Nitrous Oxide During Labor — Pain Relief You Control Yourself

The contractions are coming closer together, the pain is intensifying, and you want something to take the edge off. Nitrous oxide may be exactly what you need — a form of pain relief you control completely yourself, and that works within seconds.

Nitrous oxide (also known as laughing gas or Entonox) is one of the most commonly used forms of pain relief during labor in many countries. It's safe, easy to use, and you decide how much you need. Here's everything about how nitrous oxide works and what you can expect.

What Is Nitrous Oxide?

Nitrous oxide for labor is a mixture of 50% nitrous oxide (dinitrogen monoxide, N₂O) and 50% oxygen, often referred to as Entonox or "gas and air." It's delivered in a premixed cylinder. You breathe the gas through a mask or mouthpiece that you hold yourself.

Nitrous oxide has a calming and pain-reducing effect. It doesn't eliminate pain completely, but takes the edge off so that contractions become more manageable. Many people describe it as gaining a bit of distance from the pain.

How Does Nitrous Oxide Work?

Nitrous oxide works by affecting the central nervous system. The gas inhibits pain signal transmission in the brain and releases the body's own endorphins. The effect is twofold: you feel calmer, and the pain feels less intense.

How to Use Nitrous Oxide

1. Hold the mask firmly against your face — there should be no air leaking at the sides
2. Start breathing in 30 seconds BEFORE the contraction peaks — the gas needs time to work
3. Breathe deeply and evenly — take long, slow breaths through the mask
4. Put down the mask between contractions — you breathe normal air between contractions
5. Repeat for each contraction — you control whether you want to use it for the next one

Timing Is Key

The most important thing to know about nitrous oxide is that it takes approximately 20–30 seconds to work. If you start breathing when the contraction is already at its peak, it's too late. Your midwife will help you find the right timing.

When During Labor Can You Use Nitrous Oxide?

Nitrous oxide can be used at all stages of labor:

• Early active phase — when contractions start getting strong, but you don't need stronger pain relief yet
• Active phase — as the only pain relief or as a supplement while waiting for an epidural
• Pushing stage — some people use nitrous oxide right to the end, while others set it down to focus on pushing
• After delivery — can be used during suturing of any tears

You can start and stop whenever you want. There are no restrictions on how long you can use it, and the effect disappears within a few minutes after you stop breathing it.

Advantages of Nitrous Oxide

Nitrous oxide has several properties that make it popular during labor:

• You control it yourself — you hold the mask and decide when to use it
• Fast acting — the effect kicks in within 20–30 seconds
• Wears off quickly — the effect disappears just as fast when you stop breathing
• Can be combined — you can use nitrous oxide alongside most other forms of pain relief
• No significant effect on the baby — nitrous oxide does not transfer to the baby in meaningful amounts
• Freedom of movement — you can stand, sit, or lie down while using it

Side Effects and Limitations

Although nitrous oxide is safe, some people experience side effects:

• Nausea — the most common side effect, especially initially. Usually passes after a few minutes
• Dizziness — may feel like the room is moving slightly
• Fatigue — some feel more tired than usual
• Dry mouth — the mask can cause dryness
• Euphoria — a feeling of being "out of it" or "floaty"
• Insufficient effect — for some people it doesn't provide enough pain relief

If you find the side effects uncomfortable, just put down the mask. The effect disappears within a few minutes, and you can try again when you're ready.

Nitrous Oxide Compared to Other Methods

Nitrous Oxide or Epidural?

Nitrous oxide and epidural are very different. Nitrous oxide provides moderate pain relief and lets you move freely. An epidural provides strong pain relief but restricts movement. Many people start with nitrous oxide and switch to an epidural if they need stronger relief.

Nitrous Oxide and TENS

A TENS device and nitrous oxide can easily be combined. TENS is often used in early labor while nitrous oxide is added when contractions get stronger. Together they can provide good coverage through much of labor.

Nitrous Oxide and Natural Methods

Breathing techniques, warmth, movement, and other natural methods can be used alongside nitrous oxide. In fact, the calming effect of nitrous oxide can make it easier to focus on breathing.

Who Cannot Use Nitrous Oxide?

Most laboring people can use nitrous oxide without problems. There are a few exceptions:

• Impaired consciousness — if you are significantly affected by other medications
• Vitamin B12 deficiency — prolonged use of nitrous oxide can worsen B12 deficiency
• Pneumothorax — lung collapse (very rare in laboring people)
• Recent decompression sickness — gas in blood vessels can expand

Talk to your midwife or doctor if you're uncertain whether nitrous oxide is right for you.

Preparing for Nitrous Oxide

You can do a lot to get the most out of nitrous oxide during labor:

1. Note it in your birth plan — write that you want nitrous oxide available
2. Practice breathing — deep, controlled breathing makes nitrous oxide more effective
3. Have a backup plan — decide in advance what you'll do if nitrous oxide isn't enough
4. Talk to your birth partner — explain that you may seem a bit "out of it" and that this is completely normal
5. Pack lip balm — the mask can dry out the skin around your mouth

Frequently Asked Questions

Does nitrous oxide make me lose control?

No. You hold the mask yourself, and you are conscious the whole time. Some people experience a mild feeling of euphoria, but you can put down the mask at any time. You do not lose consciousness.

Can nitrous oxide affect the baby?

No, nitrous oxide is considered safe for the baby. The gas is eliminated quickly through your lungs and does not transfer to the baby in any significant amount.

Can I use nitrous oxide if I've had an epidural?

Yes, nitrous oxide can be used alongside an epidural. Some people use nitrous oxide while waiting for the epidural to take effect, or as a supplement if the epidural doesn't cover all the pain.

Is nitrous oxide available everywhere?

Nitrous oxide is available at most hospital maternity units and birth centers. It's one of the most widely used forms of pain relief in labor. Check with your specific birth location to confirm availability.

Can I try nitrous oxide and then switch to something else?

Absolutely. Nitrous oxide doesn't commit you to anything. The effect disappears within minutes, and you can switch to an epidural, TENS, or other methods at any time.

Summary

Nitrous oxide is a safe and flexible form of pain relief that gives you control over your own birth experience. It works quickly, can be combined with other methods, and disappears just as fast as it arrived. For many people it's the perfect first pain relief — either as the only method or as a stepping stone.

The most important thing is knowing what options you have. When you understand the benefits and limitations, you can make an informed choice during labor — in collaboration with your midwife.

Sources

1. American College of Nurse-Midwives — Nitrous Oxide for Labor Analgesia
2. ACOG — Nitrous Oxide for Pain Management in Labor
3. WHO — Intrapartum Care for a Positive Childbirth Experience