Laughing Gas Helps Moms Manage

An old drug is a new option for labor pain.


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Nurse midwife Anne Galko, left, and Dr. Amanda Calhoun pose with the nitrous oxide machine.

Photo by Saul Bromberger & Sandra Hoover Photography

The pain of labor and delivery is no laughing matter, but the use of nitrous oxide, also known as laughing gas, has made a comeback and is helping women to cope. “Our patients have been able to use nitrous oxide since December of last year,” said Anne Galko, chief nurse midwife at Kaiser Permanente Oakland Medical Center. Already, she estimates that 30 percent to 40 percent of women are using laughing gas at some point during labor. Are women falling into hysterics in the delivery room? “No, no,” said Galko. “The expectant mother might feel a bit giddy or light headed. The nitrous oxide makes it easier for the patient to relax and reduces the anxiety associated with pain,” she explained.

Nitrous oxide is an old drug. “It’s been a round for more than 100 years,” said Dr. Eric Hunt, obstetric anesthesia director for Kaiser Oakland. The gas was popular for pain relief in labor and delivery through the 1950s in the United States, but it fell out of favor in the late 1960s with the introduction of the epidural, the injection of a local anesthetic into the spinal cord in the lower back, which produces a complete loss of sensation in the abdomen and pelvic region. “The beauty of nitrous oxide in the setting of labor and delivery is that it is rapidly absorbed by breathing it in and rapidly exhaled,” said Hunt. The expectant mother experiences pain relief within a minute to 1½ minutes after inhaling, and the effects wear off just as quickly when the mother stops breathing the gas. “It doesn’t accumulate in the body, and it doesn’t cause long-term sedation to the baby or the mother,” said Hunt. That’s in contrast to intravenous narcotics and epidural anesthesia, which don’t stop working abruptly and stay in the system for a while.

“The motivation for incorporating nitrous oxide as a pain management option during labor really was about patient empowerment, patient choice, and patient demand. The patient decides how much or how little she gets,” said Dr. Amanda Calhoun, physician director of maternity services at Kaiser Oakland. The nitrous oxide is delivered in a 50/50 mix with oxygen via a portable unit kept at the bedside. A hose from the unit connects with a breathing mask that the patient holds. When the mother wants some gas, she places the mask to her face and inhales.

Other advantages of nitrous oxide over more invasive pain medications are that the mother can continue to be mobile and no intravenous line is needed—so no needles. Nitrous oxide doesn’t slow contractions and can be used throughout labor, even when the mother is pushing.

“I did have the sensation of labor pain, but the nitrous oxide enabled me to handle it. It was sort of a mental disassociation. It gave me distance from the pain,” said Jessica Burgess, who delivered her first baby, a girl, at Kaiser Oakland Medical Center in late May. Burgess learned about nitrous oxide in a birthing class and was aiming for a low-intervention birth—she wanted to avoid getting an epidural unless it was necessary. About eight hours into her 15-hour labor, Burgess started to use the nitrous oxide. “It was quick acting and disappeared just as quickly,” said Burgess. “I liked that I had control and always felt present.” She didn’t experience any side effects from the gas and did not use any other pain medication. Burgess had a difficult placenta delivery and found the nitrous oxide was helpful then, too.

Calhoun said 50 percent of all mothers who deliver at Kaiser Oakland get an epidural; 60 percent of first-time moms do. Patients can move on to intravenous pain medication or epidural or spinal anesthesia after using nitrous oxide during labor. Both Calhoun and Hunt say it’s too soon to say whether the use of nitrous oxide will have an impact on the number of epidurals given. “We want patients to be able to cope with the discomfort of labor in a way that feels right for them,” said Calhoun. “The more options a patient has, the more positive the birth experience will be and the kinder entry into life that these babies will have.”

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