Empowering Patients Using Evidence-Based Practice

Ascension Seton Medical Center Offers Laboring Mothers New Pain Management Option


Many women prefer a natural delivery, without the use of an epidural or narcotic or are not candidates for epidural. Nitrous oxide offers laboring women an alternative to decrease labor pains.

Evidence-Based Practice

The use of nitrous oxide as a labor analgesic is supported by the literature and is known to produce rapid onset and short half-life, preventing an accumulation in maternal or fetal tissues. Most women feel the positive effect of pain relief, decreased anxiety, euphoria and/or a feeling of not caring about the pain within 30-60 seconds (Collins, 2017). Yet, women remain awake and alert, with complete motor and sensory function throughout use (Stewart & Collins, 2012).


SMCA L&D nurses helping set up the nitrous oxide equipment. Thank you to Kat Eckhart and Kaitlyn Rodriguez.

Ascension Seton Medical Center Austin (SMCA) labor and delivery nurse, Emily Cowart, BSN, RN, led the initiative to implement the use of nitrous oxide as an alternative form of pain management during labor. Emily first learned about nitrous oxide as an alternative to traditional analgesics in laboring mother at the 2013 Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) conference in Nashville where she attended a presentation by Michelle Collins called “Laughing through Labor? The Resurgence of Nitrous Oxide as a Labor Analgesic.”

In 2015, Emily attended AWHONN in Long Beach, California and attended a presentation entitled, “Lead a Nitrous Oxide as Labor Analgesia Initiative at Your Site? Yes You Can!” Back in Austin, she was determined to introduce this new option to laboring mothers and performed a literature review using the Johns Hopkins Model and Tools for Research and Non-Research Critical Appraisal. Finding substantial evidence to support introducing this new option, Emily escalated her efforts to the Perinatal Services Director, Amy Bullock, MSN, RN, NE-BC, in efforts to advocate for the introduction of nitrous oxide as a labor analgesia option.

In the spring of 2017, Emily formally shared findings from the evidence with physicians and nurse leaders supporting nitrous oxide as labor analgesia as a safe, effective alternative for patients. Nurse and physician leadership approved the implementation of nitrous oxide as a labor analgesic option for patients at SMCA during delivery.

In June 2017, funding was secured to purchase the necessary equipment. In July 2017, Emily developed and implemented an education plan for the labor and delivery nursing staff and physicians regarding the management and use of nitrous oxide for those choosing to use this option.


Ascension Seton Medical Center Austin was the first hospital to implement this option in the Austin area.  Nitrous oxide is ordered by the provider and initiated and managed by the registered nurse who has demonstrated competency which is new to the organization. Laboring moms are reported (by the nursing staff) to use this option for pain management on a weekly basis.