Bans on Gas & Air!

[1stWorldProblems]

Saw this in the Sunday Times today but don't have a share token so here's the same story from the BBC Ban on Gas & Air. I'm not advocating dangerous working conditions for medical staff but felt parents should know that this is another thing that might not fit your birth plan - a number of hospitals have withdrawn gas & air as a pain relief option. As someone who depended it on for both my births, I think other parents should be aware of this change.

It was my understanding that they'll still be able to use it in home birth scenarios and ambulances, because they should be able to ventilate more easily than in your average labour ward. Which I'm pleased about, the people needing it in those situations don't have as many options for pain relief as those within a hospital setting.

I'm 28w pregnant and fully with the midwives, theatre staff, etc. on this one- having had recurrent mc myself I can't imagine what it must be like going through that or experiencing neurological issues because your employer couldn't GAF to look at the 30yr old research and make suitable changes. They did a cost/benefit analysis and the safety of their staff came out bottom. Like a PP I can only imagine there's legal action behind the reasons for the tap suddenly being 'shut' off so broadly like this.

If you want to be angry then be mad at the Trusts who have failed to address this issue for decades, whether that's by improving ventilation or providing access to epidurals for women that want them (like me) rather than asking us to labour for hours on pain relief that's ineffective for some of us and dangerous to their staff. Although their suggestion of paracetamol is so laughable I could cry, says it all about how much they think about women's' pain.

There are more pain relief options than just gas and air! I fully support the withdrawal so that midwives and doctors have safer working conditions.

Most of them are useless though. I had a five day back to back labour with dc1, first contraction hurt as much as the last which was on the drip turned up high. Tens machine was weird but provided zero pain relief, paracetamol didn't touch the sides, bath didn't help, shower targeted at my back didn't help, opoids make me feel awful and as someone who has been raped, the thought of not being able to move with an epidural terrified me. When I finally accepted he was stuck (about 10 hours before the NHS did), it still took around 6 hours...1 hour 40 of those actually with the anesthetist before I got a working epidural and even then I could still feel every contraction in my right thigh at full intensity. Being "high" on gas & air was the only thing which got me through the last 12 hours before he was born. Have to say I didn't like it though and suspect it was responsible along with my lack of sleep for my hallucinations. Certainly with dc2, I refused all pain medication until we ended up in theatre.

Obviously if it's causing fertility and neurological issues to staff then it shouldn't be used, however the NHS needs to re think it's entire attitudes to pain relief in labour. When I asked for an epidural both the midwife and then the anesthetist tried to talk me out of it...because I was allegedly coping despite being in excruciating pain. For me, thinking about dc1 the difference pre and post c section was immense. Pre (when I was in agony with contractions which started in my back and then went to my thighs locking my muscles up) I had to fight for anything besides gas and air. Afterwards when I didn't need anything despite the emcs, they were trying to push opoids on me and sending anesthetists to check I didn't have nerve damage.

And we all know that the answer will be to withdraw gas & air without addressing any of the other issues surrounding pain relief in labour.

More home births then.

They can take my entonox from my cold dead hands!!

It's still fascinating to me how much labour and pain experiences can vary between women. Someone earlier said that there are ways to cope and I believed that too before having my first. But my labour was weird. People say you get a "break" in between contractions but I didn't get that. Just 18 hours of continous pain. I can't have opiods, so I that leaves gas and air and epidural. I don't know how I'd cope if my next labour is like my first and if there is no gas and air or epidurals. I wouldn't want staff to be put at risk by the gas and air, but I do want to be able to have a labour with realistic levels of pain. I can accept that it's not pain free, but expecting a body to just cope through a day of non-stop pain without being able to even keep water down is ridiculous.

Im due in 10 weeks and my hospital has banned the use of gas and air on the labour ward. I am a bit worried about this. I know that epidurals are very much a case of timing and staffing so might be a no. What are the other options? Surely you cant be forced to give birth with no pain relief in 2023.

Unfortunately nitrous oxide (entonox) is heavier than air , so the idea a home birth is safer for staff because you can open a window is nonsense. The only way to make it safe is by using an active scavenging system ie a piece of equipment attached to a full mask that pulls the nitrous oxide breathed out etc , breaks it down and ventilates it.

The danger is not just miscarriage , the main problem is neurological. It gives permanent , non reversible, cumulative neural damage . That's why no one should be abusing happy gas like the teens sniffing creamer canisters.

In the U.K. our "safe " levels are deemed to be 100ppm. In the US it's 25ppm. As this paper shows damage can be shown at 50ppm. academic.oup.com/annweh/article/63/3/337/5373585?login=false

You will note this paper is from the 1980s.

As other posters have said in dentistry , where even in NHS practice the equipment is paid for by the practice, since the 2000s we have had to have scavengers and personal monitors where we use nitrous oxide. However I know colleagues in hospital practice continue to be exposed to levels many times the "safe" of 100ppm and told to crack on . This is with mini scavengers!

The provision of safe working practice with nitrous oxide will require ongoing monitoring and a massive investment in equipment. Those of us who worked in health professions during covid will tell you the far simpler task of increasing efficient ventilation in health buildings was in many,many places nigh on impossible and lip service only was made with , perhaps , the exception of dental practices who funded and installed ventilation themselves .

Again for those who don't want to read the paper here is perhaps the most salient paragraph. Again I would draw attention to the fact in the U.K. 100ppm is deemed to be safe, these effects were seen at 50ppm

Effects associated with nitrous oxide extend beyond personal adverse health effects and pose potential patient safety concerns as well. Acute neurologic effects from low-level anesthetic gases, such as nitrous oxide, among dentists and dental assistants have included decreases in mental performance, audiovisual ability, and manual dexterity (Fernando and Nissanka, 1991; Shaw and Morgan, 1998). Specifically, decreased psychomotor performance regarding visual perception, immediate memory recall, cognition, and motor responses have been observed in personnel exposed to nitrous oxide concentrations up to 50 parts per million by volume (p.p.m.v) over a period of 2 h according to Szymańska (2001). These neurologic effects may lead to the inability to control a dental drill or unknowingly injecting a needle in the wrong location.

There have been shortages recently of the kit needed for epidurals too.

I've never had a baby, but if someone suggested parafuckcetamol during active labour I imagine I'd shove it up their arsehole. Paracetamol barely touches period pain for some.

No, support better maternity care so that women don't have to give care without pain relief. Its perfectly possible to have safe use of gas and air for staff, if the hospital uses the appropriate machinery or ventilation.

Opioids in labour do not work for a significant number of women - either because they are not effective or actually make women ill during labour. Tens machines don't work for everyone, paracetamol is a bloody joke. Epidurals are often not available - my local maternity unit which is supposed to be a leading light tells women not to plan on epidurals either in advance or as a backup during labour because they can't rely on providing them.

Then of course, epidurals are also associated with more birth complications. I'd be interested to see a comparison in overall costs of more epidurals versus proper ventilation. Of course that won't be necessary because the reality is that removal of gas and air will not be matched by more epidural provision.

Does anybody know whether hospitals who are choosing to suspend g&a as pain relief are putting anything in place to lessen the impact on women? It will inevitably mean a lot more women will want to opt for an epidural so that’s needs addressing.

It may also mean more women will want to opt for a maternal request cesarean section or for a home birth. I hope the services are in place for those to happen.

Unless they can magic more anaesthetists and theatre space and staff out of thin air then nope unfortunately unlikely isn't it.

Given how little time midwives spent in the room with me labouring I'd be furious at having it withdrawn.
I was on my own for all but the pushing stage so please let me crack on with my preferred pain relief.

Not all women want an epidural though, I knew I didn't want one. I feel if it's causing a risk to staff defo needs looking at but not all mums want opiates or epidurals, there must be something else 🤔

From a paper I quoted earlier neurological effects are seen on staff within 2 hours . It is also not just midwives who are exposed to nitrous oxide but also ambulance , a and e and dentists etc etc

The damage is cumulative , irreversible and affects several systems including neurological.

Nitrous Oxide is also heavier than air so simply increasing ventilation , which is mostly at high level is not the answer.

In other words your suggestion still puts staff at permanent , irreversible damage.

They weren't even in the same room as me so not sure how they'd be at risk.
I understand why, they are chronically short staffed. But if there are not enough staff to adequately support women in other ways then it's not on to take away the most effective pain relief they have (in both my labours)

This whole situation screams of yet more badly managed nhs issues and poor womens labour management in particular.

Surely at the merest whiff of a risk to midwives’ pregnancies, or indeed anyone health, using chemicals then staff at immediate risk should have been supported into other roles and the safety of working with chemicals properly assessed. It’s totally unacceptable to leave the issue (as I’m now understanding) unacknowledged for decades. And then to find the answer in withdrawing pain relief which then further negatively impacts women with so little real choice already. Utterly unacceptable and awful.

The nitrous oxide will be still in the room for quite some time afterwards. How quickly it clears depends on how many air room changes per hour there are, where the ventilation is (it needs to be at floor level) and whether there are scavenging systems in place (actively removing nitrous oxide and breaking it down).
so whether or not they were in the room all the time you were using entonox they will have been exposed to it , every day in every room it was used.

Gas and air never worked for me anyway when i was in labour with my LG, in fact i vomited due to the mouth dryness it caused, so I'm not really fussed. I'm going for an epidural this time around. But for other mothers who don't want stronger pain relief in labour it's going to be a tricky one.

It's a cumulative risk. They do 12 hour shifts, 3 or 4 a week usually in the same relatively confined spaces with poor ventilation and filtration. They don't have to physically be with women whilst they're using it to be at risk, the point is it sticks around in the atmosphere. The issue is the NHS not putting the correct mitigations in space rather than staff not wanting to have the real risk of life altering illnesses and effects from their workplace.

All staff are at immediate risk of irreversible neurological damage . This is not a health risk to just women of child bearing capability.

Well then the only acceptable answer is improving ventilation, not withdrawing pain relief. Because I don't imagine they'll be increasing staffing numbers and anaesthetists in conjunction with this ban, so instead we'll be labouring alone AND in more pain. It's disgusting.

Indeed that is the correct solution, whether it will actually happen or not is to be seen. Many trusts have suspended it and have had systems installed though. I don't think many if any are saying yeah cool sounds great to take options away from women.

:(

This is the thing. I understand why they need to do this but when you step back and look at the bigger picture, it really seems choices are just being stripped away from pregnant women left right and centre.

Home birth services suspended in lots of places. If you come on here and ponder home birth you will have plenty of posters telling you how selfish and stupid you are as midwives are overstretched and ambulance waiting times are high for those who are more deserving.

Maternal request c-sections are supposed to be an option but many hospitals refuse to follow the guidelines and will make it as difficult as possible. Again, come on here or other platforms and women told they are selfish for wanting one.

Epidurals in short supply in many hospitals. Like another PP above my local hospital advises pregnant women to NOT plan one as there’s little guarantee you will be able to access one.

And now... gas and air not allowed on top of all of this. So place of birth, mode of birth, pain relief for birth= not important for mothers. It’s basically shut up and put up in a lot of hospitals. I’m really glad I’ve had my children because I’d struggle with having such a lack of control over my body.

Ventilation is not the answer. Active scavenging which pulls out and breaks down the nitrous oxide and monitoring of staff is a start. But because scavaging can still leave unsafe levels , particularly when people are not breathing and using masks properly but even often when they are , a proper look at risk assesment to staff needs to be done and more importantly followed through.
I personally have experience of people working in levels of nitrous oxide far in excess of safe levels even with scavenging system in a hospital setting. This was raised over a decade ago and still nothing has been done.