In much (most?) of the world, women are able to use laughing gas (nitrous oxide) to relieve pain during childbirth, but this is almost never available to women in the United States.

Several websites (for example,Laughing gas making a comeback for women giving birth) speculate that this is because it would lead to lower profits for the hospital, compared to other forms of pain management.

If other countries have been using nitrous oxide to take the edge off labor pain for decades, why hasn't it been offered to women in the U.S. until now?

Dixon said new nitrous oxide delivery equipment was approved by the U.S. Food and Drug Administration in 2011 plus she said it's possible that there has been concern over the years that hospitals would "lose revenue if people have fewer epidurals."

This is a little too cynical for me, though, and it doesn't seem to make complete sense, either - N2O isn't comparable to an epidural. Besides, it's used often in other areas of medicine.

Is it true that laughing gas is not used to reduce labor pains because it is cheap?

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    This is a question about motivation, and I believe we have generally held such questions to be off topic, though there is some controversy as to where to draw the line. See meta.skeptics.stackexchange.com/questions/621/… and meta.skeptics.stackexchange.com/q/2844/6308 for further discussion. – Nate Eldredge Jun 18 '15 at 14:10
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    @NateEldredge I think this question needs to be reworded slightly, but is basically on-topic. Essentially, the claim of which the O.P. is skeptical is that "Nitrous oxide is not used during labor in the U.S. because its low cost would cause hospitals to lose money (compared to epidurals)." This claim can be verified by a confimring statement from a hospital or other medical body; it can be debunked by showing that NO2 during labor isn't cheaper or is not as safe or effective as an epidural. Finding a source that has performed an analysis of the economics could provide evidence either way. – Reinstate Monica -- notmaynard Jun 18 '15 at 14:36
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    Why would the cost of nitrous oxide bear any relation to what the hospital charges for it? Apparently som hospitals charge upwards of $25 for an aspirin tablet that's available as generic for under a penny (source: healthcarefinancenews.com/blog/… but many similar can be found), so why wouldn't they charge the same for cheaper NO2, and boost their profit margin? – jamesqf Jun 18 '15 at 17:37
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    In the U.S., in addition to the epidural cost from the hospital, you are also paying a fee for the anethesiologist to administer it. – user3169 Jun 18 '15 at 20:30
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    @jamesqf Regardless of whether what you pay is fair or not, what the hospital pays is what is important to them. If they pay less, there will be more profit for them regardless of what they charge a patient. – user3169 Jun 18 '15 at 20:33


There seems to be a range of factors contributing to why N2O is not readily available in the US.


One major barrier to implementation of N2O services in the United States has been the limited availability of N2O delivery equipment. The device must be equipped with a demand valve capable of intermittent high-volume delivery capacity. Most commercially available N2O analgesia systems, such as those used in the dental industry, employ continuous-flow low-volume systems and are unsuitable for intermittent use with laboring women. As previously mentioned, single-cylinder Entonox systems used in Europe have not been approved for use by the FDA and are not available for purchase in the United States. Currently, Nitronox is the only FDA-approved apparatus for the self-administration of N2O. Matrx Medical (Orchard Park, NY), the initial manufacturer of Nitronox equipment, discontinued production several years ago, which made the purchase of new units impossible. Recently, however, the Porter Instrument Division of Parker Hannifin Corporation has secured the rights to manufacture the Nitronox apparatus, and have indicated that they intend to have a device on the market by the end of 2012 (M. Civitello, personal communication, June 2012). Reintroduction of Nitronox equipment will remove a major barrier to N2O availability.

Of course it could be argued that the reason the equipment isn't available is because there is no demand. And the reason there is no demand is because hospitals don't want to buy new equipment that will reduce their profits. So let's keep going.

Are there other reasons why an epidural may be preferable?

Nitrous Oxide for the Management of Labor Pain(300+ pg pdf)

Inhalation of nitrous oxide provided less effective pain relief than epidural analgesia, but the quality of studies was predominately poor. The heterogeneous outcomes used to assess women’s satisfaction with their birth experience and labor pain management made synthesis of studies difficult. The strength of evidence was insufficient to determine the effect of nitrous oxide on route of birth. Most maternal harms reported in the literature were unpleasant side effects that affect tolerability (e.g., nausea, vomiting, dizziness, and drowsiness). Apgar scores in newborns whose mothers used nitrous oxide were similar to those of newborns whose mothers used other labor pain management methods or no analgesia. Evidence about occupational harms and exposure was limited.


One concern with nitrous oxide use is the potential for the gas to escape into the room and potentially affect health care workers as well as other individuals present with laboring women. For this reason, multiple organizations are responsible for regulating the use of nitrous oxide, and factors other than clinical outcomes are important to decisionmaking about its use (Appendix F). Room ventilation systems and scavenging systems that remove waste gases are used to reduce exposure to caregivers and others present for labor. Equipment capable of scavenging provides constant negative pressure so that the woman’s exhalations, which contain nitrous oxide, are captured and removed from the room and facility.6

There seems to be reasons for and against the use of N2O (though the study seems somewhat supportive). Either way, it's not exactly a no-brainer.

Laughing Gas For Labor Pain — Why Not?

Holly Powell Kennedy, Ph.D., a certified nurse midwife and professor of midwifery at Yale University School of Nursing, says one of the reasons nitrous isn’t used in the U.S. is simply cultural. Many women make decisions about childbirth based on what they learn from family and friends, and most have never heard of or used nitrous oxide for coping with labor pain.

Alright, well that makes sense. But couldn't they still be conspiring against us? Well, we'll probably never know, but this article seems to give us a peek inside the important factors in hospital decisions.

The role of pharmacoeconomics in formulary decision-making

The role of cost- and pharmacoeconomic-related criteria in formulary decision-making was assessed in a literature review of 31 studies of hospital (n=18) and managed care (n=13) pharmacy and therapeutics (P&T) committees. In both settings, cost was important, although the elements of cost considered varied. Acquisition cost was mentioned more frequently than pharmacoeconomic or cost-effectiveness information. Other factors, including drug characteristics, quality of life, supply-related issues, and physician demand, also influenced decisions. Despite the relatively low reported usage of pharmacoeconomic data in decision-making, most respondents considered the information to be "somewhat" or "very" important. Barriers to the use of pharmacoeconomic information included institutional factors and lack of training. Limitations in the survey methods used and issues considered restricted the ability to identify a comprehensive and consistent role for cost information in selecting formulary drugs. Further research on the use of pharmacoeconomic information is required. (Formulary. 2006;41:374–386.)

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