Laughing through Labor


Ascension Seton Medical Center Austin offers new pain management option

The pains of childbirth are no laughing matter, but a little laughter might be just what the patient orders. Moms delivering at Ascension Seton Medical Center Austin (SMCA) now have the option of using nitrous oxide, or laughing gas,  for pain management  during labor and delivery.

“It’s important to help moms achieve the type of birth experience they are hoping for,” said Sally Grogono, MD, an OB-GYN at SMCA. “Offering nitrous oxide for pain management gives them another tool in the tool box for meeting those goals.” Seton is part of Ascension, the largest nonprofit health system in the U.S. and the world’s largest Catholic health system.

More often used in birthing centers, a growing number of hospitals are starting to offer laughing gas. It’s been widely used in the United Kingdom and other European contries, and is becoming increasingly more popular in the U.S, Grogono said. SMCA is the first hospital in Austin to offer the gas for pain management during labor.

The new old

Laughing gas has been used in dental procedures since the mid-1850s and became a popular pain management option for labor in the 1930s. Epidurals, medication administered through the lower back to reduce or even eliminate pain, overshadowed the use of laughing gas and soon became the most common method of pain relief for labor pains in the United States.

“Each women’s level of pain tolerance varies and how they want to manage it is different,” said SMCA’s Emily Cowart, RNC.  “Women want more options for pain management, bringing nitrous oxide back to the forefront,” she said.

Different from dental use

Many are familiar with laughing gas in the dental chair—it helps you relax and you may even get a little giggly. But the combination of laughing gas and oxygen used during  labor is different from what you find in the dentist’s office.

According to an article in the Journal of Perinatal & Neonatal Nursing, during dental procedures, patients receive up to a 70/30 laughing gas to oxygen ratio. During labor, the dose is set to a 50/50 ratio, which is considered safe for both mom and baby.

How it works

While the the gas can help ease laboring mom’s nerves and maybe even make her chuckle through a contraction, the exact mechanism of how it works isn’t clear.

In a review published in the Journal of Midwifery and Women’s Health, the author says the increased release of natural opioids such as endorphins and dopamine, coupled with the decrease release of the stress hormone cortisol, could play a role.

“As an analgesic, it offers relief from pain, but doesn’t eliminate it,” OB-GYN John Harkins, MD, academic medical director of perinatal services at SMCA said. “When inhaled, it can cause a sense of euphoria, and takes the edge off.”

It is self-administered, so the laboring mom can decide when to inhale and for how long. Because laughing gas does not cause numbness, moms can maintain mobility, and can use other self-soothing techniques such as a birthing ball or walking.

Safe for mom and baby

Harkins says laughing gas is a safe and effective choice for moms who are looking for more pain management options. It’s not intended to replace the epidural though, but may be considered superior to IV pain medication.

The most common side effects for a mom using laughing gas are nausea, vomiting, dizziness or sedation. The gas is fast acting and rapidly clears from your system, Harkins said. So the good news is, if you start to feel a bit sick or sleepy, those effects are short lived.

IV pain medication can have similar side effects as laughing gas, but IV pain medications don’t clear from your system as quickly as the gas. IV pain medication can also cause decreased fetal heart rate, or can make your baby sleepy even after delivery, Harkins said.

Worried about baby passing his first test? Babies who are exposed to laughing gas while being born score well during their initial post-delivery evaluation.  According to the author of the review, studies consistently show no negative effects on Apgar scores.