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Laughing gas for childbirth is on the rise in the US. What took so long?

Nitrous oxide — or laughing gas — is commonly used during births in other countries. Now it’s starting to be used in the United States.
Inhalation Sedation at Clinic
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/ Source: TODAY

When Laura was expecting her second child, she was excited to learn that her hospital was offering nitrous oxide for labor. She had used it during her first delivery, and she said it helped her cope with her fears about giving birth.

“For me, I really have more anxiety about medical procedures and I am risk-averse,” the 41-year-old from Islip, New York, who asked to have her last name withheld to protect her privacy, told TODAY Parents. “The risks associated with an epidural were more than I was willing to subject myself to.”  

Nitrous oxide — a tasteless, odorless gas commonly known as "laughing gas" and frequently used at dentists' offices — “reduces anxiety and increases a feeling of well-being so that pain is easier to deal with,” according to the American College of Obstetricians and Gynecologists.

In the United States, it's common for people receive epidurals to manage pain during delivery, though sometimes they might choose other forms of pain relief, such as opioids. An epidural relieves pain by blocking feeling, but that can also make moving difficult. Meanwhile, nitrous oxide provides something completely different.

Prior to a contraction, Laura — who gave birth at Northwell Health Huntington Hospital in Huntington, New York — would place the mask on her face and inhale the gas, a blend of 50% nitrous oxide and 50% oxygen. Soon, she’d feel the “anti-anxiety” effect of it. About a minute later, that feeling would wear off.

“You’re cognitively aware of everything that’s going on. If you don’t want the effects of it, you can simply stop using it,” Laura said. “You’re not confined. With the epidural there’s a lot of movement restriction.”

When Laura experienced contractions while using nitrous oxide, she said they felt like “intense pressure” instead of sharp pain.

“For that to hurt less (means) the more that you can relax into it,” she said. “When you’re actively inhaling the gas, you really let go in the moment and then the relaxation following the contraction … it made it easier to tolerate the next contraction.”

What is nitrous oxide or laughing gas?

Some Americans might have heard about the use nitrous oxide during birth thanks to the TV show “Call the Midwife,” which follows midwives working in the East End of London in the 1950s. In the United Kingdom, the use of nitrous oxide during birth is very common — it’s used in 60% of deliveries there, according to a paper in the journal BioMed Research International.

In Sweden, it's used even more often in 70% of births. Other countries, including Finland, Norway, Australia and New Zealand, use it in about half of all births. Nitrous oxide has slowly been increasing in popularity in the United States, though not every hospital is equipped to offer it.

“We are the second hospital on Long Island to offer this. It’s becoming more available,” Laura Jabbour, a certified nurse midwife at Northwell Health Huntington Hospital, told TODAY Parents. “More women are becoming interested in having more control over their birth experience.”

Northwell Health started offering nitrous oxide early this summer. Jennifer Baierlein, a registered nurse and director of the hospital's mother and baby unit, said this provides people with more options when it comes to pain management during delivery.

“It’s nice for our patients, especially our birthing patients, to have options to help them get through this discomfort. Some people choose not to use anything. Some people can go with other more natural methods, such as hypnosis meditation,” Baierlein told TODAY Parents. “It’s something we can utilize in our toolbox to help manage the discomfort.”

Nitrous oxide is not as powerful as other options, but many people find that its calming effects are enough.

“It doesn’t take the pain away, but it does give you a sense of euphoria that helps with anxiety that a lot of women experience,” Jabbour said. “It takes the edge off.”

Who can and cannot use nitrous oxide

Some patients opt to use nitrous oxide early on and then switch to a more powerful pain reliever later.

“Some women will use it as a bridge: ‘I’m not quite ready for an epidural but I could use a little something,’” Jabbour said. “We can try the nitrous oxide. If it’s not cutting it, then we’ll move on to an epidural.”

Others might not feel too much pain during labor, so they might eschew an epidural or other medications — only to realize later that they would like something to help. Some people might not qualify for an epidural because of spinal surgery or low platelet counts, for example, and want something to ease their pain.

“This helps us to give another option for pain control,” Baierlein said. “Another benefit of the nitrous oxide is the onset is pretty quick. But it also goes through your system and it’s out within 30 to 50 seconds.”

That means if someone doesn’t like the nitrous oxide, they won’t feel lingering effects and can still choose other pain relief options.

“We wait a minimum of 15 minutes before we would move onto another form of pain control,” Baierlein said.

Nitrous oxide could also help people who come in with quickly progressing labor who might not have enough time for an epidural. It also allows people to walk as they navigate labor.

“Some women really value mobility in labor where they’re able to get up and walk around and feel the sensation of needing to push,” Jabbour said. “It’s just a little something to help them cope with the pain.”

While a lot of people tolerate nitrous oxide just fine, there are some people who cannot use it, Baierlein said.

That group includes:

  • People who cannot hold the mask to their face
  • People using drugs or alcohol
  • People who do not have consistent oxygenation, with saturation levels below 95
  • People with a vitamin B12 deficiency
  • People who use a continuous positive airway pressure (CPAP) device
  • People giving birth when they are less than 35 weeks pregnant

For those who can use nitrous oxide, though, there’s another big benefit — it’s safe.

“There are no known side effects to mother or baby,” Jabbour said. “It’s just another option that we can offer.”

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