Women’s pain relief to boost the NHS environmental credentials

And will somebody think of the poor expectant fathers? Having your partner's nails dug into your palm as you hold them through another excruciating contraction today is bad enough, imagine how bad it will be when the mother doesn't even have a gas and air mouthpiece to hold onto an sis holding a pointy comb instead!

Has anyone done a risk assessment for use of a comb I wonder?

I'm thinking of shattered shards embedded and requiring services if a hand surgeon to remove, possible damage to impaled tendons, infection.

As regards improving ventilation this is needed throughout ward and other areas - infection control for respiratory infections such as flu and covid are non existent. Current policy is come in to work even if you are testing positive unless you are too unwell to work.

It's a discussion forum and I can ask any questions I like. Don't tell me what to do or think. I am quite capable of doing my own research and am also interested in the anecdata of midwives and women on MN, that doesn't make it irrelevant to ask. Clearly, this is an NHS infrastructure issue that has come to light because they've measured background levels and found them to be too high in SOME trust's maternity wards. So midwives who have worked there are rightly concerned about their occupational health. But how you can try and use that to justify immediately stopping gas and air for all labouring women in those trusts, without offering any alternatives other than 'hold a comb' is beyond me. And I dont believe many midwives would support that either. I work with the NHS and theres plenty of budget for expensive IT projects and cyber initiatives, believe me, so they need to prioritise some of that funding to fix this issue in the trusts where the levels have been found to be too high, such that some staff might be adversely affected, rather than throw all women under the bus. And I note that at the trust I have direct experience of, the narrative has changed now anyway to be about reducing the environmental impact of greenhouse gases, not the possible occupational health issues on midwives (and this is the comb trust).

Weirdly, there is some evidence that holding a comb helps - it may be purely a placebo effect, though some people think it's to do with activating accupressure points. So there is no harm in using a comb as well as proper pain relief. But the idea of using it instead of is unbelievable and pure misogyny. Are we giving any men a comb instead of gas-and-air when they need analgesia?

The evidence shows the risk to midwives is very real if scavenging units aren’t used. So increase in stillbirth and miscarriage. But this is reduced by ventilation

Holding a comb instead of proper analgesia? God and all the saints, please help all women giving birth…

While that might seem blasphemous it is actually more to the point than one might think.

I watched a documentary (Lucy Worsley?) and she talked about how, in medieval England, midwives would bring a little bag of tricks with them to provide at least some psychological support to labouring women. There would be a little scroll, with prayers to the patron saint of labouring women, perhaps illustrations and a little bottle of holy water. Belief was obviously very strong back then so these items probably did help a little.

Not for long though, because male priests didn’t like the idea that female midwives were stepping on their religious territory and preventing women suffering properly in childbirth, as of course they should because of that tempting minx Eve. So midwives were threatened with excommunication, most of those items were destroyed and women had to suffer agonising labour pains without so much as a tiny prayer scroll to look at…

How about the NHS provides midwives with what they need to do their job (proper ventilation) and we don’t scuttle back seven centuries?

What sample size do you think you are going to get? It's a pointless question that tells you nothing about the true risk - just gets you anecdata.

And maybe do some research on the risks to midwives before just dismissing them? It's not as simple as just treating any B12 deficiency. Irreversible neurological damage may have occurred: you can get subacute combined degeneration of the spinal cord, blindness and permanent brain damage. Giving B12 can sometimes reverse this, but not always.

We need to keep midwives safe, as well as labouring women. There are ways to do this but they are not prioritised because it's easier and cheaper to deny women analgesia.

And clearly the solution is to make trusts put in proper scavenging systems in maternity wards to reduce background levels to the recommended safe level if they don't already have them, not tellmwomen in labour to us EA comb instead FFS.

A lot of posters on this and similar threads are midwives, several on this have said they are. So not randoms. I'm curious to know how widespread a problem it is in NHS hospitals. I suspect not very. And easily adapted for and treated with B12 therapy presumably. I've worked in labs exposed to radiation and formaldehyde, both way more dangerous, and nobody was saying we shouldn't use it, we just had to take appropriate precautions. So why is it different here? Oh I know, because it's only women's pain that will be affected.

prolonged exposure causing B12 deficiency

Asking a bunch of randoms on t'internet if they personally know anyone affected isn't going to get you a useful answer. I don't personally know anyone affected by lung cancer due to asbestos exposure or by radiation exposure. Does that mean those aren't genuine environmental hazards?

Neurological damage from prolonged B12 exposure is well-evidenced and well-recognised. It's important that we consider the welfare of midwives, as well as women in labour.

However, as PPs have said, there are effective ways of reducing the risk and we should be prioritising those, not expecting labouring women to go without pain relief. If gas-and-air cannot be given safely, we need to provide safe alternatives e.g. patient-controlled analgesia via an IV.

This is a helpful article: https://www.newstatesman.com/quickfire/2023/03/gas-air-maternity-scandal

Maternity healthcare staff are predominantly women as well and their health matters.

The solution for both sides is investment in the NHS to put in the ventilation systems that help to decrease exposure.

What is the risk? What has happened to staff exposed long term? Does anyone know a midwife with a health issue related to entonox exposure?

Both my labours were entirely back pain, because I had two back to backs (joy). I had an epidural both times because of it, and fortunately was seen very quickly by the anaesthetist. I also had the option of gas and air because the hospital I was at is properly ventilated.

The NHS has known about the long term risks to staff for decades and still haven't bothered to invest in the proper systems to deal with it. It seems they value maternity nurses and midwives about as much as labouring mothers.

It's yet another example of women's pain being seen as an inconvenience rather than adequately respected and treated.

If there's issues with it and risk to staff by all means remove it IF there is a replacement option of equally good and entirely adequate pain relief for the patients. We've been using gas and air for decades, staff are not dropping like flies, and it's not ok to leave women in severe pain untreated.

We're already knee deep in women traumatised from horrible medical birth experiences, and women with inadequate pain management not being taken seriously, or expected with an hours' old major abdominal surgery to get out of bed and look after a newborn on a couple of paracetamol.

As RedToothBrush said: where else (or where with men) do you ever see pain politicised and guilt trips piled on?

I don’t think it’s acceptable to use it if there’s any risk to staff.

@AIstolemylunch because most women only give birth 2 or 3 times.

Personally I didn't use it though, I didn't use pain relief because it simply wasn't that bad, I'm no martyr! I've had far worse toothache (impacted wisdom tooth May 2020, couldn't get it out until early 2021, that was true pain! Months of it

Why is it ok to breathe it yourself for 6 hours of labour x 4 but not to be a midwife standing nearby who might inhale some gradually over a 20 year career? Are those amounts really more than someone actively using it over a numbe rof childbirths, as I did. I don't really anyone suggesting, by birth 4, that I had had enough and shouldn't have anymore, even though the last 2 were actually at the hospital that has now apparently withdrawn it and offered the comb!

Are people involved in accidents now also not given it by paramedics at the roadside where it even more directly can escape into the atmosphere?

I though the health effects were similar to huffing NOS that the youthbwent through a phase of doin, it out competes oxygen so can cause breathing difficulties and oxygen starvation, hence why they add oxygen to it in hospitals to form entonox. What are the long term risks to staff? What about operating theatre staff, I have had 2 colonoscopies and used gas and air each time, nobody seemed concerned.

Yes this. Adequate ventilation, filtration , air changes, etc are desperately needed in all hospitals to improve patient and staff safety. It comes back to investment in the nhs though, which isn’t happening in the focused way needed.

It wasn't long ago that they were saying women should stop having gas and air because of health and safety concerns about midwives and over expose being toxic.

Now this.

No where else is pain relief politicised or guilt trips brought in.

The risk to staff is also addressed by collecting and breaking down the exhaled gas. As the article linked above says:
The MDU purifies 99.6% of the nitrous oxide entering the unit and as well having a huge benefit to the environment it also benefits staff by reducing the amount of nitrous oxide they are exposed to while they work.

Just another stick to beat women with.

I'm guessing the water injections are also substantially cheaper as well.

In the article it implied it would Only help with back pain...it was a while ago since I last gave birth but I seem to remember that wasn't where a lot of the pain was.
Or am I being thick again somehow?

I mean, it beats a comb, I guess...

Gas and air also gives women control, as you are completely choosing yourself when to take and use it. I found it really helpful.