Nitrous oxide — commonly called laughing gas because it creates a feeling of euphoria — is well-known as a sedative used during dental procedures. But it is now being used to manage pain that leads to a much more joyous event: childbirth.
There are a few big benefits to nitrous oxide during childbirth. The gas can be administered quickly, releasing endorphins and dopamine in a woman’s brain to provide pain relief during labor. Plus it is eliminated from the body quickly, with few side effects.
The blend of 50 percent nitrous oxide and 50 percent oxygen is inhaled through a mask that the woman holds in her hand, so she is free to inhale it only when she needs it, giving her control. This is different from its use in dental procedures, where the mask is fastened to the face of the patient and provides a continuous flow.
The gas has no known effect on the baby and may cause only minor side effects such as temporary nausea or dizziness for the woman using it, says Allison Manko, MSN, CNM, co-director of The Nurse-Midwifery Group of Swedish Covenant Medical Group, which has been offering nitrous oxide as an option in its Family Birthing Center since early September 2017.
Because the gas begins working within seconds after it is inhaled, a woman can time it to her contractions. The effects begin to disappear as soon as the woman stops breathing it, and are completely gone within a few minutes.
The nitrous oxide unit is mobile, allowing the woman to move around and leading to an easier labor. “She can change positions, lie on her side, sit on the birth ball or be on her hands or knees,” Manko says. “When the woman can change positions, it helps the baby come down into the pelvis and also helps the natural process of labor and the mom’s comfort.”
At least 60 percent of women in the U.S. choose to have an epidural during childbirth. An epidural effectively blocks pain, but it also blocks feeling in a woman’s lower body so she usually must remain lying in bed and might not have the ability to push. With an epidural, contractions may slow down and births may take longer. There’s a chance that babies might not find the right position for delivery and are more likely to be delivered with vacuum suction or forceps.
If women who are using nitrous oxide during labor become overly exhausted or find the pain too intense, they can then have an epidural. Women can also use nitrous oxide to ease the pain of post-partum procedures such as repair of lacerations.
The American College of Nurse-Midwives’ position statement, issued in 2009 and updated in 2016, advocates for the availability of nitrous oxide as an option for pain management in labor. “It is an inexpensive, simple, reasonably safe and effective analgesic,” the group says.
The use of nitrous oxide and oxygen during childbirth is not new, and it has been widely and safely used in Canada, the U.K. and other countries for many years. It is now growing in popularity in the U.S. and is used in about 500 hospitals and birthing centers, says Mike Civitello, sales manager at Porter Instrument, the manufacturer of Nitronox, an FDA-registered medical device designed to administer a fixed 50/50 mixture of nitrous oxide and oxygen for women in labor.
Using nitrous oxide helped Chicagoan Adriana Mira-Bueno achieve her goal of a more natural childbirth. Mira-Bueno chose to give birth to her second child at the Family Birthing Center at Swedish Covenant Hospital because she knew they offered natural childbirth. She had an epidural with her first child and wanted to have a birth free of medications for the second one, she says. Nitrous oxide provided her with pain relief when her labor was longer than expected.
“I was in early labor for six days, so I was in so much pain. I was losing it when I finally went to the hospital,” she recalls. “The nitrous oxide took the edge off. I was back to feeling like myself, and I was able to smile again. I was able to walk around a little bit and use the [birthing] tub. I never felt nauseous. I felt a little bit dizzy, but not to the point where I was going to fall down because I could control how much I inhaled.”
Nitrous oxide is not only safe and effective, but also economical. Nurses rather than anesthesiologists administer it, so the cost is minimal. “Right now there is no billing code for it,” Manko says, “so some hospitals are billing an administrative fee between $100 and $200, but for the moment we’re not billing for it.”
Manko cautions that nitrous oxide is not recommended for certain women, including those who cannot physically hold their own mask and women with a known vitamin B12 deficiency, among others.
The growing popularity of nitrous oxide gives women who want to experience natural childbirth an additional gentle option to manage their pain. “The goal,” Manko says, “is to leave women empowered by the birth.”