Home Birth - Gas and Air

[JoD]

I am planning a home birth for my first child in early March. I have been told that only two canisters of gas and air will be available (each lasting 1.5 hours) and that's it. When I asked why it was limited in this way I was told "because that's all we'll be able to get" and that if I thought I wouldn't be able to get by on this perhaps I should re-consider having the birth at home.

Can anyone offer any advice about whether this is common practice, whether 3 hours is going to be enough or if it will be possible for me to get hold of further supplies of entonox independently?

It seems ridiculous (and a waste of NHS resources) that I might have to transfer to hospital purely to obtain more g&a.

I have a meeting in a couple of weeks to discuss the home birth in more detail so would be grateful to find out what others think. Thanks.

I had my first child in hospital and the second at home but for both I used only g&a. And in both cases 3 hours would have been enough. With DS I had a long second stage - was pushing for two hours and an epiosiotomy and used g&a during the stitching but 3 hours would still have easily covered it. Think TBH it is common practice and is that way because its all most people will need and there is a practical limitation on how much midwives can carry round. Although it doesn't sound like the person who answered your questins was very helpful/reassuring.

Bear in mind you can also get a prescription for pethidine to have available at home. Even if you would prefer not to use it, it might be nice to have it there as back up and then pour it down the toilet. This is what I did with DD. The midwives are not allowed to carry pethidine because it is a controlled drug so you have to have your own prescription. Also have you considered a pool and/or a tens machine?

JoD, you won't need to breathe the gas and air continuously, just during contractions, and probably not the earlier ones, so I imagine 3 hours' worth would be plenty. What do you think about alternatives for pain relief, such as TENS or pethidine? You could have something else on "standby".

JoD - I too am hoping for a homebirth for my baby due early March - it'll be my second, I had my dd 2.5 years ago in hospital. I was really interested to hear what you say about the gas and air supply - I confess that question had never occurred to me.

First time round that wouldn't have been enough for me - after 2 days of "pre-labour" at home (contractions manageable but every 5-10 minutes), I was on entonox pretty constantly for 8 hours, with contractions every 2 minutes (before it transpired that I still wasn't dilating and an epidural was yelled for!).

Obviously I'm hoping this one will be quicker, but I still anticipate it might be a long haul. 3 hours doesn't sound very much to me, but is it actually elapsed time, or is it 3 hours of sucking on the gas and air? If you were having contractions every 2-3 minutes, each lasting a minute and you just used the gas and air during the actual contraction obviously the g&a would last a fair while. Does that make any sense?

I'll be asking about g&a at my next midwife's meeting which is in a few weeks. I'd be interested to hear what you find out.

Tissy - posts crossed - yup - that's exactly what I was thinking, only you put it more clearly!

If u really can't have more than 2 canisters & no other means of getting more try 2 go as long without painrelief as poss if 3hrs of gas is all u have.U might b lucky & have a quick labour but u could also b in 4 a long haul have u thought about hiring a tens machine u can sometimes hire them frm hospital & some boots stores.Never usud one myself but its worth thinking about having alternative painrelief.Don't have a hospital birth just cos of gas situation if everything goes 2 plan have your home birth u wont regret it i had a home birth by accident with dd2 best birth yet.Good luck

My experience was the same as bozza - first birth hospital, second home, in both one canister of gas and air was plenty never mind two!
I agree it would be a good idea to look into the range of options such as tens, water pool (also rememebr you will have unlimited access to your bath, and more optiosn in terms of mobility and positions, and things to distract you than in hospital so I would imagien the need will be less).
You could ask your midwives whether they have ever had a problem running out of gas and air with a home birth - I suspect that 2 canisters would be enough for most practical purposes. Try not to worry about it and definitely don't let it stop you using it when you need to!

I had a homebirth just over a year ago. The midwife arrived with two canisters of G&A ( although I think one might have been half empty ) and I was using it for about 3 and a half hours in total. Towards the end, the second canister was running out, I could feel it getting less and less effective. I started to really panic, screaming " omg! I've GOT to have G&A or I'll die! " I basically insisted that the MW get me some more. She phoned a colleague and asked her to bring some around as quickly as possible. Thank goodness, she arrived with it before the other canister had properly run out.

It was not a question I had thought to ask and no one had said anything about the amount of G&A that was to be available, but it is definately something I will be getting straight before I have another home birth.

I also used TENS which was fantastic. Incidently, I have seen G&A canisters for sale online ( I googled it out of curiosity, as I would never want to go through nearly running out again ) but they are about £150 each.

First of all 2nd labours are much faster and easier (not less painful though!) so the gas and air quantity is not an issue for a 2nd timer... sorry !

However for JoD I would say this... do consider TENS or a birth pool (you can buy one for £70!) - water is very helpful.

I DO think gas and air in 2 canisters should be enough.... but then again I am one of those who believes gas and air is WAY over used (and often mis-used),..... what do you think they do in the rest of the world were NO ONE (except I think Australia) uses gas and air!
(for what it's worth for my 1st home baby I had a home birth and discovered I hated the gas and air - so after 3 puffs I went off it... I had thought I'd love it so was quite disappointed)

Pethidine is a bad idea for a home birth because you would need to have the antidote for it should your baby come too quickly after you were given the shot. I know many MWs really do not recommend going down the pethidine route for a home birth.

Good point about the pethidine, pupuce, but the antidote isn't a controlled drug, so wouldn't the midwives have that to hand if they knew that pethidine is on the cards?

pupuce I always thought hte answer to your question (what do they do in other countries) was either a) epidural (France, US) or b) scream a lot!
Slightly flippant but seriously I am quite interested in the answer. I found it extremely helpful for the last hour or so of the first stage. And also for the local injection for stitching the first time round.

But wouldn't you say that having the pethidine available might be a reassurance, especially if, for instance, a transfer was necessary. I got mine available but totally forgot about it during labour - but might not have done first time round. I think the biggest help with my second baby was keeping moving around. I went downstairs to find my notes 10 minutes before she was born. Had to stop half way up the stairs for a contraction, mind you. Sure I wouldn't have had two hour second stage with DS if I hadn't been laid on my back on the bed.

Women labouring at home usually need less pain relief than women in hospital - that is one of the major benefits of homebirth. You cope better with pain because you are more relaxed in your own surroundings. Our community midwives would get additional gas and air it was running low. In our area women get a presciption for Pethidine from the GP to keep in the house incase it is needed. It very rarely is for the same reasons as above. Narcan is the antidote to pethidine and midwives will carry it. It is very rarely needed. I have not given it myself for a number of years now. Babies just usually need a good rub and a blow in their faces to get then going.

ps I loved gas and air

Just to add to what Rosieposie says, ny midwife arrived with two cannisters and when I came to need them, she couldn't get one opened and the other was leaking a bit (ie when I wasn't breathing it in). It was no problem and she immediatly called her colleague to bring more when she was coming and I felt very reassured. As it was, I didn't need very much at all and even with the leaky one, there was more than enough. I managed to concentrate much better without using it and ds2 arrived shortly after. He was my third though and first labours do take longer, but even so, you won't be using it constantly. I hope all goes well for you and there really shouldn't be a problem getting more if you need it.
One thing I would say though is to check with your GP if they are happy to prescribe pethidine. Mine wasn't as there would be no doctor there to oversee if there was any adverse reaction etc - I didn't have it with either of my previous deliveries. Also, I found that the midwives were not really happy to administer it either and I got a bit nervous about not having that back-up in the house, but still determined to have ds2 at home after a bad experience at the hospital with dd. My fantastic midwife filled me with confidence though and was a huge support to me all the way through and it couldn't have been better so I really recommend the home birth thing.
Having said that, my hospital experience with ds1 was very good, and the midwife was fantasticly encouraging but I did need considerably more pain relief and had an epidural!

Pupuce - I'm right in thinking you are a MW? It's very interesting what you are saying. Would you mind elaborating on why you think G&A is over used and mis-used?

On a personal level, I thought G&A was fantastic. I hadn't had it with my first hospital birth ( I had an epidural ) and I am convinced I would not have stayed at home during my second labour if the G&A had not been available ( I would have gone into hospital for another epidural ). Despite it being my second labour, I felt I most definately needed it for a good 3 hours.

Rosie you story reminds me of one of my clients' home birth... when MW arrived the mother said "good you're here, give me the fxxing G&A".... MW's reply "I haven't go any"
Mother "Get it now or I'll die"... in a very angry tone (mother is in transition and close to delivery - I know that - not sure mother realises that herself)
MW "I haven't got any... and I am NOT leaving you as baby is coming" - on an also very angry tone (basically shouting match)

Have to say that this got the mother to focus on her labour and she managed really well once she realised that this was it (G&A was not an option) ! So you CAN do it without gas and air....

Yes, I'm sure you are right. With hindsight, I was in transition, although at the time I didn't know this and I don't think the MW did either - otherwise I don't think she would have gone to the trouble of getting more G&A. I'm sure I would have managed without the G&A, but I am very very glad that I didn't have to. It helped me enormously and I still managed to concentrate and push dd out in 17 minutes. You still haven't really answered my question as to why you think G&A is misused though.
If I'd had any idea that the g&a might have ran out, I would have preferred to go into hospital.

I am a doula. The vast majority of my clients never use gas and air (to the MWs's amazement.....) - don't get me wrong though, they don't use the gas and air because I get them to breath properly and they find that Gas and Air is more of a hindrance (sp?)... If they wish to have gas and air I have no problem but as I usually start with them at home where I get them breathing well and focused on relaxing... once in hospital (usually in late labour so wheer gas and air is definitely "usually" used) you have the MW automcatically offering it... and I am the first one to be surprised (in a G&A culture) to hear the mother saying no.... she then sometimes get reallye cnouraged by MW to try it ("come on it will take the edge off")... some agree to try and spit it out!

There is a hell of a lot to say for good breathing and relaxation ! This is probably the only time mears and I have a slightly differing view

I Holland they have a high home birth rate. In France they are epidural addicts

Mis-used because often women use it in between contractions and use it as a total crutch... not wanting to let go of it !
It can lead to very dizzy women and I have once seen it really affect negatively a 2nd stage (this is when I was training as a doula in a labour ward).

thanks - actually I think you are right ( apologies if I sounded a bit "off" with you ). In the situation that I was in, G&A WAS fantastic - but I was home alone with a pretty useless husband, and a pretty unsympathetic midwife. I do believe a sympathetic helpful female birth partner would have made my experience much better and easier to cope with.

Thanks ever so much for your most positive replies. I am hiring a birthing pool and tens machine, so hopefully a combination of all of these will help me great through.

I will also ask the midwife to define what she means about 3 hours.

I did ask about pethidine but was told they weren't keen of the use of it for home births because of the effect it can have on the baby (tbh I don't fancy pethidine, but did ask about it just as a back up).

Will update after my next appointment, Pidge. Thanks again.

pupuce - can you recommend any good reading material on breathing techniques in labour?

First time round I was totally unprepared for the degree of pain - it quite literally felt as though my body was exploding into a thousand pieces with each contraction (baby was posterior which didn't help) - and I found sucking on the gas and air was the only thing that could get me through the contractions. But even at the time I wondered how much it was helping just because it was controlling my breathing, rather than because of the pain relieving properties of the entonox itself.

I'm going to get a pool too to labour in, so am hoping that will help, but would be very interested in breathing techniques.

JoD - clearly it would be mad if your NHS area transfers people rather than supply another cannister - but honestly, I wouldn't worry too much.
I laboured for over 24 hours at home, including over 2hrs pushing and was lucky enough never to feel that I even wanted g&a. I did use Tens from the first twinge, spent all my time walking or on all fours, and had a pool. If g&a is working well for you, and you seem to be necking it, why not ask your birth partner/dp or dh to check with the MWs how much is left after you start on a 2nd cannister and start hassling for another to be delivered?

And as someone said - the 3 hours is three hours actually breathing it in, not including the time you are not breathing it between contractions.

I had my son in hospital and ended up having an epidural, more out of fear than not being able to cope with the pain. Before the epidural I had gas and air but found it useless. I found I could concentrate much better without it, useing just breathing teqniques. If I decide to have another baby I definitely will not bother with it as I didn't feel it took the edge of the pain but I suppose everyone is different.

I am not a fan of breathing technique but the reason I think my client do so well is because

1. I make sure they breath the pain away - "blow it out".... SLOWLY!!!! (no hyper-ventilating business!)- I might have to breathe with the mum for some of the contractions if she seems to struggle calmimg down.
2. I OFTEN tell women "relax your shoulders" and "relax your jaw" (your DP/DH should do this often however some women find it irritating when the men says it.... not when the doula does!!!)
3. If they have a very bad contraction and "loose the plot" from fear after that, I calm them down... give them a quiet pet talk about how labour is progressing, how well they are coping, how so much nearer the end they are.