Physicians at Dartmouth-Hitchcock Medical Center will provide nitrous oxide commonly known as laughing gas as a painkiller for women in labor beginning this summer, according to DHMC obstetrician and gynecologist Michele Lauria. DHMC will become the third hospital nationwide to offer the option, joining the ranks of University of Washington Medical Center and the University of California, San Francisco Medical Center.
Lauria said she expects the gas to be used by 10 to 15 percent of pregnant women, based on patterns at the two other hospitals that currently offer laughing gas.
Laughing gas is a "low-tech," inexpensive and portable approach to pain relief that can be administered by medical professionals other than physicians, Judith Bishop, a midwife at the UCSF Hospital, said.
"We don't have many options for women who don't want or can't get epidurals and nitrous oxide fills a perfect niche for women," Bishop said. "It has pain-relieving qualities and anti-anxiety qualities and it comes on quickly and it blows off quickly."
Laughing gas will not replace the existing methods of pain relief, but will contribute to the "spectrum of options" that medical professionals are able to offer pregnant mothers, Bishop said. Laughing gas will appeal to women who cannot have epidurals or who wish to avoid heavy medication during delivery, according to Bishop.
The gas affords women considerable flexibility in determining what degree of pain relief they desire, she said.
"They administer it to themselves so they determine how much they use it and when they use it," Bishop said. "They're in control there's a significant amount of empowerment when a mother works through her labor."
DHMC will use a specialized delivery device for the gas that administers a fixed mix of 50 percent oxygen and 50 percent nitrous oxide, Lauria said. At this level, a woman can administer any amount of gas without harming herself or the baby, according to Bishop.
Using devices that maintain a fixed ratio will also prevent family members or patients from manipulating the concentration of nitrous oxide, maximizing the method's safety, Collins said.
Laughing gas does not affect the baby or the progress of labor, according to Michelle Collins, a professor at the Vanderbilt University School of Nursing.
"[Laughing gas] is the only thing that we use for labor that is immediately dissipated through the lungs," she said. "It doesn't go through the placenta to the baby so it doesn't affect the baby."
Women experience pain relief within 30 seconds of inhaling the gas and can completely expel it from their systems after several deep breaths, according to Bishop.
"It's not necessarily a strong pain reliever, but it kind of dissociates you from the pain or makes you better able to cope with the pain," Bishop said.
Epidurals pose risks to women such as occasional difficulty breathing and increased risk of fever, cesarean section and forcep or vacuum-extractor birth that are not associated with the use of laughing gas, Collins said.
While epidurals constitute the most effective form of pain relief, they are complicated to administer and require an anesthesiologist's presence, Bishop said.
Narcotics which are administered intravenously or through injection are effective in treating pain but cannot be given to women near the end of labor due to potential risks to the baby, Bishop said.
"It can make the baby a little lethargic at birth and can affect their ability to immediately breast feed," she said.
The predominance of narcotics and epidurals in the delivery room has resulted in a 30 percent rate of cesarean sections among all births in the United States, a statistic higher than the rates in other developed countries, Collins said.
"Cesarean rates shouldn't be that high, and part of the reason is because of the things we do to women in labor," she said.
The relative scarcity of laughing gas in delivery rooms can be attributed to a cultural taboo that developed after the emergence of epidurals, Bishop said.
"When you bring it up in this country, people think it sounds pretty old-fashioned and they assume that there was some dark reason that it was gotten rid of," she said. "There were other inhalation agents that were used in the past that weren't so safe and I think that people confuse them."
Laughing gas is still a popular choice for women in labor in Australia, Canada and most of Europe, Bishop said.
"It's entrenched in those places and I think it was never entrenched in that same fashion in the United States," she said. "One reason is that in those countries midwives are kind of the front-line and do a majority of the births."
Collins said the use of laughing gas is beneficial for some women who want to be more aware when giving birth.
Laughing gas was popular in the United States during the 1950s but fell out of favor with the medical community with the advent of epidurals, which are administered by catheter into the women's spine and numb the lower part of the body, according to Collins.
Doctors administered the gas improperly during the 1950s, which caused many women to experience amnesia after giving birth, Lauria said.
