Retro Pain Relief

Laughing gas is making a comeback in American delivery rooms.


Nitrous oxide (N2O), aka laughing gas, is used in dental offices throughout the United States and in maternity hospitals worldwide. In fact, the majority of mothers in Europe, Australia and Canada—all places with better maternal and newborn health outcomes than in the U.S.—rely on it to reduce labor pain. N2O was widely used in American delivery rooms until the 1960s, when epidurals became a popular marketing tool for hospitals. Today, “Nitrous oxide lacks pizzazz, with no companies or influential professional groups that stand to profit by its greater use,” says midwife Judith Rooks, C.N.M., M.P.H., a former epidemiologist for the Centers for Disease Control and Prevention who has researched the gas’ safety, efficacy and benefits.

Nitrous oxide is far cheaper than epidurals, and because the laboring woman controls the mask, no anesthesiologist is necessary. When she feels a contraction coming, she inhales N2O mixed 50-50 with oxygen. As the pain diminishes or the woman becomes too drowsy, she drops the mask, inhales fresh air and the gas is eliminated quickly from her body. N2O works quickly during any stage of labor. “Some women use it for rough patches or before an epidural,” Rooks says. “Others use it throughout labor and delivery.”

Unlike epidurals, which can greatly reduce or even eliminate pain but render women nearly immobile, N2O dials pain down but leaves patients able to move around. It also reduces anxiety: Women say they can still feel pain, but they’re not bothered by it. The gas is reported to work better than IV narcotics such as fentanyl but does not depress the baby’s breathing the way similar drugs do. In fact, Rooks says, N2O has been widely used for labor pain relief since the 1930s, and no studies identify risks to babies or moms.

Midwives are bringing it back

Currently, only five U.S. hospitals offer nitrous oxide: the Birth Center at the University of California San Francisco Medical Center; Vanderbilt University Medical Center in Nashville, Tenn.; the University of Washington Hospital in Seattle; St. Joseph Regional Medical Center in Lewiston, Idaho; and Okanogan Douglas District Hospital in Washington state. But thanks to midwives’ efforts, renewed interest means that equipment to administer it will be more widely available this year. Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and Brigham and Women’s Medical Center in Boston plan to offer the option as soon as possible. Interested? Tell your OB or midwife and contact the hospitals where they deliver as well as freestanding birth centers that may use N2O (go to and Says Rooks, “Why should American women have fewer safe choices than women in other countries?”