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Should Laughing gas be an Option in the Delivery Room?

You see it in dentists’ offices nationwide, but until about five years ago, there was one place you didn’t see nitrous oxide (laughing gas): in the delivery room.

But this isn’t true everywhere. Nitrous oxide is an anesthesia option for laboring women in Canada, Europe, and Australia as an alternative that rests somewhere between unmedicated childbirth and epidural anesthesia. In the United States, only five hospitals and medical centers offer nitrous oxide specifically for labor analgesia:

  • The Birth Center at the University of California San Francisco
  • Okanogan Douglas District Hospital in Washington State
  • St. Joseph Regional Medical Center in Idaho
  • University of Washington Hospital in Seattle
  • Vanderbilt University Medical Center in Nashville

Independent, freestanding birthing centers may also offer nitrous oxide. In 2014, several hospitals are expected to add nitrous oxide anesthesia to their services list, including Brigham and Women’s Medical Center in Boston.

Nitrous oxide is not new to the delivery room—it just fell out of fashion with improvements to the epidural. American women commonly used nitrous oxide between 1930 and 1970 as a way to reduce labor pains and promote relaxation. When inhaled, nitrous oxide works quickly in one minute or less to relieve anxiety and reduce pain. While these effects are not as pronounced as an epidural, they offer a laboring mother greater control without limiting a mother’s feeling in her legs and back.

Today’s nitrous oxide is not the same as what your grandmother used, however. The nitrous oxide utilized more than 30 years ago was often administered in stronger percentages than today’s blend. For example, some women gave birth breathing in 80 percent nitrous oxide mixed with 20 percent oxygen. This was often combined with heavier pain medications, such as morphine, to induce pain relief.

Today, concentrations are 50 percent nitrous oxide, 50 percent oxygen, which minimizes side effects, such as reduced oxygen saturation. To utilize the nitrous oxide, a laboring mother places a mask over her face that delivers the gas. If she becomes sleepy or the pain starts to subside, she then drops the mask, and the gas quickly leaves her system.

Hospitals and medical centers must first acquire the infrastructure to mix the two gases. Currently, the U.S. Food and Drug Administration has not approved the use of premixed nitrous oxide and oxygen tanks.

With an estimated 40-60 percent of European women utilizing nitrous oxide during labor, the number of American women and hospitals offering the service is likely to increase as well. Nitrous oxide will not provide pain-free labor, but it can comfort some laboring mothers and give them added control over their pain relief.

Reviewed by Dr. Jen Lincoln, November 2018


  • Medscape
  • Nitrous Oxide Administration.
    MedPage Today
  • Laughing Gas Bringing Smiles to More Women in Labor.
    Stewart, L., & Collins, M
  • (2012)
  • Nitrous Oxide as Labor Analgesia
  • 2013 Feb; 17(1): 12]
  • Nursing For Women’s Health, 16(5), 398-409
  • doi:10.1111/j.1751-486X.2012.01763.x
    Vanderbilt Center for Women’s Health
  • Labor and Baby’s Birth.

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