What You Need to Know About Nitrous Oxide in Labor

Curious about nitrous oxide as pain relief in labor?

If you are pregnant, sooner or later you will think about how to manage the pain of labor. Some clients know they want to get an epidural, and others would prefer to either forego pain medication entirely, or see how they feel in labor and make a decision in the moment.

Pain management and comfort measures are topics I discuss at length with my clients in our prenatal meetings. When clients want to avoid or delay pain medication, we talk about natural pain relief methods like counter pressure, hydrotherapy, heat therapy, and position changes. 

When clients are open to pain medications, but want to avoid or delay an epidural or narcotic medication, nitrous oxide can be a great option.

Nitrous oxide has been used by laboring people in the United Kingdom, Australia and Canada for decades. The ACNM (American College of Nurse-Midwives) supported its use in a 2011 position statement, affirming nitrous oxide as a pain relief option that fits into the midwifery model of care. 

​While nitrous oxide was once frequently used in United States, in the 1970’s its use declined as epidural analgesia surged in popularity.  As of 2017, one report stated that nitrous oxide was available in only around 150  hospitals and 50 birth centers nationwide. 

Fortunately for those in the Treasure Valley, both major hospital systems, St. Lukes and St. Alphonsus, offer nitrous oxide, also known simply as “nitrous,” in their labor and delivery rooms.

With all interventions, there are benefits and risks. Here’s what you need to know if you are considering using nitrous oxide in your upcoming birth:​

The Benefits of Nitrous Oxide in Labor

• It doesn’t affect the normal progress of labor. Often with an epidural, pitocin (artificial oxytocin) is used to compensate for reduced uterine contractions. Nitrous doesn't interfere with the normal course of labor.  It can also be used at any stage, from early labor to the pushing stage.
• Your movement is not restricted. Although you may have to remain close to the nitrous tanks to utilize the gas, you can labor in any position: standing, squatting, bouncing on a birth ball, on all fours, etc. While you can lie in bed while using nitrous, you aren't limited to the bed as you would be if you were administered an epidural.​

• You are in control. You administer the nitrous oxide yourself by holding your own mask; when you don’t want it anymore, you remove the mask. With other pain medications, like narcotics and with the epidural, if you have a negative reaction you may have to wait until the medication runs its course through your system, or you may not have the option to discontinue its use until after your baby is born.
• Its effects are immediate. As soon as you breathe in the gas (which is actually a 50/50 mixture of nitrous oxide and oxygen), you begin to feel its analgesic (pain relieving) effects. As soon as you remove the mask, the gas dissipates quickly and its analgesic effects stop almost immediately.
• It may help you breathe more efficiently. Often people tense up during contractions, and they forget to take the deep breaths which help them more effectively manage their pain. Because you have to take deep breaths into the nitrous mask to get its full effects, you may be better able to regulate your breathing, ensuring you get enough oxygen and helping you to remain calm.
• It does not affect infant alertness at birth or interfere with breastfeeding. Pain medications like narcotics and the epidural can cause your baby to be “sleepy” at birth, which can delay the initiation of breastfeeding, or result in lower Apgar scores. These effects are not seen with the use of nitrous oxide.​

• No drop in blood pressure, so no need for an IV. Epidurals cause a decrease in blood pressure. An IV is required when you get an epidural to help keep blood pressure stable.
• No catheterization is required. When you get an epidural, a catheter is inserted into your urethra to catch urine. There is no such need when using nitrous.
• No risk of maternal fever. When you get an epidural you are more likely to experience hyperthermia, or a rise in body temperature. Sometimes this manifests as a clinical fever, which can pose risks to the baby.
• Continuous fetal monitoring is not required. When you get an epidural or narcotic medication, you will be continuously monitored for signs of fetal distress. (With narcotic medication you can usually revert to intermittent monitoring after a time). While this monitoring is usually external, sometimes internal fetal monitoring becomes necessary. No additional monitoring is required when using nitrous.​

The Risks, or Downsides of Nitrous Oxide in Labor

• Nausea or vomiting. Some people don’t tolerate the gas well, and find that it makes them feel nauseous. If this occurs, you can discontinue its use and move on to another method of pain management. Know that nausea and vomiting are common symptoms in active labor, whether or not you utilize any pain medication.
• Dizziness. Some people experience an uncomfortable dizziness or lightheadedness. You may choose to stop using the nitrous, and this feeling should go away.​

• Nitrous oxide doesn’t completely eliminate pain. My clients who have used nitrous explain that they can still feel their contractions, but they feel more relaxed when managing them.
• You must hold the mask yourself. The laboring person is required to hold the nitrous mask to their own face as a safety measure. If you become too dizzy or faint, the hand holding the mask will naturally fall away from your face, and the nitrous will dissipate. Some people find holding the mask cumbersome or tiring.
• Long term effects on fetuses and newborns are unknown. While the use of nitrous oxide has been shown to have no effect on newborn alertness, the long term effects of exposure are unstudied. One study showed neurological dysfunction in rodents when given at high doses, and there have been some concerns about harmful reproductive effects from prolonged exposure in heath care workers.
• Certain populations may have negative side effects. Those with Vitamin B12 deficiency, the MTHFR gene mutation, acute asthma or lung disease, or bowel obstruction are at risk for harmful side effects from using nitrous oxide. Consult your care provider if you fall into one of these at-risk groups.

I am a certified labor doula (birth doula) and postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley. 
Are you considering using nitrous oxide in labor? Would you like more information about it?

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