of 50% oxygen and 50% nitrous oxide (N2O). The gas is fully self-administered and only used during contractions.
Nitrous oxide is a form of analgesia — a pain medication that works systemically throughout your whole body. It alters the perception of pain, but dose not remove or numb pain.
According to the position statement on the use of nitrous oxide in labor from the American College of Nurse Midwives, “Nitrous oxide works by increasing the release of endogenous opioid polypeptide compounds (endorphins), corticotropins, and dopamine that are produced in the mother’s brain.”
These chemicals work together to reduce anxiety, lessen tension, and create a sensation of well-being. So while nitrous doesn’t get rid of pain altogether, it can take the edge off of pain and make you care less about it.
Perception of pain is more acute when you feel tense, scared or anxious, so the calming effect of nitrous oxide can also be very helpful for the labor process. While laughing gas won’t actually make you laugh through your contractions, it may help you cope with the contractions more easily and efficiently by encouraging relaxation.
Side effects and risks
For the laboring person, nitrous oxide may cause nausea, vomiting, drowsiness, dizziness, and hazy cognition. If you experience any of these side effects, you can simply stop inhaling the gas. It will clear your system in about three minutes and the side effects will subside.
There are no known side effects of nitrous oxide on the baby. Research has shown that use of nitrous oxide has no effect on fetal heart rate during labor, nor on newborn respiration or APGAR scores after birth.
Nitrous oxide does enter the bloodstream and can cross the placenta, but this is not a concern since the gas is quickly cleared from both the maternal and fetal circulatory systems when the gas is not being actively inhaled.
Nitrous oxide has not been shown to affect the progress of labor in any negative way, and there is no increased risk of cesarean birth.
How to use nitrous effectively
If you find you would like additional help coping with the pain of labor, if you are struggling to release tension, or if you are tired and need help relaxing and resting, you might find that nitrous oxide is an effective tool.
Nitrous can be used at any stage of labor, and can also be used in the immediate postpartum period to help relieve pain if a repair to your perineum is necessary.
While the majority of people who opt for nitrous oxide find it helpful, it may take you three or four contractions to get the hang of it, so don’t give up too soon!
It’s important to remember that the more nitrous oxide you take into your lungs, the stronger its pain relieving effects will be. You want to start inhaling the gas about 30 seconds before a contraction starts. If your contractions are coming regularly, your support team can help you keep track of when it is time to apply the face mask. If your contractions are less regular, you can start using the gas at the first sign that a contraction is building.
Hold the mask to your face with firm pressure. You want to create a tight seal between your skin and the mask. Then breathe slowly and deeply, concentrating on your breath. You might find it is helpful to count, aiming for an inhalation that lasts for a slow count of 5. Your partner can encourage you to take deep, long breaths by breathing slowly along with you or counting out loud to set the pace.
The gas itself is odorless, but the mask may have a plasticky smell that some find unpleasant. If you are bothered by the smell try closing your eyes and imagining you are at the beach blowing up a large rainbow colored beach ball to provide a more pleasant context.
It can be used while standing, sitting on a birth ball or a rocking chair, or while in the birth tub. You might find that you feel a bit unsteady on your feet while inhaling the gas (remember, dizziness is a side effect), so you may wish to sit or stand in one place during a contraction, but when the contraction has ended and you stop inhaling the gas you are able to walk around and change positions as desired.
If at any point you start to feel too dizzy or sleepy, take a break from using the gas and inhale a few deep breaths of normal room air.
After your contraction ends, you will stop inhaling the gas and feel it quickly leave your system.
Self-administration is key to safely using nitrous in labor. It allows you to control the amount of gas you receive, to use it only when needed, and to ensure you don’t become overly drowsy. If the gas begins to make you feel sleepy, the hand holding the mask in place will slip down and you will stop inhaling the gas, naturally self-regulating your intake. Additionally, being in control of your pain relief contributes to a sense of empowerment, which can lead to a more satisfying birth experience.
Further Reading:
ACNM Position Statement: Nitrous Oxide for Labor and Birth Analgesia
Nitrous Oxide for Labor Analgesia: Expanding Analgesic Options for Women in the United States
Top Ten Misconceptions About the Use of Nitrous Oxide in Labor
Nitrous Oxide As Labor Analgesia
Nitrous Oxide for Pain Relief in Labor
