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Childbirth

Share experiences and get support around labour, birth and recovery.

B12 and Gas + air

8 replies

Rooandtwo · 18/01/2023 13:22

Hello

This feels like a long shot but I can’t find detailed information anyway. I have an ongoing b12 deficiency which predates my pregnancy and which is treated well (I have an injection every 8 weeks and have felt fine on this both before and during pregnancy).

I understand women with b12 deficiency (not sure if whether it’s treated or not makes a difference) should not have gas and air during labour. I have heard some things about why (it inactivated the circulating b12maybe) but I’m not clear about this as in, whether I definitely shouldn’t have it, or if I could if I had an injection immediately before or after for example. I don’t feel clear on the dangers and as ever with b12 issues I feel like I am educating the medical professionals around me.

Can any sufferers of b12 deficiency who have had gas and air in labour speak to how it effected them? As I say, a long shot but there must be someone out there!

Roo

OP posts:
Follycastle · 18/01/2023 13:23

I have b12 deficiency which had been treated with 12 weekly injections for a couple of years before I went into labour. I had gas and air, no problem at all.

I’ve never heard of that it should be used?

Follycastle · 18/01/2023 13:29

Well you promoted me to Google - how interesting. My read of the guidance copied here from the gov website suggests that it would only be a problem if you were still deficient.

As it happens I’m pregnant again at the moment, so I’m going to ask my midwife at my next appointment.

Gov website below:

Vitamin B12 deficiency
In patients with subclinical deficiency of vitamin B12, neurological toxic effects have occurred after a single exposure to nitrous oxide during general anaesthesia. Assessment of vitamin B12 levels should be considered before nitrous oxide anaesthesia in patients with risk factors for deficiency of this vitamin. Individuals at risk include elderly people, those who have a poor or vegetarian diet, and those with a history of anaemia.

UsernamePain · 18/01/2023 13:35

I’ve had gas and air during 2 labours whilst having b12 injections. Midwives aware on both occasions. I had no issues at all, didn’t feel like I needed a boost after labour.

purplejungle · 18/01/2023 13:39

I was in this position. I was advised to have usual b12 injection at the end of pregnancy as close to labour as possible, and then extra after the labour (which I will pay for privately) as an additional booster to my usual injections every 3 months. I found Gas and air very helpful in labour but it is associated with reducing b12 levels which can cause postnatal mental health problems, hence why I plan to pay for a boost.

purplejungle · 18/01/2023 13:41

I should say - midwives never suggested I shouldn't have gas and air during labour, but I also didn't draw attention to the fact I have b12 injections every 3 months, because I didn't want to not be offered. It's not for everyone, but I'm glad I went about things this way given how well it worked for me during labour both times.

Rooandtwo · 18/01/2023 14:51

ah not just me after all 😂 as I suspected though it’s not all that well known that there are any concerns. I have made my midwife aware and she and the consultant apparently were none the wiser so asked me to share what I had seen which was this - www.gov.uk/drug-safety-update/nitrous-oxide-neurological-and-haematological-toxic-effects

it reads “Nitrous oxide is a medical gas used very widely in surgical anaesthesia. As a 50% mixture with oxygen (brands include Entonox), it is also widely used to relieve pain in childbirth and in acute trauma.

Risk with prolonged use
Nitrous oxide has a very good safety profile in normal use under the supervision of a healthcare professional. However, prolonged use may lead in rare cases to megaloblastic anaemia and neurological toxic effects (myelopathy) due to inactivation of vitamin B12.

For this reason, nitrous oxide should not be given continuously for more than 24 hours, or more frequently than every 4 days, without close clinical supervision and haematological monitoring.

Neurological toxic effects can occur without anaemia or macrocytosis, and even when B12 levels are in the normal range.

Vitamin B12 deficiency
In patients with subclinical deficiency of vitamin B12, neurological toxic effects have occurred after a single exposure to nitrous oxide during general anaesthesia. Assessment of vitamin B12 levels should be considered before nitrous oxide anaesthesia in patients with risk factors for deficiency of this vitamin. Individuals at risk include elderly people, those who have a poor or vegetarian diet, and those with a history of anaemia.”

Theres also this - pubmed.ncbi.nlm.nih.gov/8250714/

which reads “Vitamin B12 (cyanocobalamin) is an integral component of two biochemical reactions in man: the conversion of L-methylmalonyl coenzyme A into succinyl coenzyme A and the formation of methionine by methylation of homocysteine. The transmethylation reaction is essential to DNA synthesis and to the maintenance of the myelin sheath by the methylation of myelin basic protein. Active vitamin B12 contains cobalt in its reduced form (Co+). Nitrous oxide produces irreversible oxidation to the Co++ and Co forms that renders vitamin B12 inactive. Five cases (four from the literature and one new case) are presented in which patients unsuspected of having vitamin B12 deficiency developed subacute combined degeneration of the spinal cord following nitrous oxide anesthesia. Patients with vitamin B12 deficiency are exceedingly sensitive to neurologic deterioration following nitrous oxide anesthesia. If unrecognised, the neurologic deterioration becomes irreversible and may result in death.”

I’m not sure I understood all that but it does sound like if you’re monitored it’s perhaps ok. That the levels drop rather than anything more untoward.

OP posts:
Rooandtwo · 18/01/2023 14:52

Can I ask where you get b12 injections privately?

OP posts:
Rooandtwo · 18/01/2023 14:53

Oops, meant to tag @purplejungle

OP posts:
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