Laughing Gas During Childbirth: History, Pros and Cons

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We’ve already mentioned the hit PBS show “Call the Midwife” in another post on infant spina bifida, but you’ve probably noticed some women on the show using laughing gas while they’re giving birth. Many women will hold off and try to deliver birth naturally without any aids, but some turn to nitrous oxide to relieve pain during labor. If you’re just starting your pregnancy journey, know that much like the midwives portrayed on the show (set in the 1950s), nitrous oxide is not an outdated practice! Yes, plenty of women use laughing gas while delivering their child still today, but it’s not very common in the United States.

If you’re curious about nitrous oxide and how it may help you with labor pains, we have the answers to your questions, such as:

• What is nitrous oxide?
• Is laughing gas safe during childbirth? Can I use it instead of an epidural?
• Can I use laughing gas during pregnancy, like if I have to go to the dentist?
• What are the effects of laughing gas on my pregnancy? Are there any risks?

If you’ve used laughing gas during your labor, we’d love to hear your experiences in the comments!

What is nitrous oxide?

First off, it’s helpful to know what nitrous oxide, commonly referred to as “laughing gas,” is, though its other names are dinitrogen monoxide, dinitrogen oxide, and hyponitrous acid anhydride. This colorless gas is used as an inhalation anesthetic and is nonflammable, though it can enhance combustion of other substances at high enough temperatures and exposure to the liquid form on skin and eyes can cause frostbite. When inhaled, it can create euphoria, drowsiness, or unconsciousness.

Laughing gas doesn’t just knock you out, which is important when you need to (or want to) be awake during a medical procedure. It can’t produce general anesthesia on its own reliably, so if someone needs to be unconscious during a surgery, for instance, it can be combined with other inhalation or intravenous agents to produce a deep sleep without any sensation of the procedure to the patient.

Laughing Gas During Childbirth

Nitrous oxide is the most commonly used inhalation anesthetic in dentistry, but it’s also used in emergency rooms and for women in labor. Why?

Nitrous oxide works rapidly, and often, women turn to it instead of epidurals. Epidurals are a spinal injection that block any feeling below the waist during labor. Laughing gas, on the other hand, can keep women more active in their childbirth by only using it during the peak pain of contractions.

Laughing gas has been around since the 1800s as a form of pain relief. Before the 1950s, it was commonly used during labor, and then more powerful anesthetics came on the scene that could knock a woman in labor out — and she’d wake up with a baby. In the 1970s, epidurals became all the rage because women could stay awake while delivering their child, pain free.

A small group of midwives is now looking to revive the use of laughing gas in U.S. hospitals as an alternative to epidurals.

At one hospital in Rhode Island, a woman breathed in a mixture of 50% nitrous oxide and 50% oxygen, which made her feel giggly for about 15 to 30 seconds at a time, at which point she was able to handle the rest of the contraction. Her midwife says:

“It gives you this euphoria that helps you sort of forget about the pain for a little bit.”

About 300 hospitals and birthing centers in the U.S. offer nitrous oxide to women in labor today, though just seven years ago, only handful of them did.

Benefits of Laughing Gas During Labor

Laughing gas has low potency, so it’s relatively safe to use. The biggest benefit during childbirth is that it gives women control over their own pain relief. If they need more, they can take a few more breaths of nitrous oxide, or resume contractions as normal at their own pace. It is self-administered.

Women can also walk after inhaling nitrous oxide, whereas with an epidural, they can’t. Many women who have used laughing gas over epidurals also found that they were aware of and still felt the pains of labor, but they were more carefree. Epidurals also can prolong labor.

Nitrous oxide is much less expensive than epidurals, sometimes by thousands of dollars. It also does not have to be administered an an anesthesiologist.

Although epidurals do provide better pain relief, some women may want more options. Still, at the only American hospital to offer nitrous oxide continuously for 30 years, the epidural rate remains 75-80%.

Judith Rooks, a certified nurse midwife, comments on why laughing gas during labor hasn’t been as popular in the U.S.:

“In America, there is a tendency to want the strongest thing. Epidurals are the strongest thing.”

For women who don’t choose to use laughing gas during any stage of labor, they can still opt for it to relieve anxiety during repairs of any tears experienced during childbirth, removal of the placenta, and uterine curettage. It can also be used to help start an epidural.

Risks of Laughing Gas During Labor

All inhalation agents have an effect on our respiratory system and can increase our respiratory rate. Nitrous oxide has minimal cardiovascular effects, however, unlike some other inhalation agents. One scientific review of nitrous oxide notes: “In both normal patients and those with coronary artery disease, subanesthetic concentrations of nitrous oxide (0.1 to 0.5 MAC) have little influence on cardiac output, stroke volume, and heart rate.”

Although nitrous oxide used during labor is a smaller concentration than what you get at the dentist’s office, about 10% of nitrous users can become dizzy, so women in labor using laughing gas will want to be careful while standing. Others may feel nauseous or vomit.

While nitrous oxide is metabolized in our lungs versus our liver (like some other drugs), some of the gas may pass through the bloodstream and make its way to the placenta. However, no human studies have shown adverse effects on baby if mom chooses to use laughing gas during labor.

Safety of Laughing Gas While Pregnant (or Not)

In that same review of nitrous oxide, researchers note that using it during pregnancy is complicated and should be reviewed by a doctor, as with most drugs or things we put into our body while carrying a child. Researchers suggest avoiding any elective dental treatment during pregnancy, particularly during the first trimester, but sedation during a single appointment may be needed in cases of urgent dental care, such as infections. Various studies have not found fetal abnormalities after use of nitrous oxide during pregnancy, however, including those who underwent operations with other anesthetics.

Obviously, as with any sort of painkiller, there is a risk of potential dependence or overexposure for people who are around laughing gas a lot, such as if they work at a hospital. Nitrous oxide also has been used in the UK during festivals and concerts as a cheap high — it’s known as “whippets” when inhaled from a pressurized canister, which is dangerous and can harm the lungs — and is the seventh-most popular drug in a survey of 50 countries. Laughing gas can also cause some people to have hallucinations, and prolonged use can lead to vitamin deficiencies, particularly B12.

When not used for a medical reason, nitrous oxide is illegal in the UK under the Psychoactive Substances Act.

Is laughing gas right for my labor?

If you’re pregnant and plotting out your birth plan, you may be more interested in exploring nitrous oxide as an option for pain relief during labor. Whether you choose to give birth at a hospital or birthing center, you’ll want to check that the staff offers nitrous oxide if  you want to consider it on the big day.

If you have any concerns about nitrous oxide or other pain relief methods like epidurals, speak with your OB-GYN. While you can’t plan for everything that may happen during childbirth, you can get ready for labor with all the information you need ahead of time.

Good luck, and happy birthing!