Nitrous Oxide: Safely Taking the Edge off of Labor

One of the highlights of the American College of Nurse Midwives (ACNM) Michigan Affiliate conference this past January was the presentation on Nitrous Oxide. The presenters, Michele Amstutz, RN, c-EFM and Laura Bozeman, MSN, RNC, CNL, c-EFM, from St. Joseph Mercy, enthusiastically described how they overcame obstacles through persistence, teamwork and education to bring laughing gas to their hospital.

From an historical perspective, the presenters explained that nitrous oxide was available for pain relief in labor in the United States up until the 1980’s, when epidurals grew in popularity. In recent years, the number of US hospitals offering nitrous oxide for women in labor has increased. Currently, two West MI hospitals, Spectrum Health Zeeland and Gerber Memorial offer it. Mercy Health Hackley responded to me on Twitter in January that they don’t have a start date yet, but their goal is to have it available within the next year.

When considering pain relief in labor, many women are concerned about the impact on the fetus. Fortunately, nitrous oxide is metabolized in the maternal lungs and clears rapidly, so only 80% of 1% of what the mom inhales reaches the baby. Studies have shown that there are no adverse effects on fetuses, including effects on fetal heart rate or apgar scores.

When it comes to maternal outcomes, nitrous also has advantages over other forms of pain relief. It does not require moms to receive intravenous fluids, have the fetus be continuously monitored, or restrict mobility, as with an epidural. The units can even be used with women who are in the tub! Unlike narcotics, it is non-addictive, which may be of concern to moms in recovery.

Something that I hadn’t considered was the many ways nitrous oxide could be used during labor and even postpartum. Because it is anxiolytic, or a medication that reduces anxiety, it can be used during medical procedures that may make a woman tense, like starting an IV, a foley bulb placement, or a vaginal exam. Although it cannot be used in conjunction with an epidural, it may be used during the insertion of one. Furthermore, many providers prefer it to local anesthesia for repairing tears after delivery because there is less distortion of tissues.

Nitrous oxide isn’t for everyone. Some women prefer a completely unmedicated experience. A small percentage of those who use it will experience side effects, most commonly dizziness and nausea. There are a few contraindications, including vitamin B12 deficiency. Finally, if a woman wants complete pain relief, she will probably not be satisfied with nitrous alone.

What about you? Have you used nitrous oxide for pain management during labor?  I would love to hear about your experiences!