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Laughing Through Labor

Nitrous Oxide and Your Birth Plan

Having comfort options is important to any woman who hopes to approach her birth as a natural process. Nitrous oxide – more commonly known as laughing gas – is one such option. 

Many women in the U.S. have never heard of nitrous, and some may only be familiar with it because Kate Middleton (Duchess of Cambridge and mother of George and Charlotte) had nitrous as a part of her birth plan. While nitrous oxide for labor has been around for over fifty years, it has only recently returned as an option for women here in Richmond. In fact, Richmond was the first city in Virginia to offer this exciting comfort measure for laboring moms.

While nitrous has been and continues to be commonly used in the United Kingdom as well as in much of Europe, Canada, and Australia, I believe it was overlooked in the United States because births were considered to be hospital-based procedures, and stronger alternatives, like epidurals and twilight sleep, became the norm. More recently, couples are realizing the risks associated with over-medicated, highly-procedural deliveries. Allowing space, time, and more natural support for the birth process frequently leads to beautiful, safe vaginal births.

Nitrous oxide is quick-acting and very simple to use. It is made of a fifty-fifty mix of nitrous oxide and oxygen – a weaker strength of the laughing gas used in the dentist’s office. Laboring mothers have complete control over when to use it, how long to use it, and when to stop using it. Its use is very flexible because it clears from the body very quickly.

The laboring woman holds a mask to her face, and only breathes as much gas as benefits her. The gas can be used intermittently or regularly over a short span of time or several hours. Because the gas is cleared by a tube that is attached to the wall, its use is limited to approximately ten feet, and therefore, cannot be used in a tub or shower. However, a woman can labor with nitrous in a variety of positions – in bed, while standing, or on a birthing ball – right up to the time of birthing or getting an epidural.

Nitrous oxide can be used along with numerous support measures, and doesn’t preclude a woman from getting an epidural. It can also be used following the baby’s birth should there be challenges delivering the placenta, or if a tear in the woman’s tissue occurs and needs to be repaired.

It is helpful for laboring couples to share their interest in using nitrous with their healthcare providers, as this option is not currently available at every hospital or birthing center. In addition, an easy consent can be reviewed early in labor, and there is no delay in the woman receiving this option should it become desired as labor progresses. Typically, it is best to hold off on using nitrous until the woman is finding that other comfort measures are no longer helping her cope adequately.

While nitrous doesn’t eliminate pain, it can buffer the tricky transitions of labor. In addition to keeping discomfort under control, it can help decrease fears and anxieties.

Nitrous has been found to be quite safe for mothers and their babies. In some women, it can cause lightheadedness or nausea. These sensations clear quickly after stopping use of the gas. Nitrous is not for everyone, and those with celiac disease or problems absorbing vitamin B12 should not use it in labor.


Alice Hirata, MD, is an obstetrician and an advocate for low-intervention births. However, certain circumstances – such as high-risk pregnancies and multiple gestation births – require expertise she enjoys providing. Dr. Hirata is the proud mother of two teenage sons. She sees patients at Bon Secours Richmond OB/GYN.
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