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but felt parents should know that this is another thing that might not fit your birth plan - a number of hospitals have withdrawn gas & air as a pain relief option.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's an appalling situation all round. Hospital staff should never be put at risk and their safety is paramount.

At the same time, consideration needs to be given as to how the situation is managed for pregnant women. It's simply not good enough to make a blanket announcement in the media and not contact women individually who are affected, giving them a chance to discuss their concerns. Viable alternatives also need to be provided, such as a guarantee that all women will be able to access an epidural if they want one. Not "oh well you can have some paracetamol if you need it".

But I'm not really surprised. Maternity care is absolutely shocking in this country. I don't know how anyone can have any pride in the service we offer.

For decades plenty of women have found it extremely helpful but because it didn’t work for you it’s bollocks??

It's like me saying that white wine doesn't agree with me therefore it's bollocks 🙄

Gas and air was the only pain relief I had with my second. It was amaze-balls. I barely noticed her come out 🤣

Viable alternatives also need to be provided, such as a guarantee that all women will be able to access an epidural if they want one. Not "oh well you can have some paracetamol if you need it".

Yep when this happens I really can’t see any other underlying message than ‘women don’t matter’

Nitrous oxide has no effect on 5 to 15% of people . The way it works is that it actually only has a very small pain relieving effect , the main effect is anxiolytic ie it relaxes you.
somewhat ironically as I used nitrous oxide very successfully in work I was one of the minority it had no effect on when I tried it in labour !

This sounds like a massive scandal on all fronts.

1. midwives been left at known risk for a long time despite there being options to mitigate that risk
2. women being denied adequate pain relief despite knowing these risks
3. midwives struggling with the adverse health affects and potential trauma from that
4. sudden withdrawal of pain relief potentially leaving labouring mothers at risk of trauma

Disgraceful all round. I despair for women’s health. Solidified my thought process of never wanting to put myself through the vulnerabilities of labour again. It’s leaving midwives infertile and mothers too scared to go again. Tragic.

Gas and air was the only thing that worked for me. Pethidine just sent me to sleep between contractions and did nothing during them. No time for epidural with quick first stage labours either.

Only way I got through my pessary insertion and checks because I had tight scar tissue from DC1.

Glad I'm done. Yes hospitals actually need to sort labour facilities with suitable ventilation, especially as I couldn't have gas and air in antenatal (was allowed for one check because I was in so much pain) because of lack of capacity in labour ward.

I don’t know how they come up with those percentages but the fact is that anxiety increases the experience of pain. It is also a big part of what can make childbirth so scary. But the point is that if gas and air makes childbirth easier and less traumatic for a good number of women then it is effective, never mind why. This doesn’t mean midwives and other birth attendants should be exposed to an unsafe work environment, just that there should be a high priority placed on finding a workable solution that doesn’t put anyone at risk for long-term negative consequences. But considering the vast majority of midwives are women too I’m not holding my breath.

Gas and air is used routinely in childbirth in Australia, where the legal level is also 25ppm, so it is possible to offer this option to women without endangering staff.

It's unacceptable that the NHS has not taken the necessary action to make gas use safe long before now.

85 to 95% effectiveness sounds pretty great to me.

Women are the experts on their own experience of pain. If they say it's relieving pain, then that is what it is doing.

The NHS have really dropped the ball on this one haven't they, what horrendous treatment of midwives. I'm glad my days of giving birth are over, I only used gas and air and while I was giving birth I was found it useless, after I gave birth and they were stitching me up I found it brilliant. I found the TENS machine really good - but took it off to go in the pool and really regretted it.

Like others, I had to be coached on how to use it effectively. I was breathing it shallowly and quickly at first, taking it out to yell and scream, until the midwife encouraged me - the harder the contraction, the harder you suck on that gas.

There were several "levels" of effects that I experienced, and it was only when I inhaled it very strongly and deeply and persistently that I "broke through" to the (divine, blissful) level where my whole body went numb and floated away. Once I knew what I had to do I was able to repeat that at the peak of each contraction.

Obviously if it makes you vomit at the first sniff then you're never going to be able to inhale enough of it to get to that level. But if you can, and if you are encouraged to do so, then it is a powerfully effective pain reliever.

I've watched quite a few episodes of 'One Born Every Minute' and it shocked me the number of midwives who tried to discourage the labouring women from having an epidural. My labour pain was horrendous, there was absolutely no way I could have done it without an epidural.

This sums up how I feel about it too.

Unsurprising that the NHS have just ignored health impacts on their staff for so long - who is going to be held accountable for that? If we did something similar as a private company I'd expect there to be lawsuits and possible prison time as a consequence.

Completely absurd that there is no conversation about replacement pain relief for women in labour. Paracetamol does not fucking count.

Ds was born overseas where they don’t use gas and air. I asked about it beforehand and they described it as ‘medieval’!

Ds was born naturally and then I was given an anaesthetic injection to numb area before stitches I had by consultant, who then stitched. Felt nothing.

I completely agree I had gas and air for my labour and I had to have an emergency epidural which I was very against because of the risks. I don’t know how I would’ve laboured without the gas and air I had. I understand the risks it can cause at high exposure levels for the midwives however hospitals should then get better ventilation and filtering systems to reduce these risks for their workers. I think it’s ridiculous suggesting paracetamol and things like that as pain relief as I had limited options for my pain relief as I’m allergic to paracetamol. Some people are allergic to certain medications and they have to work around it for their birth.

One of the most shocking parts of this for me is how communications with both pregnant women and midwives have been so lacking in transparency.

Midwives 100% need and deserve a safe environment to work in. The NHS should not be putting them at risk. If gas and air is safe in some units and not others, the basis for this and the steps being taken to make the other units safe need to be made absolutely crystal-clear. They should not have to go into work fearing that they will be harmed... it is absolutely shocking.

Likewise, women giving birth are entitled to absolute transparency about what pain relief will be available to them so they can make decisions regarding their care (including transferring hospitals) on a fully informed basis. No woman should be left without adequate pain relief during labour and that should mean increased provision for epidurals at the affected hospitals as well as the choice to transfer hospital.

Both midwives and pregnant women are being let down. It's dreadful but it's not a midwives v. pregnant women scenario. I don't imagine having to deal with women who are not coping during labour when you can only offer inadequate pain relief options feels very good for midwives either.

Gas and air was hugely important for my labours.

@endofthelinefinally so sorry for my flippant posting, sorry for your losses. I had never heard of it causing miscarriages in midwives and now I feel terrible having used it. Why the hell is it still being used if the risk is known and also why hasn’t something else been invented to help women in labour.

It can be used safely. They just need to spend the money to put in the proper machinery to neutralise the gas.

I posted here as I was shocked that a form of fundamental pain relief had been withdrawn from hospitals with no big story in the media - for birthing mothers or the health staff put at risk by it. I have R4 / TV news on as background all the time so why is this not a big story?

I used gas & air effectively for both my children (DD2 was back to back & delivered by forceps after an ambulance transfer on my knees). Sorry it didn't work from some of you.

Women should at least be aware that an option that's been standard since 1960's may not be available at their chosen hospital & very few of them have been told in advance. Good luck to you.

This has been coming for some time (the medical consequences of chronic exposure were known about when I started anaesthetising over 15 yrs ago!). In addition to the miscarriage risk, subacute combined degeneration of the cord is also well known but has been more topical recently in the context of illicit nitrous use as the incidence of young people developing it has gone up.

The problem is not just one of ventilation as nitrous is a potent greenhouse gas that hangs about in the atmosphere for about a century so we can't just open the windows. Nitrous is one of the main culprits behind the 'anaesthetic gas' carbon footprint, and labour ward use is the main source of that (nitrous is actually not used that much in anaesthetics any more but labour ward theatres is one of few places where it is still widely used for anaesthesia because it has some advantages in GA c-sections). The scavenging in theatres is enough to keep us all safe, but it just vents the gases to the environment.

There is technology available that cracks exhaled nitrous into nitrogen/oxygen but that has not been widely available in the UK until recently (I think due to cost). It does depend on the patient using the mouthpiece properly, and it's disappointing to see how many people can't/won't do that. Hopefully encouraging women to use the kit properly might mean that entonox will remain available!

Developing new drugs/tech for use in pregnancy/labour is difficult for the obvious reason that performing trials on pregnant people comes with significant ethical difficulties. There is an inhaled drug that's becoming more fashionable as an alternative to entonox in pre-hospital/ED settings, but it is not thought safe for use in pregnancy. Epidurals aren't appropriate for everybody. Anaesthetists are also in pretty short supply (and already having to increase service provision to allow for all the maternal request sections). Remifentanil may well become more widely used, but as with everything else, it's not without risk.

Given I had a water birth I doubt that's an option .

It's a shame as I only needed ten minutes of gas and air but it just helped when I was told it was time to push when I was just thinking about asking for some drugs

To the Nurses and other medical staff in here, are they banning the compressed cannisters used for nebulisers throughout the hospital but especially in medical and a/e or has that been addressed already?

totally in favour of protecting midwives but ideally by investing in more appropriate options and/or making existing options safer and easier, not withdrawing them and giving women the choice of fucking paracetamol or stuff they might feel is risky or not right for them.

neither gas&air not tens did a thing for me and I suspect they may function more as a placebo or distraction but biology is weird - weed doesn't do much for me either, so I am quite willing to believe that other people experience more useful effects. but I wonder if some of those making the decision to just ban it rather than making it safe similarly view it as basically an ineffective but cheap distraction, such that investing heavily to make it safer makes it pointless?