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Nitrous Oxide During Labor

HHC Maternity Laughing GasHartford Hospital is among the few hospitals in Connecticut that offers nitrous oxide to reduce pain and anxiety during labor.

Nitrous oxide, otherwise known as “laughing gas,” is used in dental offices. It is used in a lower concentration for women in labor. The gas is odorless, tasteless and provides mild relief of labor pain.

To use nitrous oxide, you inhale through a mask you hold over your nose and mouth. The gas only flows when you inhale, so you have control over the amount used.

Nitrous oxide is used throughout the world for labor pain and is effective for many women.

Advantages

  • May enable you to limit, postpone or avoid narcotic or epidural pain medication.
  • May enable you to avoid, postpone or limit narcotic or epidural pain medication.
  • Can be used at any time in labor right up to the birth of your baby.
  • Increases your sense of personal control because you choose when to use it.
  • Can help ease anxiety during labor.
  • Does not appear to interfere with the progression of labor or your ability to push.
  • Does not appear to affect the baby at birth.
  • Leaves your system more quickly than other types of pain medication used in labor.
  • There are a few medical conditions that may prohibit the use of nitrous oxide.
  • Talk with your healthcare provider about pain relief options during your labor.

Safe-Use Requirements

  • The nitrous oxide concentration cannot exceed 50 percent.
  • It must be self-administered by the patient holding a mask to her face.
  • The equipment releasing nitrous oxide must have a scavenger system (to gather gas exhaled by the patient) and a demand valve.

FAQ

Q: What is nitrous oxide?
A: Nitrous oxide is an odorless, tasteless gas that is commonly used in dental offices, where most people know of it as “laughing gas.” The blend used in laboring women is different and does not have the same effect. It is not anesthesia. Nitrous oxide use for labor pain is a mixture of 50 percent nitrous gas and 50 percent oxygen that is inhaled through a mask. It is widely used throughout the world for labor pain.


Q: How does nitrous oxide work to relieve pain during labor?
A: Nitrous oxide can help you lessen both pain and anxiety during labor. It is self-administered by inhaling through a mask. You will hold your own mask or mouthpiece and begin to inhale the gas mixture about 30 seconds before a contraction begins. Starting to breathe the gas before a contraction begins helps the gas reach its peak effect at about the same time as the contraction reaches its peak, providing the greatest relief.

Q:
How much does nitrous oxide help with labor pain?
A: How well nitrous oxide works is different for every woman, but at least 50 percent of the women who use it say it is helpful and they would use it again.

Some women say that it “takes the edge off” the peak of contractions, enough so that they are able to cope with their labor better. Others report more pain relief.

Nitrous oxide also lowers anxiety. This helps you feel less tense during contractions, which also may help you cope with pain better. Some women do not find nitrous oxide helpful enough or do not like the way it makes them feel. They can choose to try other options to help their labor pain. Other pain relief methods still can be used after using nitrous oxide.

Q:
How will I feel while I am using nitrous oxide?
A: You might feel drowsy, lightheaded or a little silly while you are using nitrous oxide. This is why it got the name “laughing gas.” Because you may feel a little unsteady, a family member or staff person should always be in the room while you are breathing the gas. Some women feel nauseous, and other medication can be given to make the nausea go away. Rarely, women say they feel restless or confused at times.

Q:
Can I be out of bed and still use nitrous oxide?
A: Yes, you may be out of bed and use the nitrous oxide. However, because you may feel a little unsteady, you will be asked to call your nurse for assistance when you get out of bed.

Q:
Are there any effects on my baby?
A: While nitrous oxide does cross the placental barrier, based on available literature, it does not appear to have a negative impact on the fetal heart rate during labor, APGAR scores at birth or the initiation of breastfeeding. Studies related to the long-term effects of nitrous oxide are currently under way.

Q:
Is any extra monitoring required?
A: There is no extra fetal monitoring required when nitrous oxide is, however, your heart rate, respiration and oxygenation will be monitored closely for the first 15 minutes of use and then at regular intervals as for any laboring patient.

Q:
Can I use nitrous oxide and narcotics at the same time?
A: No, the combination of narcotics or sedatives (whether by mouth or IV) and nitrous oxide can slow your breathing so they cannot be used together. You must wait at least two hours before receiving nitrous oxide if you’ve been given a narcotic or sedative.


Q:
Do I have to choose between using nitrous oxide OR having an epidural?
A: No. Nitrous oxide can be used throughout the entire labor. You can, however, move to a different type of pain relief such as an epidural if you find you need to change to something else. But should you decide for an epidural, you must wait 20 minutes before the epidural is placed.


Q: Are there any reasons I could not use nitrous oxide?
A: You cannot use it if you:

  • Are unable to hold your own mouthpiece or facemask.
  • Have received a dose of narcotics in the past two hours prior to starting nitrous oxide.
  • Have a B12 vitamin deficiency (using nitrous oxide could cause a severe form of anemia).
  • Have rare medical conditions that are identified by your provider.​

Sources: American College of Nurse-MIdwives (2013. Hartford Hospital (2016). Nitrous Oxide For Use During Intrapartum/Immediate Postpartum Period.