Nitrous Oxide "Laughing Gas" for Labor Pain?

It’s now an option for laboring women at UH MacDonald Women’s Hospital

UH Clinical Update | October 2019

When it comes to controlling labor pain for pregnant women at UH MacDonald Women’s Hospital, everything old is new again. Women delivering their babies there can now opt for nitrous oxide or “laughing gas” as a means of pain control – a practice that was first introduced to medicine nearly 200 years ago. In fact, nitrous oxide gained acceptance after Queen Victoria’s use in labor in 1853 and 1857. 

“Nitrous oxide for labor has been practiced across the centuries,” says Marcie Niemi, MS, RNC-OB, Advanced Practice Nurse for Perinatal Nursing Research & Development at UH MacDonald Women’s Hospital. “It fell out of favor somewhat. Fifty years ago, we weren’t using nitrous oxide at all in the U.S. Epidural anesthesia had been proven safe, and so that gained popularity. But recently, nitrous oxide has started to make a comeback. We wanted to offer women another alternative, another tool in addition to epidural anesthesia and IV narcotics to assist with coping in labor.”

Nitrous oxide is easy for the pregnant patient to self-administer through a tightly sealed face mask, and it has no significant effects on the baby, Niemi says. It also has a short duration of action.

“Nitrous oxide effects also get eliminated very quickly,” Niemi says. “Within a couple of breaths, it’s completely eliminated from the lungs and from the body.”

The best candidates for nitrous oxide, Niemi says, are low-risk pregnant women. It is contraindicated for women with risk factors for vitamin B12 deficiency, including pernicious anemia, celiac or Crohn’s disease, a recent history of gastric bypass or lupus. Also, women receiving magnesium sulfate for preeclampsia with severe features, those less than 35 weeks gestation and those with a history of sleep apnea requiring CPAP are not candidates for nitrous oxide use in labor. 

Part of using nitrous oxide successfully, Niemi says, is being clear with the patient about what it can and cannot do.

“It’s important to manage expectations in the outpatient setting,” she says. “If the patient thinks this is going to eliminate all of their pain like an epidural, it will not. But nitrous oxide may help them cope with the pain. It’s just another tool, another effective option.”

According to Niemi, nitrous oxide is particularly well-suited to helping patients get through short, but uncomfortable procedures, such as the placement of a cervical ripening balloon.

“It’s a procedure that makes some patients uncomfortable and anxious before their induction of labor,” Niemi says. “Nitrous oxide can be used rather than IV narcotics to help the patient cope and reduce her anxiety through that procedure. Then she can put it aside until she needs it again in active labor.”

Another key advantage is nitrous oxide’s ability to keep pregnant patients up and moving – even if they ultimately opt for an epidural.

“If a patient is really set on an epidural and that’s part of her birth plan, we want to provide her with what she wants,” Niemi says. “But nitrous oxide as a bridge can keep her ambulatory a little bit longer. When she’s ready for the epidural, she may have progressed more with her labor. Every labor and delivery nurse and OB provider would say the longer she can be moving, the better. To be upright is certainly beneficial.” 

Ultimately, Niemi says, it’s about providing patients with appropriate options for them and listening to their preferences. 

“We want women to have the birth experience they’ve envisioned, whether through an epidural or nitrous oxide or some combination of the two.”

“The majority of patients want epidurals,” she adds. “There’s no doubt about it. But there are certainly some patients who choose less intervention. Some women want to have that sense of control and some want less intervention for their birth experience. Nitrous oxide provides them that option here at UH MacDonald Women’s Hospital.”

For more information about nitrous oxide as a mean of labor pain control at UH MacDonald Women’s Hospital, please email. Marcie.Niemi@UHhospitals.org.