Impact of Nitrous Oxide Analgesia on Labor Experience

Abstract

Purpose/Background Nitrous oxide (N₂O) has re-emerged in the United States as a labor analgesia option that supports mobility, autonomy, and patient-centered care. As nurses increasingly support low-intervention and physiologic birth approaches, understanding the effectiveness and safety of nitrous oxide for low-risk laboring individuals is essential. This scoping review examines current evidence on nitrous oxide use during labor, focusing on maternal pain management, satisfaction, and neonatal outcomes to inform evidence-based nursing and midwifery practice. Methods A scoping review was conducted using PubMed, CINAHL Complete, and the Cochrane Library between September and October 2023. Inclusion criteria consisted of English-language studies published within the past ten years involving low-risk laboring individuals aged 18 years or older. Eligible designs included systematic reviews, randomized controlled trials, controlled trials, observational studies, and a clinical audit. Thirty articles were screened using the Rapid Critical Appraisal (RCA) tool, and eight met all inclusion criteria. Data were extracted using a standardized charting framework capturing study characteristics, intervention details, comparison groups, and maternal and neonatal outcomes. Results: Across the eight included studies, nitrous oxide consistently provided moderate but meaningful pain relief, improved coping, reduced anxiety, and enhanced maternal satisfaction. Participants valued rapid onset, self-administration, and preservation of mobility. Reported maternal side effects, including nausea and dizziness, were mild and transient. Neonatal 3 outcomes, such as Apgar scores and respiratory adaptation, were comparable between users and non-users, demonstrating reassuring safety. Nitrous oxide functioned as both a primary analgesic and a bridging option, with conversion to epidural reflecting expected analgesic limitations rather than dissatisfaction. Variability in use was primarily attributed to institutional resources and provider training. Implications for Nursing Practice: Results provided in this scoping review support nitrous oxide as a safe, accessible, and patient-centered labor analgesic for low-risk individuals. Nurses and midwives play a key role in patient education, administration, and environmental safety. Expanding standardized training and institutional support may enhance the integration of nitrous oxide into individualized, evidence-based maternity care