Why Isn't Nitrous Oxide Widely Available for Labor Pain Relief in the U.S.?

May 5, 2008

I was recently pointed to an editorial in the March 2007 issue of the journal Birth which asks, “Nitrous Oxide for Pain in Labor–Why Not in the United States?” You may be familiar with nitrous oxide (“laughing gas”) as it is sometimes used during dental procedures, but the gas is often used in other countries as a means to control pain during labor. As the Birth editorial explains, nitrous oxide is self-administered by a woman in labor (primarily for safety reasons), allowing her to obtain a short burst of relief only when needed as an alternative to an epidural.

There isn’t a tremendous amount of research on nitrous oxide during birth, but a 2002 systematic review highlights some basic information about this technique. The authors note that the gas does not appear to affect the fetus or newborn or depress uterine contractions, although women may experience some lightheadedness and may have a slight delay in pain relief as the gas takes ~50 seconds to achieve its full analgesic effect. They also note that the gas can be both administered and stopped quickly.

Most interesting, perhaps, is this assessment of how widely use of nitrous oxide varies from country to country – “By the 1980s, use of nitrous oxide had almost disappeared in the United States. In the United Kingdom, it has been estimated that nitrous oxide is used by approximately 50% to 75% of women and in Finland by approximately 60%. Nitrous oxide is used and widely considered to be safe in many parts of the world including Canada, Australia, and New Zealand, supervised by physicians, nurses, or midwives.”

It is not entirely clear why this option isn’t more readily available in the United States. I’d be interested in hearing from readers as to whether nitrous oxide was available to you in labor – let us know in the comments! If you’re in the UK or elsewhere with common use of this option, please share your thoughts as well.

Citations for further reading:

  • Rooks JP. Nitrous oxide for pain in labor–why not in the United States? Birth. 2007 Mar;34(1):3-5.
  • Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26.
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