No laughing matter: Hospitals offering nitrous oxide for use during childbirth

Amanda Williamson with husband P.J. Cerano and their daughter Sophia in a birthing suite at Tempe St. Luke’s Hospital. Williamson chose to use nitrous oxide rather than an epidural when she gave birth to Sophia, her second child, in August. Photo by Rick D'Elia.
Amanda Williamson with husband P.J. Cerano and their daughter Sophia in a birthing suite at Tempe St. Luke’s Hospital. Williamson chose to use nitrous oxide rather than an epidural when she gave birth to Sophia, her second child, in August. Photo by Rick D’Elia.

Commonly called “laughing gas” for its euphoric effects, nitrous oxide has long been used as a pain-management tool at the dentist’s office. Now, a few local hospitals are offering it in lieu of an epidural during childbirth.

“It doesn’t make them laugh, it helps patients relax,” says Betty Hart, obstetrics director at Tempe St. Luke’s Hospital, which in August started offering nitrous oxide — a mix of 50 percent nitrous gas and 50 percent oxygen — to mothers-to-be during labor.

Amanda Williamson had an epidural for the birth of her son Dominic, who now is 4. But when her daughter Sophia was born in August, she opted for nitrous oxide at Tempe St. Luke’s.

“I didn’t like anything about (the epidural),” Williamson recalls. “I didn’t like the stuff they rubbed on my back, the putting a needle in my back, then not being able to walk or feel anything. It was just harder to use the restroom after.”

With nitrous oxide, Williamson described the sensation as “floating” during a contraction.

“I could feel the difference,” she says. “It’s kind of like your head goes in and out of everything, but it makes you control your body more just to push. You are not numb, and you are not just in pain.”

Tempe St. Luke’s and Phoenix Indian Medical Center are the only Arizona facilities currently offering the gas, which is credited with helping women in labor dull the pain and decrease anxiety without dulling their senses or mobility.

Tempe St. Luke’s sister facility, Mountain Vista Medical Center in Mesa, also plans to start offering nitrous oxide for childbirth this year. Nationwide, hundreds of hospitals are offering laughing gas for childbirth, and that number is growing. Hospitals in Europe have long offered a nitrous-oxide option for childbirth.

Midwife Risa Rispoli, who trained in the use of nitrous oxide in Scotland and now lives in the Valley, was excited when Tempe St. Luke’s adopted its use. She recommended nitrous oxide to Williamson, who was the first woman to try it at the hospital. Since then, a handful of women giving birth there have opted for nitrous oxide in lieu of an epidural.

“She was a great person to use this on,” Rispoli says of Williamson. “It allowed her body to do its normal thing and progress pretty rapidly from where she was to full dilation and pushing and delivery. It takes away a lot of the anxiety and allows (most women) to push more effectively.”

The mother uses a mask to inhale the gas during a contraction; experts say it typically takes about three deep breaths to ease the pain. Once the contraction has passed, the mother removes the mask. Rispoli likes the fact that nitrous oxide is self-administered.

“It’s patient-controlled, which I love,” Rispoli says. “They are in control — not me, not the nurse, not the husband. The patient is in control; the mother is in control.”

The American Pregnancy Association considers nitrous oxide safe for both mother and baby but warns: The concentration must not exceed 50 percent, it must be self-administered and the equipment must come with a demand valve, which is a safety shutoff.

Rispoli says the effects of nitrous oxide disappear within minutes of cessation, and there’s no effect on fetal heart rate, cord-blood gases or Apgar scores, which take into account a newborn’s color, heart rate, reflex, muscle tone and respiration to gauge his or her condition immediately after birth.

Williamson says she felt much better after her second delivery than her first, which translated into more energy both in the hospital and when she got home.

“Afterward, I would say my body healed faster with this than it did with the epidural,” she says. “As soon as I got home, I was trying to pick up everything and get back to my usual routine.”

An epidural and nitrous oxide are not used together for pain management during childbirth, but having used the gas does not mean you can’t then opt for an epidural if time permits. In fact, some women opt for nitrous oxide while an epidural is being placed in the spinal canal, because that procedure can be stressful.

Hart, the obstetrics director at Tempe St. Luke’s, is encouraged by how well nitrous oxide works.

“We had a woman come in the other day (who) was off the wall, and within about five minutes of her using the nitrous, she was very calm, very relaxed,” Hart says. “Our patients have loved it.”


  1. I do hope women offered this procedure are offered MTHFR 1298 and 766 testing prior to approval. With about 30% of the population being positive for these polymorphisms which puts them on serious cardiovascular risk if nitrous oxide is used. This is just one of the many studies done on the risk of nitrous oxyde This article is very concerning to me as my daughter was put on nitrous oxide twice without anyone testing for this common polymorphism or testing for B12 levels.

    Luckily more doctors are becoming aware of this, but still many who have not catch up. Please make an amendment to this article that otherwise will put a lot of people on risk of serious side effects.



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