It was recently reported that the interest in using nitrous oxide, or laughing gas, in the delivery room might be growing. With only two hospitals in the U.S. offering it and the expectation of more to come as early as this summer, we wanted to comment on it.

We understand and see a lot of patients who fear epidurals and the potential that another form of pain relief would be available for these mothers is promising.  We do not have any personal experience in using nitrous oxide in our practice.  After consultation with the head of anesthesia here at Good Samaritan Hospital he commented that it was used many years ago and was not a very effective form of pain relieve for labor.  Nitrous oxide is also a gas and goes directly to the baby via the mother’s blood stream.  The nitrous oxide wears off very quickly and is a weak anesthetic so it is most likely that the sedation effect to the baby is minimal unlike that with intravenous sedation.

In intravenous sedation the medicine also goes directly into the bloodstream, passes through the placenta and can sedate the baby.  However, the medications used in intravenous sedation have a longer duration of action than nitrous oxide and the potential for serious respiratory depression in the baby is greater if given too closely before delivery.  A medication can be given to the baby after delivery if the baby is too sedated.  Like IV sedation, using nitrous oxide during delivery wouldn’t necessarily knock out the pain entirely it may make the mother drowsy or sleepy in between the contractions but awaken her during the contraction when the pain becomes intense.

We understand that giving birth can be scary – we have patients who are afraid of epidurals because they’ve heard the myths that they can end up paralyzed or with back pain. This is a myth too! Culturally, we’ve seen how some family members discourage epidurals because they feel birth is something in which the mother needs to “tough it out.” This too is not necessarily the case. As doctors, we want our patients as comfortable as possible.

As a rule, we try not to use general anesthesia, because the medication crosses the placenta and goes directly to the baby, making the baby very drowsy.  We would typically only use it in emergency  cesarean situations where the baby needs to be delivered quickly, and time or the mother’s condition doesn’t allow for an epidural to be placed.

Here are a few things to remember about epidurals:

  • Epidurals do not put a stop to the labor process and result in a cesarean. Scientific studies have proven that this is not true. Women who end up with a cesarean after a long labor most likely had another dysfunction from the beginning, like the baby was too big or was coming through the birth canal in the wrong position
  • Epidurals do not affect the baby. The amount of medication absorbed into the bloodstream is minimal, so babies are born alert and active immediately after delivery.
  • Epidurals do not cause chronic backaches. The birth process alone puts a lot of strain on a woman’s back, as does carrying around extra weight the last few months of their pregnancy, carrying around a newborn and a diaper bag, and everything else that is new and different.
  • It’s true that after an epidural, a patient can experience a little soreness or bruising at the insertion site for a few days to a few weeks, but this soreness does not cause long-term chronic back pain.
  • In a few situations, an epidural is not advised or isn’t possible, such as women who are on blood thinners, have difficulty with blood clotting, or have abnormalities of the spine. You should always discuss the safety of an epidural with your doctor.
  • The most obvious advantage to having an epidural is pain relief and the ability to relax in between the challenge of pushing.
  • Pushing can be more difficult if you have had an epidural because you are not as in tune you’re your body and feeling where and how hard to push.
  • Some side effects are possible, such as hypotension, or a drop in blood pressure, spinal headaches, labor duration, and fever, all of which can be easily treated and managed by your doctor.