Nitrous Oxide Analgesia for Child Birth

by Claudia Copeland, PhD

laboring women using nitrous oxideAs a mother who has given birth naturally (no drugs or major interventions), I know firsthand how difficult the natural birth process can be. Though non-invasive techniques like hypnobirthing and acupressure worked wonders to ease the pain of my labor, it was still the most intense pain I have ever experienced.

Many of my friends ardently wanted a natural birth, but then caved in when the pain became too extreme. I have often thought that what so many women could use is a "middle path;" a mild analgesic that could be safely used during birth, with little or no effects on the baby. It would be okay if this analgesic let in some pain. For me, and for many women attempting natural birth, it would make all the difference to have just "a little something to take the edge off."

Nitrous Oxide -- That Little Something

As it so happens, that "little something" is available to women in almost every developed country -- except the United States. The drug is nitrous oxide, or laughing gas. It is mild, has little or no effects on the baby being born, and is used by midwives throughout the world for labor. It is not a strong anaesthetic, but it is effective for many women.

Dr. Mark Rosen, M.D., of UCSF Moffitt Hospital in San Francisco, describes it this way, "Although the efficacy of nitrous oxide has not been well defined and seems limited compared with that of epidural analgesia, it appears to provide analgesia at a level comparable to that of paracervical block and probably better than that provided by opioids. When applied properly, it appears that nitrous oxide inhalation can provide significant pain relief for at least 50% of patients, a conclusion reached 30 years ago."

In the U.S., however, it is currently available only in San Francisco (UCSF Moffitt Hospital) and Seattle (University of Washington Hospital), with approval for future use in one small community hospital in Hawaii (North Hawaii Community Hospital). For the overwhelming majority of women giving birth in the United States, nitrous oxide is not available as a choice.

Affect on Baby

Babies born under nitrous oxide analgesia are not significantly affected by it; Apgar scores, neonatal survival, and neurobehavioral assessments (Neurologic and Adaptive Capacity Score and Early Neonatal and Behavioral Scale) are not significantly different from those for unmedicated birth. It is excreted through the lungs, so in less than a minute, it is eliminated from the baby's body. In contrast, the opiates and cocaine-derivatives used in epidurals are processed through the liver. A newborn baby's immature liver can take months to eliminate the drugs.

Reasons Mothers Choose Nitrous Oxide

Doesn't lead to further intervention: Mothers like nitrous oxide because, in contrast to the epidural, it does not lead to the "chain of interventions" that often ends in cesarean section, which has become the birth method for almost one in every three American mothers.

Nitrous oxide also has no significant effects on the natural progress of labor. When used under standard conditions, side effects are minimal (such as dizziness or euphoria), and there is no significant difference in maternal oxygen saturation compared with completely unmedicated births and births with an epidural.

Self administered: Standard conditions for use of nitrous oxide during labor include a 50% oxygen mixture, scavenging equipment and a one-way valve to minimize escaping gas, and a hand-held mask, so that, if a woman were able to ingest a dose high enough to make her very dizzy or faint, her hand would fall from her mouth and the flow of gas would stop.

Helpful during rapid labor: Judith Rooks, a midwife and advocate for the use of nitrous oxide, states that "it is particularly helpful for women experiencing rapid labor, transition, second-stage labor, and while suturing the perineum. It can be extremely helpful for women who want to avoid an epidural, useful for women who have to wait for an epidural, and a blessing for everyone when there is a sudden, unexpected need for analgesia for an invasive procedure required because of an obstetric emergency."


I have just read that Dartmouth Hitchcock in Lebanon NH is going to start using Nitrous Oxide during childbirth.