Nitrous Oxide as Pain Relief in Labor

  • By:  Melissa Waddell, WHNP

Is nitrous oxide a safe pain reliever during labor?

Nitrous oxide is a mixture of nitrous oxide and oxygen. It is also known as laughing gas and is used commonly in dental procedures around the world. It is a gas that you inhale through a mask and can help manage pain throughout the whole body without causing a total loss of feeling or any loss of muscle movement. Nitrous oxide has also been used in managing pain during labor for more than a hundred years.

Nitrous oxide is a tasteless, odorless gas that is easily given through a mask the woman in labor holds over her nose and mouth. For maximum pain management, one should start inhaling about 30 to 45 seconds before the contraction begins so that the drug peaks at the same time as the contraction does. Oxygen levels will also be monitored closely during this process.

Every medication has pros and cons. Some pros to nitrous oxide are that it can provide pain management for women who don't want an epidural. It provides about the same level of pain relief compared to injectable opioid medications but does not carry the same side effects for the newborn. Mothers do report that nitrous oxide is less effective than an epidural but are equally happy in the outcome.

A second pro is that it can be used during all stages of labor, even after the delivery for example, during the repair of a perineal laceration. A third pro is that it can be stopped at any time, started at any time, or switched to something else at any time. It can supplement an epidural that is not working very well. Finally, it may create a sense of pleasure and relaxation.

Some cons to nitrous oxide are the fact that it is less effective than other forms of pain management such as an epidural. It requires repeated self-doses, so a woman would have to hold the mask to her face when she wants the pain management. Some women, who are exhausted or tired, might not want to have to keep doing that.

Nitrous oxide can also give you a sense of detachment, sleepiness, dizziness, and nausea or a sense of claustrophobia from the mask. Some researchers expressed concern that the nitrous oxide can disrupt cellular processes in both the mother and the newborn for several days. However, the long-term impact of this is not really understood.

Finally, there are safety precautions that healthcare providers have to take to reduce exposure to the gas themselves. This is an issue because 99 percent of the nitrous oxide that a person inhales comes out when they exhale; therefore 99 percent of it is still there in the room. If a patient breathes back into the mask, that can help contain the gas.

In summary, nitrous oxide appears to be safe for labor and has a long track record of use during labor and dental procedures. An interesting fact is that mothers who use nitrous oxide report really high satisfaction with their births even though the effect on their pain isn't really that good. It's not really intended to relieve pain so much as to help women cope with the pain better. Some like this option because it gives them a sense of control and freedom to move around during labor.

Melissa Waddell, WHNP, is a nurse practitioner at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com for more information or to make an appointment.

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