Before giving birth, I was terrified of labor. To be honest, I wasn’t entirely convinced that the baby was going to come out the way my medical providers said she was. After doing some homework, watching a pretty graphic documentary and taking three months of childbirth classes, I determined that I wanted to have an intervention-free, unmedicated delivery. I felt like my best bet was to be as well-informed and in control as possible.
Unfortunately, the pain relief options available to me (a spinal block or an epidural) didn’t seem like they would leave me in control. Little did I know, nitrous oxide, known as laughing gas, the pain reliever that we associate most with dentist visits, could have helped.
The treatment, which has a 200-year history of use in Europe, was also used in the U.S. in the early 20th century, then was quickly replaced by more potent analgesia. Laughing gas for labor is now making a resurgence in the U.S. as more birthing people are choosing it to manage pain during birth—and it’s becoming more available in hospitals and birthing centers nationwide. – Allaya Cooks-Campbell
What is laughing gas?
Before you start humming the music from “Little Shop of Horrors,” you should know that nitrous oxide, or laughing gas, is the same gas that you get when at the dentist. The clear, odorless gas is delivered through a mask in a strict ratio of 50% oxygen, 50% nitrous oxide, according to Drs. George Mussalli and Jaqueline Worth of Village Obstetrics. This 1:1 ratio means that you won’t be singing any show tunes—and you can actually administer it yourself.
The name ‘laughing gas’ is a bit of a misnomer—there’s a slight euphoric feel, but it isn’t likely to make you laugh your labor pains away. Instead, in small doses, such as when used in labor, laughing gas acts as a pain reliever (analgesic), and can reduce anxiety. Patients describe the effects of breathing in the gas as helping them simply notice their pain, while caring less about it. In larger doses, laughing gas can be used in combination with other drugs to provide a loss of sensation (anesthetic).
What are the benefits of using laughing gas for labor?
Using a mask similar to the ones used for asthma treatments, laboring mothers can inhale at will. It’s very different from the “all-or-nothing” approach that an epidural and spinal block provide. With either of the standard pain relief options, patients often worry about things like “is it too early in my labor to get pain relief? Is it too late? What if I have a bad reaction to it?”
According to The American College of Obstetricians and Gynecologists (ACOG), nitrous oxide “reduces anxiety and increases a feeling of well-being so that pain is easier to deal with. Nitrous oxide is mixed with oxygen and inhaled through a mask. A woman holds the mask herself and decides when she will inhale. It works best when a woman begins inhaling 30 seconds before the start of a contraction.”
Nitrous oxide has the benefit of being available at any point in labor, even after you deliver the baby. That means that you can have something to distract you from the post-delivery cleanup, stitches and that fundal massage.
What are the risks of using laughing gas?
Leaving someone who’s in pain in charge of their own pain relief sounds worrisome. So is it possible to overdo it? Dr. Mussalli asserts that it’s not. “You have to create a very tight seal with the mask,” he says. “If you’re too groggy, you won’t be able to hold the mask. It’s kind of its own fail-safe.”
Nitrous oxide also addresses some of the other concerns parents often have around the use of narcotics and anesthesia during labor. The substance leaves the mother’s system fairly quickly and seems to have no impact on the baby’s heart rate or APGAR scores.
The side effects also seem to be mild, with patients rarely reporting adverse reactions such as nausea, vomiting and unsteadiness. Dr. Mussalli states that given the relatively flexible nature of this particular pain relief option, it would be an ideal way to soothe patients with anxiety, fear of needles and those who were waiting for their window to receive an epidural.
Making laughing gas part of your birth plan
If this seems like an option that you’d be interested in pursuing, Drs. Mussalli and Worth advise you to talk to your doctor or midwife about laughing gas early in your prenatal care. Nitrous oxide is becoming more widely available, but it’s not offered everywhere yet. “However, the equipment and the gas are not very expensive for the hospital to obtain,” Dr. Mussalli says.
But be sure to check the costs before you add it to your birth plan, as there’s no standardized billing code for nitrous oxide. In some instances, laughing gas is offered at no cost or billed directly to insurance, but in other cases, you may be saddled with a hefty bill, depending on the way it’s coded.
It’s worth exploring, though, as laughing gas offers a pain relief option that both minimizes impact on mother and baby, while empowering more women to be in control of their birthing choices—which is no laughing matter.
A version of this story was originally published on Feb. 14, 2017. It has been updated.