Most Americans who have experience with nitrous have received it during a dental procedure, such as getting a cavity filled as a child. While the use of nitrous in labor is a fairly new concept to most modern-day Americans, it has been used for pain relief in the labor and birth setting in Europe, Canada, and Australia for over 100 years. It was also used in American labor and delivery wards earlier in history before being dismissed and demoted after the advent of the epidural. Unlike an epidural, however, nitrous does not numb the user and has minimal adverse effects. Because of its effectiveness and versatility, many hospitals started reintroducing nitrous for labor pain relief in the state of Massachusetts in 2014.

• Nitrous oxide use is controlled by the user via patient-controlled mask so there is no risk of overdose

• The effects of the gas are only felt as long as it is inhaled and wear off within minutes of removing the mask

• Nitrous oxide use does not numb the user as an epidural would, so the user is still free to move and change position freely

• Nitrous oxide has minimal side effects and the most common (nausea, dizziness, and lightheadedness) are minimized with relaxing breathing exercises

• It can be used at any point during cervical dilation and even postpartum such as for perineal repair


• There are no effects on fetal heart rate or breathing ability at birth


• It does not slow labor progress


• There are no long term adverse effects for the user or their baby

  
  Nitrous oxide provides the best relief when the laboring person starts inhaling the gas approximately thirty to forty five seconds before they think a contraction is about to begin. Hence, support from the birth team is key as the team can help track the timing of contractions. Some people inhale the gas throughout the entire contraction, while others find they only need it until the peak of the contraction has passed.

Embrace Midwifery uses a portable PRO-NOX™ Nitrous Oxide delivery system to administer nitrous oxide for labor pain relief. The PRO-NOX™ unit is an FDA approved medical device that is set to deliver a 50/50 mixture of nitrous oxide and oxygen to the user every time. There is no way for the user to adjust the concentration and since it is self-administered, there is no risk of overdose.

When nitrous is used in dental procedures, a 70% nitrous and 30% oxygen mixture is delivered to the patient. However, the PRO-NOX™ system automatically delivers a 50/50 mixture, which has been the concentration safely used in obstetrics around the world for over 100 years. Therefore, if you have ever received nitrous for a dental procedure and felt very ‘out of it,’ do not worry, the effect will not be as strong in labor. Nitrous gives the user a ‘disconnected’ feeling from the pain, as if they can feel the pain, but they ‘don’t care’ about it as much. It has a very effective ‘anti-anxiety’ effect, which helps the user relax more easily to conserve energy in between contractions. It is particularly helpful for feelings of panic during ‘transition,’ considered the most intense, but shortest phase of labor, and it can help the user get through those last few intense contractions before one is able to push. During pushing, nitrous can be used in between contractions to help the user relax and conserve energy.

The Embrace Midwifery team is happy to be able to provide this safe and effective method of pain relief for our home birth clients for a flat rate of $250 per birth to cover the cost of the gas and the disposable mouthpiece and tubing. Embrace Midwifery offers nitrous oxide for home birth labor pain relief for clients in Massachusetts. If interested, please speak to your midwife at your next prenatal appointment.