Why Is Laughing Gas for Labor Still Not the Norm in the U.S.?

Laughing gas can relieve labor pain without the side effects and limitations of an epidural, so why isn't it more popular in America?


Most mothers-to-be know about popular ways to relieve labor pain: epidurals, spinal blocks, and medications like Demerol. But did you know that nitrous oxide, commonly known as "laughing gas," is an option in some hospitals and birthing centers? Yes, this is the same odorless, colorless gas used during dental procedures!

Nitrous oxide has long been a go-to labor pain management tactic in countries like Canada, Australia, the United Kingdom, and the rest of Europe, says Jennifer Butt, M.D., FACOG, an ob-gyn at Upper East Side Obstetrics & Gynecology. It was also relatively common in America until the 1970s, when epidurals became commonplace.

High amounts of nitrous oxide function as a weak anesthetic. But in smaller doses—like the blend of 50% oxygen and 50% nitrous oxide given to laboring moms—laughing gas has pain-relieving and anxiety-reducing qualities.

Laughing gas for labor is self-administered, meaning you can position the mask over your own nose/mouth whenever you'd like, says Adrienne L. Simone, M.D., who wrote The New Rules of Pregnancy with Jaqueline Worth, M.D. and Danielle Claro. There are plenty of other benefits to laughing gas for labor as well, including the low cost, ability to move around during use, rapid pain relief (usually within 30-50 seconds), and fewer side effects than epidurals and narcotics.

Despite all the benefits, however, only a few hundred American hospitals currently offer laughing gas for labor. This is an increase from 2011 when only two offered it, but it's definitely not widely available. "So why is laughing gas for labor still not the norm? It poses a whole set of new situations during labor that can be tricky to manage. We spoke with experts to explore the topic."

It’s Not Super Effective

Unlike an epidural, which numbs the body below the injection, laughing gas doesn't completely block pain. Instead, it makes everything feel less severe and promotes a sense of relaxation. What's more, "some women may not respond to the medication at all or very minimally," says Dr. Butt. In fact, those who receive laughing gas decide to get an epidural most of the time, according to findings from the American Society of Anesthesiologists. "The scientific literature looking at nitrous oxide use for labor pain is poor, so many of the recommendations come from clinician experience and expert opinion," elaborates Dr. Butt. "The general consensus is that neuraxial anesthesia, like an epidural, is more effective."

Timing is Everything

Once you start breathing laughing gas, it takes 30-50 seconds to feel the full effect. Therefore "the gas must be timed properly with the contractions," says Dr. Simone.

It Could be a Workplace Hazard If Not Managed Properly

When patients breathe out, nitrous oxide is released into the air, causing nurses and healthcare workers to inhale it. According to the Centers for Disease Control and Prevention (CDC), excessive exposure to laughing gas may have "short-term behavioral and long-term reproductive health effects." Proper ventilation helps with the issue, as does making sure the patient exhales into the mask.

It Creates More Work for the Laboring Woman

When getting an epidural, an anesthesiologist inserts the IV into your spine, and you're pretty much confined to the bed during labor and delivery. With laughing gas, you have to actively bring the mask to your nose/mouth whenever you need pain relief. Nobody else can administer it for you for safety reasons. The action can get exhausting, especially when you're in the midst of a contraction.

You Can Get Drowsy

Common side effects of laughing gas include nausea, vomiting, and dizziness. The medication can also make you feel drowsy and disassociated, which isn't ideal for women who want to stay alert throughout labor and delivery. "There is a dose-dependent relationship such that the more a patient uses it, the more drowsy they can feel," explains Dr. Butt.

There’s Not Much Research on It

"Although the mechanism of action of nitrous oxide is not fully known, it is generally thought to be safe for the mother and fetus," says Dr. Butt. A 2011 study from J Midwifery Womens Health confirms this fact: "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," the study states. Even so, Dr. Butt mentions that more research is needed on the topic, especially about long-term complications.

Limitations Exist

You shouldn't take nitrous oxide if you have a vitamin B12 deficiency, since the laughing gas lowers your levels of the vitamin. Also avoid nitrous oxide if you have had inner ear surgery or gastric bypass surgery, which may cause gas to collect in the body. Dr. Simone adds that sleep apnea and high BMI are other medical limitations. Ask your doctor for more information.

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