Entonox has been suspended in some hospitals

[Soubriquet]

link

It’s a hard one. I mean, on one hand I feel for hospital staff. No they shouldn’t have to be exposed to something that can cause health problems now it’s being documented. But labouring women also need pain relief and not every alternative works.

Oramorph did nothing for me
Pethadine made me sleepy
I wasn’t allowed a water birth
Epidural is known to need more interference.

I do hope a compromise is made somewhere

Hospitals could potentially upgrade their scavenging systems to remove the excess better. I worked for 15 years on a labour ward with no scavenging system, lots of colleagues with fertility issues and miscarriages and pre term birth. Beginning to make sense now.

Better ventilation is definitely an option. I wonder if it would help long term?

Inadequate ventilation was highlighted as a huge issue during covid in hospitals. (not just maternity departments)
Many are old buildings with nothing but an open window to move air in and out.
The disruption and cost is huge to upgrade these systems.
Yet another pressure on NHS services that needs addressing.

The one pictured in the link is Peterborough hospital. It’s not an old one. It’s a relative new one. They have a separate women and children’s building away from the main hospital.

It was opened in 2010

Yes. It was known about as far back as the 80s. The research was done based on theatre staff. So many of us had late miscarriages. Nobody gave a toss though.

Gosh that's awful.

Is there a difference if it's tanked rather than piped? Is it the women's expiration that causes the problem, or leaks in the pipes?

Expiration, leaks and tanks cause the highest ambient levels, piped systems are apparently better. That was what the 1980s reserch concluded. It was in the BMA. I can't remember exact details but I looked it up when 3 of us miscarried at 12, 13 and 14 weeks. At work on the labour ward. In a 6 week period.

Thank you endof. I'm so sorry.

If it’s not safe in some settings it’s got to be stopped until it can be made safe. It’s not a safety issue for the labouring woman because there are other pain relief options available (ones that actually work, unlike entonox in my experience!) If they want it and can’t choose to have it that’s unfortunate but cannot trump safety.

As soon as anaesthetic or recovery practitioners tell their manager they are pregnant they are removed from those areas of practice in their first trimester.

That’s how we usually discover they are pregnant way before most people generally announce it.

No I agree, the safety of the staff is paramount to the temporary comfort of labouring women, but I also think a compromise is needed so that they are able to have gas and air.

Better ventilation or a different way getting rid of the excess so that staff arent compromised

I guess that is some small improvement since my day. Several of my colleagues had fertility problems, including one who miscarried at 12 weeks. Honestly, nobody was the least bit interested, even when shown the BMA article.

Midwives aren’t removed though. You can be pregnant and spend a 13 hour shift in a tiny room with a woman using entenox and no ventilation. I suspect this will become a major class action by ex staff and staff against the nhs at some point. I never knew of the dangers. Literally only started hearing about it last year.

Even with improved scavenging there are issues.I believe there are quite a lot of countries where nitrous oxide isn't used any more for environmental reasons, as it's a greenhouse gas. Certainly over the course of my career in anaesthesia the use dropped off massively. I won't be surprised if it's banned completely eventually, or at least highly restricted.
As a PP said, the issues around miscarriage/infertility in staff who are regularly exposed to nitrous oxide have been known for a long time. I started my career in the 80s and it wasn't news then. It was one of the drivers for improvement in scavenging and so on. When I first started work it was fairly common for there to be scavenging systems in theatres but none at all in the anaesthetic room. In fact some of the hospitals I worked in gave nursing staff the option of not working in anaesthetic rooms whilst pregnant for that reason. (Didn't apply to pregnant anaesthetists mind you!) The environmental impact of anaesthetic gases etc wasn't really discussed til years later but it was being taken seriously by the time I retired a couple of years ago and things have changed a lot, and I think will continue to do so.

That link takes me to Facebook so I can’t open it.

Is it possible to share a link to the actual article rather than through Facebook?

This is crazy that it was known about since the 80s and nothing done. I don't think I would have had the straight forward birth I had without Entonox ...but at the same time it is unacceptable to those working...if a solution was worked with on from when this was first known then staff could be protected as well a labouring women having the option for Entonox

If they get rid of a good proportion of NHS managers who are paid staggeringly high wages, they'd have so much more money in the NHS

@Glitteratitar its a FB post from NWAnglia FT Maternity Services. Text below:

You may have seen concerns raised recently at other NHS Trusts around the use of Entonox (also known as gas and air) in maternity units in England.

There is no risk to women or babies using Entonox during labour but after testing the air quality in our maternity units, we have identified a potential risk of prolonged exposure for our staff. We have therefore made the decision to temporarily suspend the use of Entonox in our maternity units with immediate effect to protect our midwifery, nursing and medical teams.

We understand this may cause some concern for women and their birthing partners using our services and want to reassure you that our teams will be speaking to everyone using our services about alternative pain relief options. Our home birth service remains able to provide Entonox to women and people in their homes as we are able to permanently ventilate these spaces, eliminating the risk of prolonged exposure.

This is a decision that we have not taken lightly and we thank you for your understanding. We will update you further as soon as we have more information.

For FAQs on this matter, please visit our website: www.nwangliaft.nhs.uk/_resources/assets/attachment/full/0/21235.pdf

only this one

I had no idea of the risks to staff. Amazed steps haven’t been taken before. So sorry for anyone affected. Another example of “clap for the NHS” but sod their working conditions, pay etc. Something has to change. Surely.

I didn’t know either until I think I read on Mumsnet about the issue.

I can’t remember how it came up, but I remember reading it

I wonder if this is the reason why my Italian cousins/friend in Spain both didn't have gas an air as a childbirth option at all.

I asked my Italian Dr friend (gp not a gynecologist) and as far as he knows its mainly used in ambulances in Italy but not really anywhere else.

So sorry for all the midwives/theatre staff affected 💐

This is heartbreaking and I had no idea.

I gave birth in Peterborough hospital 2 years ago and used entonox (and then had an epidural). I had no idea it posed a risk to staff.

I'm a dentist and trained in relative analgesia in the 80s . In dentistry we use higher percentage nitrous oxide than entonox which is premixed and comes only in 50% concentration.
We have had to install scavengers etc in the surgeries since , I think early 2000s and the dangers of neurological damage was known when I was training in the 80s.
Because we are independent contractors we have had to have scavengers and monitoring since then. However even scavengers don't keep the air free of nitrous oxide particularly when you are so close to the patient. We monitor regularly .
In contrast my colleague who works in community dental practice , which is run by the NHS , has some equipment but still , on monitoring , has levels of nitrous oxide many times in excess of "safe" levels but for many years has been told to crack on.