Boston hospital offers laughing gas for labor

Brigham and Women’s Hospital on Tuesday became the first labor and delivery center in Boston to offer nitrous oxide or “laughing gas” to women in labor. Women inhale at the beginning of every contraction to take the edge off their pain and relax a bit. It takes about 30 seconds to work, and wears off about 30 seconds after the mask is removed, said Dr. Bill Camann, director of obstetric anesthesia at the Brigham.

“Patients control it themselves and take as many breaths as they like,” he said; usually, they remove the mask in between contractions.

For unknown reasons, laughing gas for labor pain fell out of favor in this country several decades ago. Only a handful of hospitals including the University of Washington in Seattle have continued to use it through the years, but it’s been used routinely in other countries, including Great Britain, Australia, and Canada.

Camann said his colleagues at other Boston hospitals have been asking him about it and seem eager to try it. Over the past few weeks, the Brigham has used the gas on about seven or eight patients, he estimated, before officially implementing it as an option for routine clinical care today.

“It’s about giving people more choices and flexibility,” he said, “one more item on the menu of options for labor pain.”

Epidural injections won’t be replaced by nitrous oxide since an epidural completely blocks pain, which laughing gas doesn’t do. Patients may find that the gas works during early labor with milder pain but then switch to an epidural once the pain gets excruciating, according to Camann.

Women, like myself, who have very fast labors might find the gas works better. During my second labor 16 years ago, my epidural kicked in just as it was time to push -- and then I had a hard time trying to do it correctly with a complete lack of feeling. I decided to skip it during my third labor, but gas might have helped dull the intense sensations of pushing.

(Epidurals have also improved since then, Camann told me, allowing women to control how much medication they receive with the push of a button.)

Both forms of anesthesia are very safe, and serious side effects are extremely rare. In about 1 percent of cases, women who have epidurals can develop severe headaches that may last a day or two, Camann said. Epidurals also require women to stay in bed during labor, while if they use laughing gas, they can walk around or even take a bath -- as some women like to do during labor.

The laughing gas can cause nausea, especially with prolonged use, and shouldn’t be used in women with a rare form of anemia.