Several hospitals around the country have suspended the use of gas and air in recent weeks, leaving many mothers without access to it for pain relief during childbirth.

Some women have spoken out about how being denied gas and air during labour made the experience traumatic.

Here i looks at why some hospitals have stopped providing gas and air to women during childbirth.

What is Entonox?

Entonox, commonly referred to as gas and air, is a medical gas comprised of 50 per cent oxygen and 50 per cent nitrous oxide.

It’s widely used as a form of pain relief during labour but can also be offered to patients in many other medical settings.

Why have some hospitals suspended the use of gas and air?

Peterborough City and Hinchingbrooke Hospitals and Basildon University Hospital in Essex are among those that have suspended the use of gas and air – and continue to do so.

Hospitals said they made the decision to take the action to safeguard their staff who are working in maternity units for long periods of time.

The suspensions were implemented after air quality tests revealed unsafe levels of nitrous oxide.

Basildon University Hospital temporarily halted access to gas and air after test results showed levels at 3,000 parts per million (ppm) compared to the safe limit of 100ppm.

It comes after the hospital reinstated its use in December following a previous suspension.

A spokesperson for Mid and South Essex NHS Foundation Trust said: “We made the difficult decision to suspend the use of gas and air in the maternity suite at Basildon Hospital to protect our staff who are working on the labour ward for extended periods of time. We note the latest NHS guidance and are following all the correct procedures and hope to have a resolution to this issue as soon as possible.”

What are the safety concerns?

Experts say that in small doses gas and air does not pose a risk of harm to women and babies. But nitrous oxide is a hazardous substance and if exposure to it is not properly controlled it can cause health problems.

Prolonged exposure to the gas can lead to issues with vitamin B12 deficiency and folate deficiency anaemia, conditions that can worsen over time if left untreated.

Symptoms of vitamin B12 deficiency and folate deficiency anaemia include:

  • rapid breathing or shortness of breath
  • headaches
  • indigestion
  • loss of appetite
  • palpitations
  • vision problems
  • feeling weak or tired
  • diarrhoea
  • a sore or red tongue, sometimes with mouth ulcers
  • problems with memory, understanding and judgement (cognitive changes)
  • numbness
  • muscle weakness
  • psychological problems, which can range from mild depression or anxiety, to confusion and dementia
  • problems with balance and coordination
  • pins and needles
  • incontinence

What does this mean for women giving birth in hospital?

Hospitals have not taken a blanket approach to suspending the use of gas and air. In some cases its use has been limited or restricted to certain rooms.

Where the use of Entonox has been suspended, women are offered other forms of pain relief and the option of giving birth at alternative hospitals where gas and air is still available.

Jo Bennis, chief nurse at North West Anglia NHS Foundation Trust, which runs Peterborough City and Hinchingbrooke Hospitals, said: “We appreciate that this is a very anxious time for women who were expecting to be able to use gas and air while giving birth at our maternity units. This was not a decision that we made lightly and was based on national advice we’d received, and the concerns raised at other hospitals.

“We continue to work closely with our women to ensure they can make the best alternative pain relief choices for them and their baby and support them through what we appreciate is a really difficult time.”

What can be done to make the use of gas and air safer for all?

The Royal College of Midwives (RCM), whose health and safety representatives can legally undertake an inspection of their members’ workplaces, said the problems are being caused by poor ventilation.

Dr Suzanne Tyler, the RCM’s executive director, trade union, said: “Too many of the buildings that house maternity services are simply not fit for purpose. This issue has arisen because of poor ventilation in delivery suites and labour wards.”

Hospitals are investigating how to reintroduce gas and air safely. One way units can make labour wards safer for staff is by fitting them with ventilation or machinery to remove the waste gas.

In December 2022, routine testing showed that some samples were above the accepted levels of nitrous oxide given in national guidance at the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust. In response, the trust limited usage of gas and air in specific rooms, dealt with on a case-by-case basis.

Helen Blanchard, interim chief nurse at the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, said: “At no point did we suspend the use of gas and air and we have no plans to do so in the future. We have worked with our teams to ensure that the ventilation and extraction systems used in our maternity suites are working effectively, and there is no risk to those giving birth or their birthing partners and babies. We have a testing programme in place to ensure that we quickly identify such issues in future.”

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West Hertfordshire Teaching Hospitals NHS Trust also installed machines which effectively remove waste anaesthetic gas from delivery rooms instead of suspending its use.

Princess Alexandra Hospital in Harlow temporarily stopped providing gas and air to maternity patients in January after concerns were raised by other hospitals and tests results from its maternity unit.

Giuseppe Labriola, director of midwifery and assistant chief nurse at the Princess Alexandra Hospital NHS Trust, said: “Following tests on the use of gas and air in our maternity unit, we made the decision to suspend the use of gas and air on a temporary basis (19 January). We have since put in place three temporary gas and air units and can now offer gas and air to women and birthing people on our labour ward. We also have permanent gas and air units being fitted soon.”

In a statement on the trust’s website Joanna Keable, head of midwifery, said: “As we currently have a limited number of machines, we may not be able to offer gas and air to everyone who would like to use it at this time.”

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