There have been various news reports recently concerning expectant mothers being forced to endure “excruciating” and prolonged labours with no gas and air (links at the bottom of this article) with little to no explanation from hospital staff as to why it is not being provided.
The use of gas and air during pregnancy
Gas and air, which is also referred to as Entonox, its brand name, is a mixture of 50% nitrous oxide and 50% oxygen. It is a self-administered form of pain relief during labour and childbirth, which means that the woman can control the amount of gas and air that they inhale via a mouthpiece.
Gas and air is commonly used by many expectant mothers during labour as it is safe, easy to use, and doesn’t have any long-term side effects. It can help to reduce the pain of contractions and make the mother more relaxed and comfortable during the labour process. It can also help to reduce anxiety and make the experience of childbirth less stressful.
Hospitals suspending the use of gas and air during labour
Several NHS Trusts across the country have temporarily suspended its use of gas and air in maternity units. The primary reason for doing so is due to warnings that have been raised over medical staff being exposed to nitrous oxide for prolonged periods of time in unventilated delivery rooms and labour wards.
The Health and Safety Executive recorded 11 nitrous oxide incidents in NHS Trusts between August 2018 and December 2022, according to an analysis carried out by the BBC. The safe exposure limit for nitrous oxide is 100 parts per million (ppm), but some hospitals reported levels well in excess of this amount.
Some of the hospitals which have suspended the use of gas and air include:
- Basildon University Hospital in Essex – tests revealed levels at 3,000 ppm
- Peterborough City Hospital and Hinchingbrooke Hospital in Huntingdon
- The Norfolk and Norwich University Hospital and The Queen Elizabeth Hospital in King’s Lynn – suspended in certain rooms
- The William Harvey Hospital in Ashford, Kent
- Watford General Hospital – tests revealed levels at almost 5,000ppm. The Hospital has not suspended the use of gas and air but has instead installed machines to remove gas from delivery rooms.
Many pregnant women have expressed their concerns over the suspension of gas and air during labour. Further, in a number of cases, the suspension of gas and air isn’t being communicated to pregnant women and they first become aware of it when they arrive at the hospital in labour.
Whilst other forms of pain relief haven’t been banned, e.g. epidural, they are not always an option available based on the circumstances of a woman’s labour. Additionally, other types of pain relief carry more medical risks than gas and air.
Val Willcox from the National Childbirth Trust commented:
“Hospital trusts need to urgently look into how to make the environment in maternity wards and birth centres safer, so that midwives are protected and women in labour have more choices around pain relief.”
However, others have emphasised the importance of protecting the health of midwives. Midwife and author, Leah Hazard, said:
“We want birthing women to have access to a wide range of pain relief options, but staff also have the right to safe working conditions.
“Midwives especially over the last few years with Covid have been exposed to such dangerous environments at work. It is unfortunately having a knock-on effect on women but it is a basic safety at work issue and it needs to be addressed.”
The Royal College of Midwives (RCM) has said that the issue has cropped up due to poor ventilation in delivery suites and labour wards. In respect of Basildon Hospital, the RCM said its members at the hospital were contemplating taking legal action due to them being exposed to almost 30 times the exposure limit for nitrous oxide.
Comment
The utmost concern is safety, and of course, the mother and the unborn child must be a priority in considerations. However, it is becoming clear that the use of gas and air poses a risk to the staff delivering babies and it must be accepted that they have the right to be safe at work.
Everything has to be balanced, and clearly, there are risks to both sides. It needs to be considered that there are risks of using gas and air in terms of exposure limits to staff and whether this is the safest option, but also risks of leaving labouring mothers enduring significant pain and prolonged labours.
What stands out most, though, is that clearly the issues and considerations are not being communicated effectively. For any mother in labour, it can be a frightening time and it may feel like your wishes and concerns aren’t being listened to. Hospitals need to ensure that all of the information is explained, and probably at an earlier stage than when labour has started, so that expectations are managed, and a mother knows all of the details in advance. Other options for pain management can then effectively be explored during pregnancy and properly explained. It is down to healthcare providers to find a way to deal with this issue, and it is important that they do so soon.
How can we help
If you have any questions in relation to the subjects discussed in this article, then please get in touch with a member of our expert Medical Negligence team in Derby, Leicester, or Nottingham on 0800 024 1976 or via our online form.
Contact us