Why is entonox not available in the US and some European countries?(41 Posts)
Just curious really!
I'm due to have DC2 within the next few weeks, and I'll be relying on gas and air I'm sure! So I just wondered why it isn't available in other countries (I only know this from reading threads on here).
Not sure why it's not available in the US labor wards, I've heard it's a combination of concerns over prolonged exposure for workers and just plain custom.
Births in the US tend to be more medical with a high number of women opting for epidurals, it seems to be the culture.
Here in NL the prevailing culture is for no pain relief at all. Only 10% of births are with an epidural. We also don't have over-the-counter medications for colds and flu. I guess it's the Calvinist thing!
I had DC2 in hospital here 2 weeks ago with just a stress ball for pain relief!
I suspect because it's cheap and US hospitals profit driven
I was told that in Belgium where I had DC2, that is was not used as there had been a study done that showed increased miscarriage among midwives in units that used it (although I can't confirm this is the truth, this was 3rd hand. All my doc said was that he was campaigning for its use). There was also a rumour that the anaesthesiologists were against it as it would reduce their fees... Not sure what the truth was.
The pethidine injection was also not available as there had been a miscalculation of dosages previously which led to serious consequences so it was banned.
The options were epidural or nothing.
The option in Belgium is epidural or nothing. When we asked a couple of years ago (pre-DS1 birth) if gas and air was available we were told it is just a placebo so they don't offer it. I guess it is a placebo in a way as it doesn't relieve pain but rather takes your mind off the pain.....
Some areas in Sweden have no gas and air option because they say it doesn't do any good anyway. They also think it is bad for the enviroment and can be damaging to the staff at the hospital and the mother.
The area where I live does let you have gas and air but not at the pushing stage I think they want you to be as on the ball as possible. If you do have an epidural they also try to time it so it runs out when you are pushing.
This is some Swedish news in English about it www.thelocal.se/39600/20120310/#.UM36EsVceqg
It may be a placebo, but a very good one as it makes you focus on your breathing, so sort of like yoga or hypnobirthing
But I've also heard that pregnant operating theatre staff should avoid all anaesthetic gasses so maybe it's an occupational health issue??
it may be profit driven too as when I went private (for non birth op) they were very keen for me to have more doses of pain relief medicine than I really needed as they charge though the nose for each dose, there might be a good profit in epidurals and sod all in G&A
Don't know but G&A didn't do anything for me - does it work for anyone?
in ITaly it's epidural or nothing. Translated in most cases as....nothing.
inadreamworld worked amazingly for me - although only once the midwife showed me how to use it properly, its all I used even with syntocin from halfway through and eventual ventouse! Still can't quite believe I managed!
mrscogon I had the syntocinon (or however you spell it!) drip as well - and definitely needed epidural!! You are good at dealing with pain. Obviously I am strange and G&A works for many people.
Entonox is 50/50 Oxygen and Nitrous Oxide combination - in a premixed form - in one gas cylinder. This is not FDA approved in the US. It is not over safety concerns of using nitrous oxide and oxygen. It has been shown at varying temperatures that the premixed gas can separate in the cylinder - resulting in potential higher percentages of Nitrous Oxide being administered - and no way to regulate or control it.
Nitrous Oxide and Oxygen (N20 and 02) for pain management, is used everyday in the US in dental offices and many hospitals (in areas like Emergency Departments). The reason it has not been used more widely for Labor and Delivery is that a special "device" is needed for this application. This device "blends" Oxygen and Nitrous Oxide (at a 50/50 ratio) - and is administered by the patient through a special demand valve that they control themselves. Our company is about to re-launch such a device and you will start seeing nitrous oxide and oxygen used more often in hospitals and birth centers in the US. This is going to start happening in January!
Regarding some of the previous posts:
Workplace safety - yes this is a concern - but is dealt with by always making sure the device is connected to a "Vacuum" source to scavenge (remove)away the exhaled gas - out of the building. This virtually eliminates any exposure risks. Some other countries do not have guidlines for scavenging - which is where you see issues with workplace safety. Chronic exposure to many things is often not good - so N20 is no different than many other drugs and chemicals used in the healthcare environment.
Patient Safety - Nitrous Oxide and Oxygen has been proven (over 100 years of use) to be safe for patients. As with any medication - there are some health conditions that you would not want to use nitrous oxide with. Your medical professional would be able to advise you on this.
Environmental Issues - Yes N20 is a greenhouse gas - and is used widely for medical applications (often used by anesthesiologists). That said - medical use of N20 accounts for about 1% of greenhouse gas exposure. The majority of exposure is created by farming and agriculture related industries.
N20/02 and Epidurals - N20 and 02 are used for pain management. It will not eliminate pain - but it will help you cope with pain (which is why some will say - "it didn't work". It will not replace epidurals - and if the expectations are not realistic - it will be a negative experience by the patient. There are a few hospitals in the US that use N20/02 for labor and delivery. In most cases women that use N20/02 in the US - about 50% convert to epidurals. It is a good option compared to not having anything at all!
Benefit of using N20/02 - it is a good option for pain management - and it is patient self administered. The patient administers the N20/02 when they need it. N20/02 is a mild analgesic - and allows the patient to be conscious and in the labor and delivery setting - participate in the birth of their baby. N20/02 is very short acting (minutes) - which will allow the mother to get up and move around during her labor - and after delivery. Epidurals will potentially last for hours - confining the mother to her bed.
Again - N20/02 is not a replacement of other options - it is just a good addition - and in the labor and delivery area - an option that doesn't currently exist here in the US.
I'm not familiar with all of the rules for the forum - but if allowed I can post some links to videos and other websites.
Interesting that G&A is soon to be used in the US. I live in the UK - will be giving the gas another try with next labour but likely will have an epidural again! Also when you breathe too much g&A it males you feel sick. Or maybe that was just me. My husband says he wants some gas next time though!
I loved gas and air... I was high as a kite, telling OH the name of every child who was in my class in primary one and asking the standard taxi driver questions to the midwives! I think it makes you feel like you have regained some kind of sense of control once the initial high wears off. Gives you something to focus on? I couldn't imagine having given birth without it. I think it helped with the pain, as it lightened my mood.
I had three homebirths and used G&A every time, was definitely a pain killer for me couldn't imagine giving birth without it!
Mike, thank you, that was very informative. I am currently in a non Gas and Air using country, and if I get pregnant again, I'd go back to the UK to give birth! Had G&A with my first (homebirth) labour, and it worked a treat. Loved it!
Why doesn't it work on me
Worked brilliantly for me up to about 5cms both times then I had an epidural. Basically I stoked myself up doing lots of deep quick breaths as soon as I felt a contraction and was away floating with the fairies for the worst of the pain.
With my first it took me a while to get the hang of it, and I found that taking normal breaths on it was no bloody use at all to me.
Gas and air worked brilliantly for me, I've had three babies and used it each time. I get totally wrecked and I didn't really feel much in the way of contractions. I love it. The midwife tried to take it off me at the pushing stage but soon gave it back. I think the trick is to never let it leave your mouth or something. Every breath I took was g&a. Ds4 is due in 6 weeks and I am most looking forward to getting off my face again!
But my friend used it and if made her throw up.
I'm not sure why it suits some people more than others.
For my first labour it was not very effective and I've always been half convinced the canister was not turned on properly. For my second labour it was amazing at helping me cope with the pain, I ended up reducing the amount I was using it as it was getting me too high but it was great stuff.
Mike, that is fantastic news in regards to the states, I've always thought it was mad that the pain relieving options were epidural or nothing for childbirth over here!
I gave birth last night and the gas and air was bloody amazing! I also had a mobile epidural and topped up with the gas and air but the gas seemed to do more than the epidural, my mum thinks maybe they gave me a false epidural as I really didn't feel any difference.
I don't know! We get it at the dentist...
I do have to say my epidural was the bee's knees, however.
I'm glad I asked the question now - very interesting thread!
Personally, I couldn't have done without it in labour with my first. I was fine with a Tens machine until 8cm dilated, then had a terrible urge to push. The midwife suggested gas and air (after I'd refused it earlier) to help, and it really relaxed me and I could stop pushing.
I had my first DC in the UK and used G&A and pethidine..it was effective in taking my mind off the pain but I was high as a kite and, in retrospect, I can't really remember much about giving birth to my DD.
I've just had my 2nd DC a week ago in France...epidural or nothing....I had the epidural and it was amazing! I got to 5cm dliated with no pain anyway, they then gave me the epidural, it started to wear off at 9cm so I had a little top up. 6 pushes and the baby was out with just 2 stitches. I had been worried that i wouldn't be able to push as I had no feeling but it wasn't the case. I had a pain-free labour and birth and I feel as though I could do it all again tomorrow. The post-birth recovery has been much less painful this time too...less swelling and pain.
Vive la peridural! Vive la France!
I have low bp and the gas and air made my bp drop more and too much made me faint - which removed the pain which came back gradually as I came round! It was amazing, after that I learned how I could take enough to get to almost fainting but not pass out which really helped the pain - perhaps people with higher bp would find little affect?
That's interesting Princess as I have low blood pressure in pregnancy and I found it very effective.
Didn't do anything for me in terms of pain relief but it made me breathe deeply (like yoga breathing) and when I tried to breathe through a contraction without it I failed miserably and panicked. I don't know how I'd have managed without it. I even had it (through a mask though) in theatre while they were siting my spinal block.
I thought it was brilliant, adn was harping on to the MW about how she should set up a pub where you could sit in warm water whilst having G&A. Got almost to the point of pushing with just that, then had morphine.
I had no idea that it wasn't available in some countries. It's quite widely used in the UK isn't it? Are you ladies in France saying that you can't have morphine/pethedine either?
That's right Visualiseahorse, I'm in France and it's an epidural or nothing. The care I received was exceptional and my birth experience a million times better than in the UK but it is very medicalised so if you're a water birth and whale music kinda gal then France wouldn't be ideal. I loved it.....why suffer in pain?? My medical team here were horrified when I told them I hadn't had an epidural first time and when I tried to explain that I'd had G&A and pethidine...they didn't understand what I meant.....although that could be my terrible French!!
I live in the UK but agree with the French attitude femmeeaufoyer Is it only us crazy English who want to suffer and think an epidural is failure/terrible? Having said that, even though I want strong pain relief I think the water birth/whale music/homebirth people should have the right to do that if that is what they prefer. I have heard a very small percentage of women are lucky enough not to suffer as much with labour pains.....not sure if this is true.
I don't like that there is no middle ground in France. In my case (where I wanted as natural birth as possible, epidural was the last thing on my list) would mean that I would've had to go to the big hospital instead of using the local birthing unit. I used G&A most of the way and morphine at the very end. By using this it meant I could be mobile all the time, and straight away after, and go home within 4 hours of birth.
Sorry, missed this bit on the end...
It meant I had more control over what was happening, and although the pain was horrific, for me, that pain (for me) is important in some respects.
For the Frenchies...I thought that my hospital didn't offer G&A until I spoke specifically about this to my midwife last week about it. It turns out my local (pretty small) hospital does do it though in my last pregnancy they never mentioned it. It's known as MEOPA and the midwife says she has English girls all the time mimicking the mask on face gesture for their gas because they don't know the word for it .
Don't know if this review undertaken at Imperial college in 2008 by Sanders and Weimann helps:
"Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing."
Interesting about the pros and cons. I found it took the edge off the pain but I forgot where I was and what was happening, and it is quite distressing to be in loads of pain and have no idea why - I felt like a wounded animal
There isn't any scavenging device used in the labour rooms where I work. I'm worried now about my long term exposure to it!
That is a very interesting article about the use of gas and air
There are two major differences in what the article you referenced is discussing versus how nitrous oxide (and oxygen) are used during labor. The differences are Anesthesia versus Analgesia (pain managment) and administering "only" Nitrous Oxide versus a combination of Nitrous Oxide and Oxygen.
This topic is often confused - and is a completely different use for a different application. The article referenced covers the use of Nitrous Oxide as an Anesthetic agent, administered at 100%, and for long durations.
Nitrous Oxide (N20) used as a single agent (100% N20) can achieve general anesthesia on a patient. This is very rarely used anymore in most countries - and not used in the U.S. as anesthesia.
The combination of Nitrous Oxide and Oxygen (02) - is used very frequently as an analgesic and sometimes for minimal sedation (patient is awake, alert, responsive, etc) - such as in the dental office or in the hospital during labor - for brief periods of time. For labor applications the typical "mix" is 50% N20 and 50% 02. The patient is actually receiving a higher concentration of 02 than what they are breathing in room air.
The confusion sometimes comes from how we talk about N20. You often hear someone say "I was at the dentist and they gave me nitrous oxide". Actually - they were getting both Nitrous Oxide and Oxygen. All modern delivery systems here in the US (and most of the world) cannot deliver N20 without 02. In fact - most systems are designed to automatically shut off if the 02 supply runs out.
Hope that helps clarify a sometimes confusing topic!
Here is another great article that was published last month on N20/02 use for labor:
There are also a couple of You Tube videos of patient use of Nitronox on our website: www.porterinstrument.com/nitronox
Porter Instrument - Nitronox
"Ushy Fri 21-Dec-12 19:13:41
Don't know if this review undertaken at Imperial college in 2008 by Sanders and Weimann helps:
"Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing." "
I had G&A in France and pethidine was an option. It's not common and you have to ask but it's there.
Join the discussion
Please login first.