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Is it safe? · Pregnancy Smart

Is nitrous oxide for labor safe during pregnancy?

Assigned clinical reviewerMatt Stahl· PharmDDraft · pending clinical reviewUpdated

What does the evidence say about nitrous oxide for labor during pregnancy?

  1. ACOG advises against giving inhaled nitrous oxide at the same time as systemic opioids or sedative-hypnotic drugs because deeper sedation, respiratory depression, and maternal low-oxygen episodes may occur. 1
  2. ACOG describes labor nitrous oxide as an oxygen mixture inhaled through a mask and notes that only some hospitals offer it. It is one option among systemic, regional, local, and inhaled analgesia. 2
  3. A systematic review of 58 publications representing 59 study populations found nitrous oxide less effective for pain relief than epidural analgesia. Only two studies were rated good quality, 11 fair, and 46 poor, limiting confidence in comparisons. 3
  4. The same systematic review identified nausea, vomiting, dizziness, and drowsiness as the main maternal tolerability effects. Newborn Apgar scores were not significantly different from other analgesia or no analgesia, but evidence quality and longer-term outcome data were limited. 3
  5. A 2020 review describes patient-controlled delivery through an unstrapped mask and rapid clearing after inhalation stops. It reports that 40 to 60 percent of users in available studies moved to epidural analgesia, while satisfaction often reflected control and mobility as well as pain scores. 4

Is nitrous oxide for labor safe in each trimester?

  • First trimester. Labor nitrous oxide is an intrapartum option, not a first-trimester pain medicine. Occupational exposure from dental or clinical work is a separate question that depends on ventilation, scavenging, and workplace controls.
  • Second trimester. Labor nitrous oxide is not used routinely for second-trimester pregnancy discomfort. If a procedure is needed during pregnancy, anesthesia planning should address the specific procedure, dose, exposure time, and maternal health rather than borrowing labor protocols.
  • Third trimester. Before labor, ask whether your hospital offers nitrous oxide, how it is monitored, and which conditions or recent medicines would exclude its use. A person can switch to another analgesic method if nitrous does not provide enough relief.

Frequently asked questions

How is nitrous oxide used during labor?

The laboring patient holds an unstrapped mask and inhales an oxygen-nitrous mixture through a demand valve. Self-administration is a safety feature because letting go of the mask stops delivery if drowsiness develops. Staff provide instructions and monitor maternal and fetal status.

Does nitrous oxide remove labor pain completely?

Usually not. Nitrous oxide may make contractions easier to cope with and can reduce anxiety, but systematic-review evidence finds less pain relief than epidural analgesia. It is reasonable to request another option if the relief is not enough.

How quickly does labor nitrous oxide work and wear off?

Nitrous oxide acts within breaths and clears within a few minutes after inhalation stops. Because peak effect is not instant, hospital staff commonly coach users on timing breaths before a contraction. Follow the device and unit instructions rather than a fixed home timing rule.

What side effects can nitrous oxide cause in labor?

The most commonly reported effects are nausea, vomiting, dizziness, drowsiness, and an unpleasant mask sensation. Tell staff immediately about marked sleepiness, breathing difficulty, confusion, weakness, or inadequate pain relief so use can stop and the plan can be reassessed.

Can nitrous oxide be used with IV opioids in labor?

Not at the same time. ACOG advises against co-administration with systemic opioids or sedative-hypnotic medicines because the combination may deepen sedation and increase respiratory depression and maternal low-oxygen episodes. The care team should manage spacing or switching between options.

Can I still get an epidural after trying nitrous oxide?

Yes, if an epidural is otherwise available and appropriate. Nitrous oxide does not commit you to one plan. Available studies report that many users later chose epidural analgesia, which reflects nitrous oxide's more modest analgesic effect rather than a complication by itself.

Does nitrous oxide affect the baby?

The 2014 systematic review found no significant difference in newborn Apgar scores compared with other labor analgesia or no analgesia. That finding does not prove equivalence, and the review emphasized poor study quality and limited evidence for less common or longer-term outcomes.

Who may not be a candidate for labor nitrous oxide?

Tell the anesthesia team about B12 deficiency or pernicious anemia because nitrous oxide interferes with B12 function. Impaired consciousness, inability to hold the mask, trapped-gas conditions, pulmonary hypertension, and some heart conditions can also make it unsuitable. Disclose recent opioids or sedatives; simultaneous use is not advised.

Related in the library

References

  1. Use of Nitrous Oxide in Labor and Possible Interaction with Systemic Opioids or Sedatives/Hypnotics

    ACOG · https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/07/use-of-nitrous-oxide-in-labor-and-possible-interaction-with-systemic-opioids-or-sedatives-hypnotics

  2. Medications for Pain Relief During Labor and Delivery

    ACOG · https://www.acog.org/womens-health/faqs/medications-for-pain-relief-during-labor-and-delivery

  3. Nitrous oxide for the management of labor pain: a systematic review

    PubMed · https://pubmed.ncbi.nlm.nih.gov/24356165/

  4. Nitrous Oxide for Labor Analgesia: What We Know to Date

    PMC · https://pmc.ncbi.nlm.nih.gov/articles/PMC7755562/

  5. Nitrous Oxide

    NCBI Bookshelf · https://www.ncbi.nlm.nih.gov/books/NBK532922/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.