Nurse-Midwifery M.S.

Year Approved


First Advisor

Wu, Katrina


Background: All women will experience pain while going through childbirth. The pain is caused by pressure and stretching on the uterus and visceral organs, lack of oxygen during uterine contractions, and musculoskeletal and perineal stretching. Difficulty coping with pain leads to an increase in catecholamines, which further complicates the labor process and can contribute to long term psychological consequences. Up to 75% of women in other countries use nitrous oxide, a colorless odorless gas, to manage their labor pain. In the United States, the options for managing labor pain have consisted of non-pharmacological methods such as massage, breathing and relaxation techniques, hydrotherapy, etc; neuraxial methods ie: epidurals or spinals; and parenteral narcotic administration. Up until about 2015, only five hospitals in the United States offered nitrous oxide and women in the United States have fewer options available for pain management than other countries. Multiple other hospitals and birth centers have begun to offer this option. The American College of Nurse Midwives has indicated that women should have as many safe options for pain management as possible and has encouraged the use of nitrous oxide, as well as continuing research. Purpose: To evaluate the safety and efficacy of nitrous oxide in labor and delivery. Results: Twenty-four articles were identified for review and appraised using the Johns Hopkins Research Evidence Appraisal Tool. The major findings of the reviewed literature include that nitrous oxide is safe to use for both mothers and babies. Nitrous oxide is safe to use in special circumstances, such as when epidural or parenteral opioids are contraindicated, for postpartum perineal repair or cephalic version, and has some anxiolytic properties that appear valuable as well. The efficacy of nitrous oxide is less clearly defined due to difficulty in measuring pain and the highly individualized nature of labor and delivery. Efficacy appears highly dependent on patient expectation, though in populations where nitrous oxide has been used, its use is heavily favored and recommended. Conclusions: Nitrous oxide is very safe for both mothers and infants. It is cheap, easy to use, and does not require the presence of anesthesia staff to administer. It is easily portable and fast to set up and administer. Discussing pain management goals and expectations will help improve satisfaction, as well as ensuring proper use to achieve maximum effectiveness. Consistent with King’s Theory of Goal Attainment, nitrous oxide offers a patient-controlled analgesia option that maximizes a woman’s access to, and control of, safe, effective options for managing their pain while in labor. Implications for Research and Practice: There is considerable room for further, good quality, randomized controlled trials. Areas of study needed include the use of nitrous oxide in specific situations, and especially its use as an anxiolytic. There is enough evidence currently to support the promotion and use of nitrous oxide for pain management in labor and delivery. The use of nitrous oxide fits the practice philosophy of nurse-midwives well, and nurse-midwives are well-suited to champion the use of nitrous oxide in practices of all types, including birth centers and rural settings.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis