Use of Nitrous Oxide for Pain Relief During Labor and Delivery Reevaluated in Light of Greenhouse Gas Emissions Concerns What are the main findings?

Response: Data from 243 women were analyzed. Opioid use significantly increased when N2O during labour was withheld (n=122). There was no increase in epidural use and no significant differences in delivery mode, labour, maternal or neonatal outcomes were observed.

The usefulness of and the need for the availability of N2O in labour wards could be questioned, particularly given the current debate around greenhouse gas emissions from healthcare sectors. A recently released professional document, the Australian and New Zealand College of Anaesthetists advocated for a reduced utilisation of N2O as part of an approach to enhance environmental sustainability in anaesthesia. What should readers take away from your report?

Response: Women can be reassured that, should N2O be withheld from clinical practice, this action appears to be safe for labouring women with regard to the maternal and neonatal outcomes assessed in this study. Women should be made aware that effective, safe and more sustainable methods of labour analgesia are available to them. What recommendations do you have for future research as a result of this study?

Response: In any debate on replacing N2O with low carbon alternatives, safety outcomes should be balanced against maternal satisfaction and could be assessed in larger studies in the future.


Froessler, B., Malek, M., Jila, M., Parange, A. and Kelly, T.-L. (2022), The impact of withholding nitrous oxide in labour during the COVID-19 pandemic on maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol.

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Last Updated on August 21, 2022 by