The vast majority of women who go through child labor report that it hurts, and it hurts a lot. Any medical intervention to ease pain is welcomed. It seems that nitrous oxide, commonly known as “laughing gas,” once used long ago to ease the pain of labor, is starting to make a comeback.
History of use
Nitrous oxide or “laughing gas” was first discovered in 1771 as an odorless, colorless gas. It was considered a real medical breakthrough in the field of anesthesia for medical pain relief and prevention.
It is the same gas used in most dentists’ offices today, but when used to ease the pain of labor, it is administered at lower dosages. At a dentist’s office, the dentist controls the amount, often giving up to a 70 percent mixture of nitrous oxide and 30 percent oxygen. In the delivery setting, it is a fixed 50/50 percent mixture of nitrous oxide and oxygen, and the mixture is controlled by the patient in labor, usually through a mouthpiece or mask. This is called “self-administration.”
Nitrous oxide was widely used for anesthetic purposes in medical settings around the turn of the century until other, more effective medicines were developed. The first documented use of nitrous oxide in labor was in 1881, but it was not widely used for relieving the pain of labor until the 1930s.
It is unclear why nitrous oxide fell out of favor in the U.S. around the 1970s and ‘80s, but it is believed that, in part, it was replaced with the more effective use of anesthesia “epidurals,” where a small amount of anesthetic and/or narcotic pain reliever is injected directly into the spinal canal, producing anesthesia (numbness, lack of pain) or analgesia (decreased pain, pain relief).
“Having delivered almost 10,000 babies, I used it [nitrous oxide] often and with good results from about 1963 to 1970. Epidurals became more popular, and the use of nitrous oxide diminished,” reports Charles E. Crutchfield Sr., M.D., renowned obstetrician and gynecologist.
Current use trends
Interestingly, nitrous oxide is currently and widely used around the world to relieve the pain of labor. Women in the United Kingdom, Canada, Australia and Finland use nitrous oxide at levels approaching or exceeding 50 percent of all deliveries.
Although the University of California-San Francisco has used nitrous oxide to ease the discomfort of labor for over 30 years, less than five percent of U.S. hospitals offered nitrous oxide for labor pain relief in 2012. Its popularity is now on the rise.
“We use it on a regular basis at Hennepin County Medical Center during childbirth,” comments Randy Borrero, M.D., family medicine resident. “My colleagues report they are using it at HealthEast hospitals, too. It decreases both pain and anxiety and gives laboring mothers a greater sense of control. Most patients who use it, really like it.”
The key is that nitrous oxide reduces pain (analgesia) but does not eliminate pain (anesthesia) like an epidural. Once the gas is inhaled, the effects can last 30-60 seconds. As soon as room air is breathed, the analgesia quickly fades.
It can be timed and used to ease the pain of contractions. The woman really has an increased sense of control, because it is only used as a self-administered treatment. Many report that they are still aware of the pain but can distance themselves from it.
Nitrous oxide is also a very effective anxiolytic; that is, it can effectively reduce the anxiety associated with childbirth. Some patients do feel a bit nauseous with the laughing gas, but if it is a problem, they can stop using it.
With epidurals, the anesthesia can last several hours, and many patients complain of feeling “loopy, drugged.” They also say that the total numbness that comes with an epidural can affect their ability to push when needed. In fact, nitrous oxide is not meant to replace epidural. It is just another option for mothers who want to ease the pain of labor.
Nitrous oxide is generally considered safe, and even though it crosses the placenta, it quickly dissipates when the baby starts to breathe. The use of nitrous oxide in dentists’ offices throughout the U.S. supports a strong safety profile.
There are still many questions to be answered as nitrous oxide gains popularity, such as how will insurance cover the payment when it is used (it is much less costly than an epidural) or who will administer or supervise the administration of nitrous oxide. Many midwives support the use of nitrous oxide, but not all doctors are “on-board” yet.
Above all, patient safety is the main concern. As the saying goes, “What’s old is new again”; more and more birthing centers are offering nitrous oxide as an option for laboring mothers who want pain relief and to decrease anxiety. If you are expecting, be sure to discuss with your doctor the availability, advantages and disadvantages in using laughing gas (nitrous oxide) during your labor and delivery.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.