Appledore Medical Group - September 10, 2018

Nitrous Oxide for Pain Relief During Childbirth
Thomas Zarka, MD - Ob/Gyn

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Many women look to their doctor for guidance about easing the pain of childbirth. In the United States, the most traditional methods to help manage labor pain in the past few decades include:

  • Epidural: Medication is delivered into the lower back, causing some loss of feeling, but allows the mother to continue to bear down and push her baby through the birth canal.
  • Spinal Block: Spinal blocks are administered as a shot into the fluid around the spinal cord. They work quickly to relieve pain, but last only an hour or two. Spinal blocks are often used for Caesarean sections.
  • Systemic Opioids: Systemic opioids (a type of narcotic) are given as a shot or intravenously (IV), and bring about a calming effect.
  • Local or Regional Anesthesia: Local anesthesia provides pain relief to a small area of the body, like the perineum. Regional anesthesia provides pain relief to a larger area, such as everything below the waist.

One pain relief method that is not common in the United States, but is popular in Europe and other countries with high standards for safe childbirth, is nitrous oxide (N2O). It is usually delivered as 50% nitrous oxide (N2O) mixed with 50% oxygen (O2). In the U.S., nitrous oxide, commonly called laughing gas, typically is associated with dental procedures. Nitrous oxide has become more readily available as a safe and effective method of pain management during labor and delivery.

Pros of Using Nitrous Oxide (N2O)

Nitrous oxide works by increasing the amount of endorphins, corticotropins, and dopamine released in the mother’s brain. The result is temporary pain relief and an overall calming effect. Benefits of using nitrous oxide for pain management include:

  • It is less potent than other analgesics like epidural blocks, but more effective than many systemic opioids.
  • It is simple to self-administer and works quickly to provide pain relief. After a brief explanation, the mother can administer N2O to herself through a facemask, which allows her to time the amount and frequency she receives with her contractions.
  • N2O can be used during all stages of labor, as well as in some postpartum procedures like perineal repair.
  • N2O is safe and effective for the mother and her baby. A long track record of safe outcomes for mothers and babies in the United Kingdom and other countries where the use of N2O is prevalent.
  • N2O does not require increased monitoring of the mother or child, and is not associated with an increased risk of complications for either.
  • N2O has no impact on the ability to breastfeed immediately after birth.
  • N2O can be discontinued quickly and easily if another pain relief method is desired. The effects of N2O dissipate within about five minutes after discontinuing its use.
  • N2O is significantly less expensive than other pain relief methods.

Cons of Using Nitrous Oxide (N2O)

Some studies raise rare, but serious concerns, about repeated exposure to nitrous oxide, especially for healthcare workers employed in settings without proper ventilation. These concerns include:

  • An occupational health risk to female healthcare providers, including nurses and midwives, who may have some adverse effect to their reproductive system, including increased difficulty becoming pregnant and increased risk of spontaneous miscarriage.
  • Those with certain medical disorders are at increased risk of adverse effects from exposure to nitrous oxide, including those with vitamin B12 deficiency disorder, pernicious anemia, Crohn's disease, Ileal disease, chronic malnutrition due to alcoholism or pregnant women who are strict vegans, chronic N2O drug abusers, and surgical patients who receive high doses of N20 anesthesia (not analgesia) for more than six hours.

To help alleviate the risk of prolonged exposure to N2O, the following precautions can be taken:

  • High-risk groups with these medical conditions can be treated with vitamins to lower the risk of adverse effects from N2O exposure.
  • Proper ventilation is key to preventing adverse outcomes and most modern facilities have precautions in place to help monitor and protect their healthcare workers from excess exposure to N2O.
  • Teaching mothers to exhale into the facemask also helps prevent off-gases from entering the surrounding environment.


Commonly used in Australia, Canada, Finland, Sweden, and the United Kingdom, nitrous oxide is a safe, viable option for pain relief during childbirth. Long-term research supports its effectiveness, safety for the mother and her baby, and unique benefits as an analgesic. Just as important, nitrous oxide empowers mothers by giving them an option to take the edge off of the pain while allowing them to control when and how much of the gas they receive.

In addition, N2O is a lower cost alternative to many pain management options, which may be especially significant to those without insurance or in lower income areas of the country. The American College of Nurse-Midwives takes the position that, “The experience of labor pain differs among women, and the response to pain is highly individual. Women should have access to a variety of approaches to promote comfort and reduce pain throughout labor...” The use of N2O in labor and delivery departments throughout the United States should be evaluated, and certified nurse-midwives and certified midwives should be trained to administer and oversee the safe use of N2O during labor. While no method is foolproof, nitrous oxide should be made readily available to American women as one option for pain relief during childbirth.

If you have any questions about the use of Nitrous Oxide, pain management during childbirth, or are looking for a new women's health provider, contact Dr. Thomas Zarka of Women's Health Associates of Derry at (603) 421-2526, or click the link below to schedule an appointment.

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American College of Obstetricians and Gynecologists (ACOG)
American College of Nurse-Midwives (ACNM)
National Institutes of Health