After nearly disappearing from labor and delivery wards in the United States due to the availability of the epidural, nitrous oxide has grown in popularity as a pain-relief alternative during labor over the past few years as patients seek low-intervention pain relief options.
Porter Instrument, the manufacturer of one of two main nitrous oxide systems, says more than 300 U.S. hospitals and birthing centers offered nitrous oxide as an option to laboring patients as of 2016, and that number is expected to grow, although it’s not covered by health insurance plans. And while its efficacy is still being studied, a 2011 review published in the Journal of Midwifery and Women’s Health found it to be a sound epidural alternative for both mom and baby; the American Pregnancy Association and the Association of Women’s Health, Obstetric and Neonatal Nurses also deem it safe.
“It’s has a long safety track record in countries throughout Europe,” says Grace Lau, MD, assistant professor in the department of obstetrics and gynecology at NYU-Langone Medical Center. In fact, statistics from the American Society of Anesthesiology show nearly 60 percent of U.K. births and 50 percent of Canadian births occur with the use of nitrous oxide as pain relief. “It can provide pain relief, but some women feel it provides relaxation and a sense of well-being, rather than completely stopping pain,” says Lau.
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Michelle Collins, PhD, director of nurse-midwifery speciality at the School of Nursing at Vanderbilt University — affiliated with Vanderbilt University Medical Center, which offers nitrous oxide during labor — agrees. She adds that, for some women, nitrous oxide is a great in-between step if they’re deciding to have an epidural. “Nitrous oxide is effective in early labor, when a woman still may want to move around and not be limited by an epidural,” says Collins. “Not only that, but the nitrous oxide can provide pain relief during the insertion of the epidural itself, which some patients fear.”
Collins adds that nitrous oxide can safely be used concurrently with an epidural, providing relief for patients who may experience breakthrough pain with the epidural alone. “I’ve seen nitrous oxide as a great option for women who may want to give birth naturally but are nervous about the pain. After the mask is taken off, the gas is exhaled from your lung tissue within a few breaths, so you wouldn’t feel loopy or drugged like you might on narcotics,” she says.
Collins has also seen nitrous oxide be beneficial for women who have given birth naturally but tear during delivery. “After delivery, some women really experience a lot of pain, since the adrenaline of labor has worn off. We offer nitrous oxide to those patients while we stitch them.”