Laughing gas for ladies in labor

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49 Responses to “Laughing gas for ladies in labor”

  1. HarveyBoing says:

    Copeland points out that, unlike an epidural, nitrous doesn’t so much eliminate pain as make you not really care that pain is happening. …

    I doubt shots are really a good metaphor for the pain of childbirth…

    Maybe not. But the “…make you not really care…” aspect resonates with my experience of having my lung reinflated, two different occasions. At the same time, my own experience was probably a lot more similar to childbirth than simply getting a shot. The procedure involves being slowly stabbed with a long needle roughly 5mm in diameter (as painful as it is, the current state of the art is certainly better than the whole “stick a chest tube in” approach), so that they can then suck the air that’s inside the chest cavity but outside the lung.

    Childbirth pain goes on for much longer, but I can assure you that for the minute or so that it takes for the surgeon to insert the needle into my chest cavity, without the help of drugs the pain is right at the maximum I could probably take without passing out.

    In my case, I found that Oxycodone had the “…make you not really care…” effect, and insisted that the ER surgeon (same guy second time as the first) give me some and let it take effect before he did the procedure. The comparison between first and second times was like night and day. Not that I’d ever voluntarily want to go through it either way, but I didn’t feel like I was going to die the second time.

    If nitrous can accomplish the same thing, I’d say I’d heartily recommend it for similar situations.

    All that said, here’s a great comment from someone else above:

    Look into hypnobirthing, no need for painkillers, drugging yourself and your baby at the point of birth. The amount of women that are conditioned to expect unbearable amounts of pain and go straight for an epidural alarms me.

    All three of our children were delivered without drugs (epidural or anything else). And my wife is no glutton for pain, nor particularly resistant to it. But she followed the Hypnobirthing technique closely, and found it worked extremely well for her. Even the 10+ lb baby, while he did require a lot of effort on her part, she did not find painful per se.

    The “hypno” in the name is somewhat misleading. It’s more of a targeted relaxation technique, rather than involving being hypnotized per se. Any form of practiced meditation is likely to have a similar outcome. But part of the Hypnobirthing propaganda (and I use that word without any intent for negative connotation :) ) is to point out that female mammals are generally well-evolved to tolerate childbirth, and that much if not most pain women experience is a consequence of anxiety, which in turn is induced by the barrage of cultural references telling them to expect the experience to be a disaster. Self-fulfilling prophecy and all that.

    Having experience self-induced pain at the dentist myself (in spite of being completely numb from Novocain, my anxiety was causing extreme muscle tension in my jaws, creating immense pain…once I realized what happened, and focused on relaxing, the pain went away completely), I can easily see how this would manifest itself during childbirth.

    Fact is, modern medicine offers a number of safe, practical approaches to childbirth. Each woman should choose for herself what she is most comfortable with, and I wouldn’t think of criticizing someone for choosing an epidural (in spite of disadvantages it comes with, including its interference with the normal contraction process). But I would definitely encourage any woman expecting to deliver a child to seriously consider natural meditation techniques, whether following the Hypnobirthing program, or just doing yoga (which was also very beneficial for my wife) and/or other practices. They work extremely well, and have great application throughout one’s life even beyond their use in childbirth.

  2. Anonymous says:

    Shots and childbirth… both can start with a little prick

  3. Anonymous says:

    What about the baby? Everything the mother takes/breathes goes directly to the baby also.

  4. bardfinn says:

    Also, some people don’t respond to nitrous with an analgesic effect, and people with a history of opioid use respond less well to nitrous with an analgesic effect than those without a history (the opioids induce an analgesic tolerance which is also nitrous analgesic tolerance).

    • Ugly Canuck says:

      Interesting about the observed cross-tolerance …as opiates and nitrous differ so much in chemical structure, is there any indication what the bio-chemical mechanism of the tolerance observed may be?

      Are all analgesics so similar in mechanism that they produce cross-tolerance between each other, regardless of their differing underlying chemical structures, or is only nitrous “like opiates”, in this way?

    • Ugly Canuck says:

      Yeah…do you have a cite for the observed cross-tolerance between opiates and nitrous oxide?

      I’m intrigued.

  5. Shart Tsung says:

    Love the stuff, we’d call it ‘hippie crack’.

  6. hadlock says:

    Neil Stepehenson makes an interesting point in Snow Crash – or is it Zodiac? – that if you’re going to put drugs in to your body, they should be the least complex substances possible. Nitrous Oxide isn’t much more complex than water at the molecular level.

    “Sangamon’s Principle,” I said. “The simpler the molecule, the better the drug. So the best drug is oxygen. Only two atoms. The second-best, nitrous oxide—a mere three atoms. The third-best, ethanol—nine. Past that, you’re talking lots of atoms.”
    “So?”
    “Atoms are like people. Get lots of them together, never know what they’ll do.”

  7. Heather says:

    I was given nitrous during my unplanned C-section in an Oakland, CA hospital about 3 and a half years ago. I’d been in labor for 113 hours (not kidding) and had been given pitocin to help further dilation as well as an epidural the evening before. I’d been pushing for 4 hours when they asked me to make a decision about whether to have a C-section or not (as far as I could tell, my decision was have the C-section or die in childbirth). I was exhausted and very unhappy about going through all that only to get cut open — and to calm me down (I was on the verge of just freaking out) they gave me a mask with nitrous flowing through it during the C-section.

    The nitrous did calm me down, but I soon got that “whomp-whomp-whomp” feeling that comes from too much nitrous, and I pulled the mask away, as I didn’t want to be that high when I met my son for the first time. There was a moment a few minutes later when they quickly dialed it back down (they didn’t want the surgeons to get high!), and later when I went to use the mask to calm down, I was bewildered why I couldn’t get anything out of it. I don’t know whether they’d just cranked it up high for me to make sure I calmed down quickly, or if the self-administered nitrous in other countries works differently, but I wonder if this potential to make the air in the room nitrous-filled is part of why US hospitals don’t offer it?

    This post also makes me wonder if nitrous during the actual pushing might have helped relax me enough to get things moving (though there were other complications that suggest not). In any case, had they offered it during labor, I would have tried it before I got the epidural, that’s for sure. I hated the idea of a needle in my spine (though by the time I got it, I was in too much pain to worry about it).

    I’ve also had nitrous during root canals, which makes that procedure not such a big deal; the nitrous seems to be a continuous steady dose during those, but never to the “whomp-whomp-whomp” levels.

  8. skreader says:

    In Hong Kong, another former British colony, Entonox (gas-and-air) offered to women in labor too. I used it for two births and it helped take the edge off the contractions. But I have other friends who found it either useless, or it made them nauseous. So, it’s not for everyone, but it was great for me, and I was glad to have the option.

  9. Anonymous says:

    22 comments and only one regarding the recreational use of Nitrous.
    I believe it was a popular party trick with the victorians, and is now being rediscovered in a fairly big way, in Europe at least.
    It took me a few balloons to get it, but I fell in love, and enjoy a good dose whenever the occassional opportunity presents itself.
    ‘Those little slices of death, how I love them’.

    -Throw a Stone for Jesus-

  10. apoxia says:

    My dentist doesn’t even use nitrous. He said he hadn’t had a nitrous tank in years. I think he was kind of surprised I even asked about it. He said the reason was that a injected anaesthetic was much faster and less fuss. He pulled out my two top wisdom teeth in under five minutes. I had to agree with him.

    • Rosetta says:

      If you have to have something done that will really hurt, like wisdom teeth being removed, I’m pretty sure (?) you’re supposed to get an injection and then you can also get nitrous if you want.

      I agree with the idea that nitrous doesn’t keep you from feeling pain at all but it keeps you from minding (although that might only work with low level pain, I don’t know). I once had some shallow cavities; the dentist said they hadn’t reached the root so I shouldn’t feel any pain when he drilled, but I could have nitrous to make the whole thing less uncomfortable. I had nitrous and it was great. I was conscious and I was watching a TV on the ceiling, but I was very relaxed, felt like I was napping. I felt like only 20 minutes had gone by, until I realized I’d watched 3 half hour shows. The noise of the drill didn’t bother me. It was great. I wouldn’t do it recreationally (might as well take a nap) but if you have to sit through something uncomfortable its a huge help in relaxing and not minding.

      Then after I had to come back in the chair for just like 2 minutes of drilling to file down a little pointy bit on one of the fillings, and it was terrible. Without the nitrous the drill was so loud, the position so uncomfortable, it was going through my jaw. It didn’t hurt exactly, but I hated it strongly.

      Now, childbirth obviously does actually hurt, but I still think nitrous would help make the whole thing less traumatic, whether or not you also had some other sort of painkiller. I’m not planning on having a baby for a few years, but I wonder if I’ll be able to find a place that will let me try nitrous when the time comes.

    • Loraan says:

      My process was a root planing, where they basically do a normal scaling/cleaning, but much deeper below the gum. They gave me Novocaine for the pain, sure, but it was still a pretty traumatic experience. All the grinding and scraping would really have freaked me out if I hadn’t had the nitrous.

  11. cella says:

    First few hours of labour it was me, nitrous and a Moby selection CD. Me and hubby pretty much had a mini rave in the delivery room while the midwife popped in every hour or so to measure dilation.

  12. Anonymous says:

    As others have said, self-administered “gas and air” ie nitrous oxide plus oxygen is absolutely standard in childbirth in the UK. It’s pretty effective too. I had 40 hours in labour on it, supplemented by one shot of pethidine (estimated duration of effectiveness about 3 hours) and was coping fine until they told me nothing was progressing and I needed syntocinon, and for syntocinon I’d need an epidural too.

    You don’t need to time the breathing to just on the contraction for gas and air to work … but I suspect that the fact it makes one focus on breathing is an additional benefit. It has to be gas and air, not just pure nitrous oxide – that would indeed be asphyxiating and potentially hazardous.

    Very sad that US women are denied this safe, effective and patient-controlled method of pain relief.

  13. Shai-Hulud says:

    Humphry Davy approves.

  14. Anonymous says:

    I live in Canada and had a natural labour in the hospital with the support of doula. Nitrous was available to self-administer as needed. I used it for maybe 4-6 contractions and it was…pleasant. And it really didn’t do more than make the pain a little less intense–no lasting effect. The rule was that the patient HAD to do it, and no one else in the room was to assist in administering it or touch it. It seems like a way of ensuring proper dose. Anway, I’m shocked that such an effective form of pain relief is not widely available in the US; it was a great aid to an otherwise natural (epidural-free) birth.

  15. Beryllium says:

    Canadian here – my wife used nitrous during her labour, and no epidural was required. The nitrous didn’t go over well at first (it causes a bit of nausea in the first wave), but once she was comfortable with it, it really helped take the edge off of the contractions.

    We also had a midwife and a doula. I highly recommend the Birth Doula service to fathers-to-be … really helps keep the situation under control. And a midwife is generally more concerned with your overall birth experience than is a doctor, which is a good thing.

  16. Anonymous says:

    UK it is standard practice, in fact the nurses pretty much recommended it. They do make sure people don’t take too much as otherwise can get too high basically and not concentrate.
    (for our second child wife overdid it is a bit at one point and was talking nonsense for a good 10 minutes)

  17. PinballPie says:

    My doula told me that the reason so many hospitals in the US don’t offer nitrous is because of fear of employee abuse. It is interesting that only a handful of hospitals make it an option. It didn’t do much for me and I ended up getting an epidural anyway.

    • Loraan says:

      My doula told me that the reason so many hospitals in the US don’t offer nitrous is because of fear of employee abuse.

      This just doesn’t ring true to me. Dentists’ offices have tanks of nitrous, and nurses are trusted with access to way more potent drugs than nitrous.

      Quite possibly, timing. It only provides a few seconds of relief, so you have to hit the contraction right before the peak. It wears off almost immediately, so 20 minutes of continuous inhaling wouldn’t provide much benefit.

      This does not jibe with my experience of taking nitrous at the dentist. I speculate that you have only “huffed” nitrous from cartridges or balloons. When nitrous is given in a medical setting, it is mixed with oxygen so that you can take it continuously. I was given nitrous for about an hour while a particular dental procedure was performed and felt full effect the entire time.

      Which leads me to the comment I came here to make: There is a world of difference between nitrous plus oxygen in a medical setting and nitrous by itself in a recreational setting. When you take nitrous by itself from a charger or balloon, part of the effect you feel is asphyxiation. The nitrous binds preferentially to oxygen in your red blood cells and you get a similar effect to holding your breath, in addition to the dissociative effect of the nitrous itself. When you get nitrous in a medical setting, they mix oxygen in with the nitrous so that the asphyxiation doesn’t occur, and you get the pure dissociative effect (along, possibly, with a little bit of euphoria from the increased oxygen level, depending on the mixture).

      I point this out for trivial interest, but also so that if you’re thinking about home-birthing, don’t think you can just go buy some NO2 cartridges from the local head shop and be good to go.

      • Beryllium says:

        I was speaking from observational experience of being in the delivery room while my son was being born. What I said was quite true: The effect only lasts for a few seconds, which is why you have to time it perfectly with the peak of contraction pain. It doesn’t stop the pain, it just stops you from caring about it for a few seconds – a key few seconds, so that you can have a bearable experience and (in some cases) be able to go home the same day.

    • Snig says:

      People are wired very differently for pain, and there are a lot of differences in tolerances, as well as variability in some people getting relief from certain meds but not others. I wonder if it makes sense to do a test run way ahead of the birth on tolerance/comfort/efficacy of nitrous. Efficacy is often researched by how long you’re comfortable sticking your hand in a bowl of ice water, nothing drastic.

  18. Anonymous says:

    I had nitrous offered for the births of both my first child (in Canada) and second (in the UK). First time round, it didn’t do much of anything but make me nauseated. Second, it was fantastic. No idea why the difference.

    Ideally, it is self-administered. The labouring woman holds the mask, and starts inhaling deeply as the contraction rises, so that peak effect is reached as the contraction peaks. The self-administration ensures that if you overdo it, the hand holding the mask falls away from your face, self-correcting the dose (unlike if someone else is holding it on your face), so it’s theoretically safer. It worked perfectly in that regard for me too.

    So many medical interventions or options have local variability based on habit, supply (how come Europe has IV aspirin and we don’t?), or one bad case that put a whole hospital/city/generation off something that is used to good effect elsewhere. I suspect nitrous is one of these. Who knows, maybe it’ll catch on now as an option.

  19. Snig says:

    Some of the differences between developed countries’ medical systems are based on historical medical tradition vs. any real reasoning. Studies are often what drives change, or consolidation to smarter ideas. Research in the obstetrical field is a litigation landmine, so it’s unfortunately has not had the tweaking it should. It’s also a field where things can go tragically wrong, without the doctor doing anything wrong. But if anything is different from the norm, the doctor is afraid he/she could be sued.

  20. Anonymous says:

    I’ve only had nitrous once and it was at the dentist’s office. Novacaine doesn’t totally work for me; it takes the edge off for sure, but I can still feel pain. So my dentist suggested I try nitrous and see how that went. I put the mask on for a few minutes, but pretty soon I started flailing my arms around in the chair because the room had started spinning and I was going to fall out of the chair. Yeah, no nitrous for me.

    I did get Halcyon when I got my wisdom teeth out and that stuff was MAGICAL. I hardly remember the experience, save for a moment of seeing the doctor with his foot up on the arm of the chair, wrenching something out of my mouth. I wish they’d give me Halcyon every time I went in for a cavity!

  21. Sekino says:

    In Canada as well and I used it after 13 hours of labour. Unfortunately, it didn’t do anything at all for me except making me feel a bit light-headed (which may have been from fatigue). Eventually, after 15-20 min of my desperate inhaling, the midwife just took the mask away and offered other options.

    I wonder, what makes the gas effective in some people and not in others?

    • Beryllium says:

      Quite possibly, timing. It only provides a few seconds of relief, so you have to hit the contraction right before the peak. It wears off almost immediately, so 20 minutes of continuous inhaling wouldn’t provide much benefit.

  22. Anonymous says:

    My … it’s complicated … used nitrous during the birth of our son (in a Canadian hospital; no doula or anything like that). She said it felt more like it compressed time than dulled pain, but it does sound like it made a positive difference. She had bad scoliosis, so an epidural wasn’t an option. Plus the idea of a needle in the spine made us both uncomfortable.

  23. Michael Smith says:

    I nearly lost an arm to nitrous oxide. You see I was holding the nozzle slightly out of my wife’s reach. A contraction started and she needed the gas right then so she grabbed for it and I just barely let go in time.

  24. jamiethehutt says:

    While it is safe, if your mother huffs too much you’ll be born so asleep that you’re not breathing and it’ll take two shots (of adrenaline, I assume) to wake you…

  25. teapot says:

    This is NOT how doctors administer nitrous to pregnant women.

    Disclaimer FTW!

  26. Anonymous says:

    Nitrous Oxide isn’t a conventional anaesthetic but a dissociative. Like Ketamine, it doesn’t stop you from feeling pain, but disconnects parts of your brain so the pain doesn’t register as something you need to stop. The most common side-effect of these drugs is an out-of-body experience, which is the best way of understanding how they work. You’re aware of the pain, but in a quite abstract sense, as if it’s happening to someone else.

    Dissociative drugs are supremely useful in many branches of medicine, because the patient can still tell you what hurts where. I’m quite shocked that nitrous isn’t used in childbirth in the US – as “gas and air” or Entonox, nitrous oxide is the gold-standard of safe pain management in the UK.

  27. annie bacon says:

    they are offering this in at least one birthing center/hospital here in San Francisco – I’m pregnant and have been researching places to give birth. honestly I don’t see how it would be much use as it’s got such a short peak and as Beryllium said you’d have to take it at the perfect moment of the contraction, and if you’ve ever seen a woman in the middle of a contraction you probably know that it’s a pretty all-consuming experience. but the places we’ve seen that offer it have explicit notices that only the laboring woman is allowed to use it, which we thought was funny.

    • Anonymous says:

      G’day Annie @#11, it is widely used in Australia for childbirth. It is supplied through a mask pre-mixed with oxygen, so you just pop that over your mouth and nose and breathe deeply whenever you feel a contraction coming on …

  28. bcsizemo says:

    When I was around seven I had a couple of extra teeth removed (I have had several “extra” permanent teeth that have formed over my life.) with nothing but gas. I don’t really remember feeling much, or caring, kind of a warm fuzzy feeling. Don’t know how it’d work in labor, but it’s interesting either way.

  29. Anonymous says:

    Obstetric anesthesia is very complex issue. As an anesthetist I can tell you that all methods are subject to carefully considered ongoing risk/benefit analyses.

    For those who elect to receive treatment for labor pain, spinal and epidural techniques have been shown to be very safe for mom and baby. These methods deliver the drugs to the areas of maximum effect, thus reducing the amount of drug given to mom, and subsequently to the baby. Mom gets excellent pain control, while remaining alert and involved in her child’s birth. Baby is delivered with the minimum exposure to medications that could complicate the profound transition from fetus to newborn.

    Nitrous is a very safe and potent analgesic. But like all medications it has risks associated with it use. I quote but but have deleted the references…

    “Animal studies have shown adverse reproductive effects in female rats exposed to airborne concentrations of N2O. Data from these studies indicate that exposure to N2O during gestation can produce adverse health effects in the offspring.

    Several studies of workers have shown that occupational exposure to N2O causes adverse effects such as reduced fertility, spontaneous abortions, and neurologic, renal, and liver disease. A recent study reported that female dental assistants exposed to unscavenged N2O for 5 or more hours per week had a significant risk of reduced fertility compared with unexposed female dental assistants. The exposed assistants had a 59% decrease in probability of conception for any given menstrual cycle compared with the unexposed assistants. For dental assistants who used scavenging systems during N2O administration, the probability of conception was not significantly different from that of the unexposed assistants. Since environmental exposures were not measured during these epidemiologic studies, no dose-effect relationship could be established.”

    see http://www.cdc.gov/niosh/noxidalr.html for refs.

  30. Anonymous says:

    I’m an anaesthetist (=anesthesiologist) and intensive care doctor in the UK. The use of Entonox, a 50:50 mix of oxygen and nitrous oxide, is standard practice over here. It’s an efficient painkiller with a short onset and fast offset, so it’s ideal for contractions.

    It’s safe in labouring women. The reason your dental nurse was not allowed to administer it is that N2O exposure carries a small excess risk of miscarriage in the first and second trimesters, and so it is advised that we avoid it’s use in patients at that stage of pregnancy, and pregnant members of medical staff avoid exposure. Unsealed systems like a face mask lead to significant exposures for everyone in the room. Although there is a slight excess miscarriage rate in female anaesthetists it cannot directly be linked to nitrous, but most of my colleagues change their anaesthetic technique so that they use oxygen and air as a carrier gas for volatile anaesthetics, rather than oxygen and N2O.

    By and large it is very safe and effective in modern use.

  31. mainelee says:

    The reason dentist don’t use nitrous with pregnant woman or when an assistant is pregnant is the higher risk of spontaneous abortion in the first trimester. But by the time of delivery that risk seems to have lessened.

  32. Anonymous says:

    At my daughter’s birth here in Switzerland, my wife used nitrous and said it definitely took the edge off the pain. I snuck a huff when the midwife left the delivery room and have to say it didn’t do much for me.

  33. Anonymous says:

    I’m a dentist, for what it’s worth. We use nitrous on pregnant patients all the time… it is relatively safe for the 30 minutes or so that it takes to do the procedure. We don’t let our pregnant assistants around it, however, because some studies suggest that continuous low-level exposures over a long period of time might be harmful. Also, it doesn’t work on everyone… great for kids, but some adults just don’t respond. I hope it becomes more widely used, and this sounds like a great application!

  34. opmaroon says:

    Look into hypnobirthing, no need for painkillers, drugging yourself and your baby at the point of birth. The amount of women that are conditioned to expect unbearable amounts of pain and go straight for an epidural alarms me.

  35. robulus says:

    Yeah they have nitrous available during childbirth in Australia, but it’s pants. They mix it liberally with oxygen. Far better to buy “Whipping Cream” gas bulbs from the supermarket and suck them down through a Soda Siphon. That’s the shit. Only don’t do it with soda bulbs, they’ve got CO2 in them and they’ll kill you.

    Anyway, I’ve been reliably informed that having children is immoral because they might be unhappy (no really), so this is a moot point given the end of all human reproduction once that bombshell gets out.

    • robulus says:

      And yeah if I’d had a closer look at the picture I would have realised my contribution was superfluous. Doh.

  36. Boba Fett Diop says:

    Due to other biological factors, I will likely never be in a situation where I would be administered nitrous during childbirth. However, I was given it when I had my wisdom teeth removed- I was offered the choice between nitrous and lidocaine, or partial sedation. Looking at the recovery times, the choice was pretty obvious for me: half-an-hour vs. six (and those six likely spent with my parents).

    I have a pretty high pain threshold, so my results may not be typical, but I found that the procedure posed no problems at all for me under nitrous. I was aware of everything, even the sound of my back teeth being cracked out of my jaw, but just didn’t care.

    Of course, I have also used nitrous recreationally and haaaavvve quiiiiiiite enjooooyyyyyed iiiiiiiit.

  37. bardfinn says:

    From Wikipedia article on Nitrous: “A study of workers[69] and several experimental animal studies[70][70][71][72] indicate that adverse reproductive effects for pregnant females may also result from chronic exposure to nitrous oxide.”

    When they say “chronic” here, they mean repeated exposure to clinically significant levels for several hours every day for an extended period.

    Upon recovery from nitrous anaesthesia, as the gas is being moved from the blood into the alveoli (lung sacs), it displaces oxygen and CO2, causing a drop in their partial pressures, and causing oxygen and CO2 to leave the blood into the alveoli as well – and since the increased level of CO2 in your blood is what makes you feel like you need to breathe deeper to get more air, you would “feel fine” while the effects of hypoxia were present. During childbirth, the mother supplies the child with oxygen, so this is a problematic effect. Modern equipment and anaesthesiology, with training, would prevent this problem – but if you have to stop administering nitrous because of a problem in the childbirth, then you have a second problem along with the fact that in two minutes’ time, the mother is going to be very much in pain and caring about it.
    If you don’t have an anaesthesiologist, problem.
    If the delivery takes several hours, problem.

    Psychologically, it can induce depersonalization and derealisation, which may interfere with mother-child bonding, especially if the mother has never experienced a dissociative emotional episode and has negative reaction to it.
    It crosses the placenta, so the fetus is exposed to the gas as well – which, from the ObGyn I’ve talked to, is a reason that intravenous and inhaled anaesthetics are avoided in the US, so that they aren’t potentially causing a problem for the fetus, as much less drug is transferred to the fetus from an epidural. The flipside here is that even with epidural, fetuses are exposed to some of the epidural drug(s) and their metabolic products, and then have to metabolise and excrete those.

    In the US, the risks of epidural versus the risks of nitrous are weighed and often epidural is less risky – ObGyns here would, I imagine, encourage “natural” rather than go with nitrous given

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