Use of Nitrous Oxide during Labor in an Academic Medical Center in a Rural State

This study examined the use of inhaled nitrous oxide as a pain management option during labor. Nitrous oxide offers a noninvasive, self-administered pain relief option that allows patients greater autonomy compared with other methods such as epidural analgesia or intravenous opioids. Its effectiveness and patient satisfaction remain a debated topic, however, with mixed results from previous studies. The primary aim of this cohort study was to analyze nitrous oxide utilization by focusing on identifying factors influencing its continued use during labor.

This was a retrospective cohort study of information collected from patient charts of those who used nitrous oxide between January 1, 2020 and July 1, 2023. Demographic and clinical characteristics were reviewed to assess patterns in continued nitrous oxide usage.

There were 267 women who selected nitrous oxide for pain relief during labor. The study showed that the type of healthcare provider (certified nurse midwives vs doctors of medicine) (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.89, P=0.0115), and race relative to Hispanic patients, that non-Hispanic White women had a lower odds of remaining on nitrous oxide (aOR 0.27, 95% CI 0.11-0.68), as did non-Hispanic Black women (aOR 0.39, 95% CI 0.16-0.93) were significantly associated with continued nitrous oxide use during labor. The factors of maternal age, gestational age (term vs preterm), marital status, type of insurance, and parity were not significantly associated.

Women who selected and continued using nitrous oxide until delivery were more likely to have a certified nurse midwife managing their labor/delivery and were more likely to be Hispanic. The study underscores the potential use of nitrous oxide to enhance patient autonomy during labor. Further research is needed to clarify the use of nitrous oxide for pain management during labor.