Laughing through Labor: the new old pain relief method

By Eva Martin, MD of Elm Tree Medical, Inc.

Fans of “Call the Midwife” might recall the adorable scene in which Chummy demonstrates how to use “the gas” during labor for pain relief only to over-inhale and fall blissfully into the hospital bed. Most Americans have never heard of using laughing gas for labor pains since epidurals became the anesthesia-du-jour in the 1970s and are now used by the vast majority of women in the US. However, people looking for relief have used laughing gas since the 1800s, usually for dental procedures. In the early 1900’s, laughing gas was introduced for labor, but never gained lasting traction in the US. Now, thanks to a small resurgence in popularity, you may see “laughing gas” on the menu of options at your hospital.

The formal name for laughing gas is “nitrous oxide.” As used on Labor and Delivery, a mixture of half nitrous oxide and half oxygen is delivered to patients through a face mask on a rolling cart. After a patient inhales the gas, relief comes within seconds. Women can time their doses with the peak of contraction pains, and the giggles last less than a minute. The gas produces a feeling of euphoria, which makes the contractions easier to withstand, instead of stopping the pain, per se. Women have control- they can choose when to inhale the gas and how much to inhale. And, between uses, they can walk around and feel their legs!

Two manufacturers offer a device for laughing gas during labor, and they report increasing sales. One system (Nitronox) is available in almost 300 hospitals and birth centers. Wary consumers may be wondering if it’s safe to use laughing gas during labor. Just like Chummy in Call the Midwife, mothers have been using “the gas” regularly in Europe and data supports its safety. The American College of Nurse-Midwives supports its use. However, there are doubters: The American Society of Anesthesiologists argue that they want to see newer studies before getting on board. Laughing gas is considerably less expensive than epidurals, which require an anesthesiologist to administer them.

Why not just stick with an epidural? We know that epidurals lead to longer labor. Plus, many women don’t want to be immobilized during labor or to lose feeling below the waist. Although this topic is controversial, many birthing experts feel that immobilization during labor contributes to more difficult labor, such as difficulty with pushing. Epidurals are associated with Occiput Posterior positioning of the infant, which makes vaginal delivery more difficult. Finally, epidurals are expensive, sometimes do not work, and can lead to complications like headaches.

I, for one, am very excited about this option becoming more available for women in the US. If for no other reason, I like that it gives women another option beyond narcotics and epidurals. Women can research and speak to trusted professionals and decide for themselves if it’s the right option for them. Whether a woman wants no intervention, gas, or epidural is a personal decision. I personally like the promise of increased patient control and ability to walk around and maintain sensation that come with laughing gas. We want to hear from you! Does your hospital offer laughing gas? Have you ever supported a woman in labor using gas? Would you try it?