Suspended gas and air in some maternity hospitals

Pregnant women will have a harder time getting gas to relieve pain as hospitals suspend its use over concerns for the safety of midwives.

A hospital in Essex has become one of the last to ban pregnant women from inhaling nitrous oxide for fear that medical staff will be exposed to high levels for prolonged periods.

The tasteless, odorless gas has been used as a childbirth analgesic for over a century and became widely available to women during childbirth in the early 20th century. Although safe in small amounts, long-term exposure to unsafe levels can be dangerous, leading to infertility, vitamin B12 deficiency and nerve damage.

In January, Princess Alexandra Hospital in Harlow, Essex, suspended the use of the gas, depriving expectant mothers of vital pain relief like Amy Fantis.

Hairdresser Fantis told the Sunday Times that the gas withdrawal was causing her stress and labeled it “madness”.

“It’s not available to everyone and maybe I won’t make it. My birth may be just 40 minutes away. It’s stress you don’t need. I understand they have to keep midwives safe but just taking them out seems crazy. It is the poor mothers who are paying the price,” she said.

Other hospitals suspended gas

The gas, administered under the brand name Entonox, is mixed with oxygen and is more commonly known as gas and air. It is breathed in through a mask or mouthpiece when the contractions start and takes 15-20 seconds to work. While it doesn’t eliminate all the pain, it can help make it more bearable.

Alex Field, Division Director, Consultant Obstetrician and Gynaecologist, at Princess Alexandra Hospital NHS Trust, was quoted by The Guardian in late January as saying: “We have temporarily suspended the use of Entonox across the maternity unit to protect our midwives and doctors team.”

The hospital follows others in suspending gas amid discovery of nitrous oxide levels 50 times the safe limit, such as Watford General Hospital.

The Queen Elizabeth Hospital in King’s Lynn also experienced high levels of nitrous oxide due to poor ventilation in some rooms.

The findings come from a BBC investigation that found 11 notifications to the Health and Safety Executive, between August 2018 and December 2022, from seven NHS funds and one private hospital in relation to nitrous oxide – almost all related to maternity units.

Installation of air purifiers

Because nitrous oxide is heavier than air, it builds up in clouds, often at ground level, experts say. Midwives can be exposed to many hours of nitrous oxide-laden air in rooms with closed doors to ensure the mother’s privacy.

One way to bring it down is to install air purifiers, which is what Watford General has now done.

The Princesa Alexandra Hospital has also purchased machines, which absorb exhaled gas and transform it into nitrogen and oxygen, but there are only three available, the newspaper reported.

Ipswich Hospital restored gas after installing new ventilation units.

A spokesperson for NHS England said: “NHS England has been working with Trusts where gas and air supplies have been affected due to different and localized issues – this is not a widespread issue and patients should continue to access services as normal.” .

West Hertfordshire Hospitals NHS Trust Head Nurse Tracey Carter said: “Our maternity safety champions and property team have carefully monitored nitrous oxide levels since we became aware of the issue in October 2021. Our ownership means we cannot put a mechanical ventilation system in place, but we install machines that effectively remove residual anesthetic gas from delivery rooms to ensure the safety of patients and staff.”

BOC, which supplies nitrous oxide to Princess Alexandra Hospital, was contacted for comment.

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