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    Women Are Using Laughing Gas To Take The Edge Off Childbirth Pains

    Because labor is no laughing matter.

    It's no secret that labor can be an intensely painful, overwhelming experience.

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    It's called labor for a reason, right?

    But you may not know that you can actually use "laughing gas," or nitrous oxide, to take the edge off.

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    Imagine a nurse or midwife rolling up a little cart with a tank of gas, connected to a hose with a mask at one end. Whenever you feel a contraction, you grab the mask and breathe and relax into a little cloud of bliss. According to a recent report from NPR, this exact scenario is becoming increasingly popular among women in the US.

    So BuzzFeed Health reached out to Dr. Michelle Collins, professor and director at Vanderbilt University School of Nursing and member of the American College of Nurse-Midwives, to find out more about this labor pain alternative — which, according to Collins, is now offered in over 300 hospitals and 50 birth centers in the US (compared to just a few hospitals back in 2011).

    Nitrous oxide is a sedative agent that's mixed with oxygen and administered via mask or mouthpiece — like the kind you get at the dentist.

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    Yep, we're talking about that gas that tastes kind of sweet and makes you feel totally comfortable despite having a bunch of sharp metal tools in your mouth.

    Nitrous oxide doesn't knock you out but it has anesthetic and analgesic effects, so it can decrease sensation and pain while you remain awake. "The name is a bit of a misnomer — it doesn't actually make you laugh, you just feel very relaxed and the pain doesn't bother you as much," Collins says. There can be side effects like nausea and vomiting, but women are notified about these before they give consent.

    Collins explains that the nitrous oxide used for labor doesn't make you as loopy or out of it like it does during dental procedures. That's because the kind given to adults during dental procedures has a higher concentration of nitrous oxide as compared to the 50–50 nitrous oxide and oxygen mixture given fo childbirth. Additionally, the nitrous oxide at the dentist is usually free-flowing in a mask strapped to the patient's face so they breathe it in constantly. During labor, people actually use the nitrous oxide intermittently, Collins says.

    During childbirth, a person can pick up a mask and breathe in the laughing gas whenever she chooses.

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    "The woman controls everything — they hold the mask or mouthpiece up to their face and breathe in the gas when they need it," Collins says. Nobody else can hold the mask to the patient's face or assist them in inhaling. A bedside physician or nurse will train them on how to use the mask or mouthpiece properly, Collins says, and monitor how they're using it throughout labor.

    Plus, the masks have a built-in safety control to prevent you from breathing in too much of the gas. "There's a demand valve inside so it only releases gas when you create a tight seal around your mouth with the mask or mouthpiece and breathe deeply to create negative pressure," Collins says. When you've had enough laughing gas, it's pretty difficult to operate the equipment properly.

    So a lot of people feel like this allows them to have more control over their pain and their body.

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    First, nitrous oxide is easy to use, works very quickly, and it's convenient for the patient and provider. But Collins says the patient-controlled aspect can also give patients a sense of control over the pain and even some self-empowerment.

    Plus, nitrous oxide won't limit your ability to move around during labor, the way some epidurals do. "Unless you get a walking epidural (combined spinal-epidural) which not all hospitals offer, you can end up being confined to the bed during labor," Collins says. Nitrous oxide allows them to maintain mobility so they can walk around, sit on a birthing ball, dip in a tub, etc.

    Finally, it's great for reducing anxiety. "It has a lot of utility beyond just decreasing pain, such as helping women relax while we turn around the baby in a breech birth or draw blood or repair vaginal lacerations," Collins says. "It gives you this euphoria that helps you sort of forget about the pain for a little bit," one woman told NPR.

    And it's totally safe for the baby.

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    There is data which shows that nitrous oxide is safe for the baby and unlike narcotics which can make a baby sleepy during birth, Collins says nitrous oxide passes through the mother and the child too quickly to affect the baby.

    "After it's inhaled, the gas is excreted through the mother's lung tissue and a very small amount will diffuse into the placenta and reach the baby — but it's such a secondary method of receiving the gas that it doesn't affect the baby and it's gone after it takes one or two breaths," Collins says.

    It's also safe for most women — but like any medication, it isn't recommended for everyone.

    "Women shouldn't use nitrous oxide during labor if they have the potential for the gas to collect in a a space in their body, for example if they've had a recent collapsed lung or bypass surgery," says Collins. It's also not an option if you are physically unable to hold the mask or mouthpiece, Collins says, either because of a disability or due to impairment from drug or alcohol abuse.

    "Nitrous oxide also isn't for women who are severely deficient in B12 like we see in people with Crohn's or celiac disease, because the nitrous oxide binds with a core component of B12 so using the gas could result in dangerously low B12 levels," Collins says.

    It's actually been widely used in Europe for over 100 years!

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    It's hugely popular in the United Kingdom, Sweden, and Norway, Collins says, but also outside of Europe in Canada, Australia, and New Zealand.

    "We have a great deal of anecdotal evidence from nearly 100 years of use in very large populations and several countries where 60–80% women use nitrous oxide during labor," Collins says. Some studies have shown that nitrous oxide effectively reduces pain during labor, but a systematic literature review which compiled all studies on the topic found that overall there isn't a wealth of good medical research and more needs to be done.

    However, the first-hand experiences of women are still important. "We can't discount the positive experience of millions of women who have used it in other countries for nearly a century," Collins says.

    It was popular in the US too until the 1950s, when more potent anesthetics like epidurals came onto the scene.

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    Laughing gas became a viable option for labor in the 1930s, but by the 1950s doctors began experimenting with anesthetics and opioids. These caused negative side effects and basically knocked people out for their entire labor.

    The solution was regional anesthesia (like epidurals), which eliminated pain during labor but allowed people to stay awake. By the 1970s, most people in the US were opting for regular epidurals, a periodic injection through the lower back into the spinal fluid which blocks all feeling below the waist.

    After laughing gas fell out of favor in the 1950s and 1960s, Collins says there became a huge generation of providers in the US who had never used or even seen nitrous oxide for childbirth. So a major reason why it isn't more popular in the US is because so many OB/GYNs and nurse-midwives aren't trained to use it.

    But now it seems that people are asking for more options when it comes to managing pain during labor and delivery.

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    In the US, the pain medications for labor and delivery are pretty much limited to anesthetics, which block all feeling, and analgesics, which remove pain without losing all feeling — which come in IV or shot form. However, Collins says that more people are speaking up and saying they want access to all the available and safe options for pain relief during labor — which includes nitrous oxide in addition to anesthetics and analgesics.

    "Part of it is consumer demand — women are consumers of their own healthcare and they want input in the choices made about their childbirth," Collins says. Plus, there's the internet, which has made it easier for people to research childbirth practices around the world. "They might see that laughing gas is an option in Europe and think 'hey, I should have access to this too'," Collins says.

    But you'll still have to ask your provider for nitrous oxide or find one who offers it for labor pain.

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    Typically, laughing gas isn't advertised next to anesthetics and analgesics as a common medication to ease labor pain — at least in the US. "Women have to ask their provider if nitrous oxide is available where they plan to give birth or at any other nearby hospital or birthing center," Collins says.

    An interesting detail is that despite its limited availability, nitrous oxide is significantly cheaper than the cost of epidurals. The gas only costs about 50 cents an hour to run and the single-use mask is only $25.

    "There's no specific charge code yet so hospitals and birthing centers have to find their own way to charge patients but regardless, it's a very small out of pocket cost," Collins says.

    "Hospitals and providers should lay out all the options for women to choose from, like a menu," Collins says.

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    Obviously whatever pain management you choose for your labor and delivery is entirely up to you and your doctor. But when it comes time to make that decision, Collins says that people should be able to get the info on all of the options available to them.

    "Most providers only offer an epidural because nitrous oxide isn't available — but not all women want an epidural," Collins says. So your options may ultimately be limited by your specific provider or birthing institution. Collins says she hopes that more hospitals train staff to use nitrous oxide for labor so that it can be an option for more women in the US.

    "It's the patient's birth and the patient's right to choose the method of pain relief," she says.

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