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

Why do I have a feeling this is going to become the next scandal?

It needs to be more known. All I’ve seen on fb is people complaining about not being allowed it yet having no idea about the health hazards it’s posing medical staff

@Girasoli I was going to say it's never been an option in some European countries.

I'm desperately sorry for everyone affected. I had 2 very pleasant births with only gas and air, and would be absolutely bricking it if I was pregnant now. I wonder how home births will be affected, isn't entonox the only option available at home?

I keep typing BMA. I meant the BMJ. Sorry.

Miscarriage isn't the biggest issue and could be solved by giving pregnancy staff gardening leave or redeployment. My concern would be the link to VB12 deficiency and megaloblastic changes.

Exactly , it was the neurological damage we were taught about in the 80s , seen very often in colleagues who abused nitrous oxide . Hence the reason people should be very worried about their teens and younger sniffing creamer gas which is nitrous oxide.
However there is a double standard where if you are an independent contractor ie dentist in practice , you have to have monitoring,scavengers etc for decades , whereas if employed by NHS it's taken until now to sound the alarm.

I had no idea about this. I've been a nurse for 14 years but never worked on maternity as I'm not a midwife. I've used entonox in A&E in small enclosed cubicles and also on wards in a bay if we we're altering traction or moving a #femur.
It's bad enough working in buildings with asbestos and plumbing that floods the ward and ceilings falling down.
The nhs is absolutely scandalous when it comes to looking after it's staff. God knows what else they put us at risk of without telling us.

I’d never heard about this anywhere 😱
And it was my pain relief method with my 3 births. Wow. Jesus Christ I really hope I haven’t caused anything horrific for anyone else, this is terrible. 😶

Here's a paper from 1982 acknowledging the damage from nitrous oxide on staff administering it. As said before when I trained in the 80s we were all warned about effects and in dentistry have had to have scavenging since early 2000s I think. www.jstor.org/stable/44540221

Unfortunately there has long been a culture of expecting health staff to provide care at the expense of their physical and mental health. That's not just the NHS , it's society at large . It's now chickens are coming to roost as there is just no more slack in terms of clinical staff and younger colleagues, in particular , are voting with their feet.

What do you mean by the term “Scavenging “?

Sadly not true everywhere. My risk assessment stated I couldn't work in areas using radioactive material but was absolutely fine to carry on in anesthetics. I requested a reduction in peads lists as the use of sevo via an open mask (while they're wiggling and breaking any hope of a seal) obviously increases the amount I'm inhaling. They were somewhat happy with that. But I most certainly continued to work in anaesthetics throughout my pregnancy until some non clinical time at the very end of my third trimester due to covid. Same went for all my colleagues and occupational health agreed there was no need to be isolated from the use of gasses throughout pregnant. Including first trimester.

It’s like a filtration/sucking up device which filters the air and removes nitrous oxide in the atmosphere.

my local labour ward still does not have one and still allows entenox to be used. Risking staff daily

Hospital staff should absolutely not be put at any risk in order to allow (minimal) pain relief for labouring women. Of course it should be suspended.

Nitrous oxide is safe for a patient because there is only so much you can "absorb" the excess is breathed out. That nitrous oxide (entonox) builds up and up and up in the room even with good ventilation , which very few health buildings have.
A scavenging system is something which removes that exhaled nitrous oxide. It is either passive ( just a pipe attached to mouthpiece vented out ) or active ie the excess nitrous oxide is actively "pulled" out via a special mouthpiece , piping and vents .

Entonox is normally no more sophisticated than a mouthpiece and a canister which can be wheeled anywhere. Scavenging requires pipework, machines and vents plus monitoring equipment to make sure levels are safe.

This means anywhere nitrous oxide is used has to have mouthpieces , pipework , machines and vents to the outside to "scavenge" nitrous oxide.

Those of us who worked in healthcare during covid can tell you of the enormous problems of getting satisfactory ventilation in healthcare buildings . In many places it was impossible. Now add the requirements for scavenging and it will require massive investment , building and equipment requirements.

Entonox isn’t just used in labour wards but for a lot of minor procedures too. I use it every time I go in. There isn’t really an alternative.

Entonox for home birth is still ok as there is decent ventilation

I wonder how home births will be affected, isn't entonox the only option available at home?

Home births are usually considered low risk with NO because homes can be ventilated much easier than hospitals

A midwife called Samantha Nash has spoken out about NO for years, due to its links to B12 deficiency
www.britishjournalofmidwifery.com/content/comment/vitamin-b12-deficiency/

As another poster posted Entonox has very minimal pain relief properties , it is anxiolytic (ie removes anxiety ) mostly.
Pain is very poorly understood but certainly being anxious makes perception of pain worse , so Entonox by removing some of that anxiety reduces perception of pain.
It does not work on everyone , around 5 to 15% of people it has very little effect on. Somewhat ironically as someone who used nitrous oxide a lot in work it had no effect on me in labour so didn't bother second time around at all .

This is awful. I can't believe this has been known about for so long and such little has been done about it.

Like a PP I had two very straightforward births just using gas and air. I'm glad I'm not having anymore babies as I wouldn't want to labour without it.

The safety of the staff comes first though.

This is appalling. Would masks covering the mouth and nose, with scavenging built in, work? I had one like that for a home birth, but just a mouth piece in hospital.

I did really well with entonox. I'd miss it!

I'm shocked that the dangers have been understood and not acted on.

Double standards, awful.

If it reduces anxiety which in turn reduces pain then it is a pain reliever. Pain is often as much mental as physical and this is a well known thing

I would not say that nitrous oxide is safe for staff in home births as ventilation alone is not enough to bring levels down to safe . You need to have active scavenging as well. Even passive scavenging can leave levels too high to be safe . Seen it myself with nitrous oxide monitoring.

I had gas and air for my first birth but not for the second; I didn't notice any difference.

I used it when having stitches done and I felt it helped but more because it gave me something to do and focus on, rather than actual pain relief.

‘Gas and air’ has always struck me as a pretty piss poor cheap choice for women in pain tbh. You may as well give them a stick between the teeth.

In America where people pay for and expect a decent standard of healthcare, epidurals are routine. That’s because they’re the Rolls Royce of pain relief in labour. That’s what would be in place if men gave birth but no, British women have been fobbed off with third rate, cheap as chips gas and air since the 1950s.

That’s the scandal.

Also nitrous oxide is heavier than air so ventilation needs to be at ground level.
I know of a workplace where miniscavengers were used and nitrous oxide levels monitored.
In the U.K. safe levels are 100ppm, in the states 25ppm. With a mini scavenger levels were over 300ppm , equipment and use checked.
In dentistry obviously we can only use nasal masks , where full masks can be used and less risk in other specialities .