Laughing gas for ladies in labor


Apparently, nitrous oxide—the stuff they give you at the dentist—is a safe anesthetic to use on women who are giving birth. Pretty surprising to this American. I've always generally had the impression that gas was dangerous for pregnant ladies—in fact, I've had dentists who wouldn't let pregnant nurses administer nitrous to me. But the case made in this Slate article by Libby Copeland sounds well-supported by evidence. Even more interesting, none of this is likely to raise eyebrows in Europe, where lots of women have used nitrous during labor for decades.

So why isn't this normal in America? From the sounds of things, it's a combination of a difference in mid-century medical culture, and some really bad timing.

The gas was first used on laboring moms in the 1880s and came into more widespread use in the 1930s, when a series of technical advances in Great Britain made it easier for laboring women to self-administer through a mask. Nitrous is still used widely in other countries' delivery rooms: According to data parsed by nurse-midwife and former Centers for Disease Control and Prevention epidemiologist Judith Rooks, well over half of laboring women sampled in the United Kingdom use nitrous oxide today. In other places, including Finland and the Canadian province of British Columbia, close to half of women use it.

Why don't we have it here? As the Associated Press has reported, only a handful of American hospital delivery rooms still offer nitrous to laboring women. It was more widely available in this country from the '30s through the '50s, says pediatrician Mark Sloan, author of Birth Day, but several factors blunted its popularity. For some reason, Sloan says, the idea of women self-administering nitrous oxide didn't catch on here the way it did in England, where midwives started towing nitrous around with them to home births. In the United States, by contrast, hospital deliveries were the norm, and doctors and nurses were told to deliver nitrous by holding a mask over a laboring woman's face with each contraction. When, in the '50s and '60s two rival inhalational anesthetics came along, both of them less time-consuming to administer, they elbowed nitrous oxide out of the way. It later turned out these rivals were dangerous, but just when nitrous might have been poised to make a comeback, the epidural arrived on the scene.

Copeland points out that, unlike an epidural, nitrous doesn't so much eliminate pain as make you not really care that pain is happening. That rings true for me. Personally, I credit nitrous with getting me over a paralyzing fear of needles. Back in junior high, I once panicked and tried to run during an MMR booster, and nearly got the needle broken off in my arm. But in college, when I faced my first cavities, my then-dentist suggested nitrous. I still felt the shot. But I didn't feel the terror, and the nitrous made the pain of the shot seem like not such a big deal. Today, when I get a cavity, I don't even use the gas any more. I'm still probably more anxious about shots than the average person, but the gas really helped me break down the mental block I had, so I can actually get the medical treatment I need now.

I doubt shots are really a good metaphor for the pain of childbirth, but the pain of childbirth certainly is scary to a lot of women. If you don't think you want an epidural, but do want something to take the edge off, nitrous does sound like it could be a nice third option—somewhere between toughing it out and using effective painkillers that have the unfortunate side-effect of preventing you from walking around or peeing on your own. Women are different, and have different needs. It would be nice if they had more than two ways to deal with labor pain.

Image: Nitrogen day, a Creative Commons Attribution (2.0) image from recphoto's photostream. This is NOT how doctors administer nitrous to pregnant women.