Gas and air?

[summer rain]

In this area it's 2 medium sized canisters, I've never heard of this scavenging thing before but I can only presume that since most homebirthing midwives only deal with a few homebirths and the rest of the time they're in a hospital environment, then they aren't getting much more exposure than their patient. Also homes tend to be far better ventilated than hospital rooms.

 

[summer rain]

Casann yes that's the whole Uk

 

[KandyKinz]

In this area it's 2 medium sized canisters, I've never heard of this scavenging thing before but I can only presume that since most homebirthing midwives only deal with a few homebirths and the rest of the time they're in a hospital environment, then they aren't getting much more exposure than their patient. Also homes tend to be far better ventilated than hospital rooms.

Really? Maybe I'm a terrible person but I WOULD NOT agree to bring nitrous to a homebirth if there was no scavenging. I would be petrified of the accumulative effects of the nitrous on my own health and the health of future children. And here full time midwives generally only attend 2-3 homebirths a month... But that's still too much exposure for me to feel comfortable with.

 

[Mervs Mum]

Im still in shock over the fact midwives provide G&A at homebirths in other countries. If you have a homebirth in the US you can expect NOTHING in the way of pain relief. You get a pat on the back and a good job hun, you can do it.. lol!

That's because you CAN do it!

Yeah!!!

Thanks for that info about scavenging! Really interesting! I'm going to talk to some colleagues about their understanding of the approach in the UK.

 

[Mervs Mum]

In this area it's 2 medium sized canisters, I've never heard of this scavenging thing before but I can only presume that since most homebirthing midwives only deal with a few homebirths and the rest of the time they're in a hospital environment, then they aren't getting much more exposure than their patient. Also homes tend to be far better ventilated than hospital rooms.

Really? Maybe I'm a terrible person but I WOULD NOT agree to bring nitrous to a homebirth if there was no scavenging. I would be petrified of the accumulative effects of the nitrous on my own health and the health of future children. And here full time midwives generally only attend 2-3 homebirths a month... But that's still too much exposure for me to feel comfortable with.

I do think if there were hard documented evidence it would be more common knowledge as a risk. Its the first I ever heard of it including during my training which obviously goes into detail on ALL forms of pai recluse used in childbirth.

 

[flubdub]

Its the first I have heard of this Scavenging too, but I just did a quick Google, and it is mentioned on BabyCentre;

"Gas and air is perfectly safe for you to use during labour. However, there have been concerns about the safety of people who are exposed to a lot of nitrous oxide in their work. In large quantities, nitrous oxide can interfere with the body's levels of B vitamins and with cell development. If you work as a midwife, you need to be aware of how long you are exposed to nitrous oxide, particularly if you are planning to get pregnant yourself."

Also, this is a very good info site;
https://www.birthinternational.com/articles/birth-intervention/137-nitrous-oxide-no-laughing-matter

It goes into a lot of depth. It does say that in the UK the levels are regarded as safe for working in day to day, but further on it says, there is more concern for people working very long shifts.

"How are safe levels of exposure determined?
Given the concern for the health and safety aspects of exposure to anaesthetic gases for health workers, an occupational exposure standard (OES) for each gas has been established. "An OES represents airborne concentrations averaged over a specified time period which, according to available scientific knowledge, will not damage the health of workers exposed to those levels by inhalation day after day" (Meldrum 1999). The process for establishing an OES involves research reviews, independent evaluation and careful analysis of available data."

 

[Mervs Mum]

I just spoke to one of my colleague and here's and here's what she said:

There is the potential for long term side effect which is why the protection of hospital workers is mentioned but, you have to have regular exposure, as in daily, for months at a time for this to happen. So, if this happens, it's more likely to occur somewhere like a burns unit where G&A is used daily for patients having dressings.

Having G&A at a home birth is perfectly safe. There is no need to scavenge for such a short exposure.

 

[flubdub]

I just spoke to one of my colleague and here's and here's what she said:

There is the potential for long term side effect which is why the protection of hospital workers is mentioned but, you have to have regular exposure, as in daily, for months at a time for this to happen. So, if this happens, it's more likely to occur somewhere like a burns unit where G&A is used daily for patients having dressings.

Having G&A at a home birth is perfectly safe. There is no need to scavenge for such a short exposure.

That would go for a hosptial too though wouldnt it?
Used daily for prolonged periods? And probably in every room too, which are only small aswell so no ventilation?

 

[Mervs Mum]

I just spoke to one of my colleague and here's and here's what she said:

There is the potential for long term side effect which is why the protection of hospital workers is mentioned but, you have to have regular exposure, as in daily, for months at a time for this to happen. So, if this happens, it's more likely to occur somewhere like a burns unit where G&A is used daily for patients having dressings.

Having G&A at a home birth is perfectly safe. There is no need to scavenge for such a short exposure.

That would go for a hosptial too though wouldnt it?
Used daily for prolonged periods? And probably in every room too, which are only small aswell so no ventilation?

Yes but see highlighted above......we are talking about G&A and scavenging (or lack of) in the home

ETA: I'd imagine if there's a notable risk to staff that the NHS wouldnt just ignore it! Staff are savvy enough to make sure they are not exposing themselves to a known danger! Think about staff working in radiation areas such as Xray - they dont take any chances with them and it's a well known, well documented risk they'd be exposed to

 

[summer rain]

The NHS are absolutely crazy about health and safety of their staff often going well overboard IMHO (even midwives have complained to me about this) so I'd be very surprised if they were somehow missing something when it comes to gas and air exposure, it has been used since about 1950 in this country for births. I do suspect this worry about scavenging in the US is really more about scaremongering; as gas and air is cheap and is not going to make loads of money for big drug companies as other pain relief methods can do. Thank you flubdub and merv's mum for the information. Also not a lot of people are aware of this but the air we breathe normally is 79% nitrogen, and only 20% oxygen.

 

[Jenniflower]

Ok I know in the US laughing gas is JUST Nitrous Oxcide. But in the UK Gas and Air is a mixture of 50% Nitrous Oxcide and 50% Oxygen. Do you think this is why there's a difference of oppinion between the countries?

 

[Chocciebutton]

when it is used in a general anaesthetic situation it is 80% nitrous oxide.....then it becomes different ...using it 50% is fine

 

[Mervs Mum]

Summer Rain that's a good point about the cost element.....I also wonder if the make up is different as Jenni said....

 

[KandyKinz]

The reason to my knowledge that nitrous oxide has not been supported as a pain relief option in labour in the US is due to the potential occupational risks it poses to health care workers. Which personally I find somewhat completely ridiculous as with modern day scavenging equipment exposure to contaminated air is very minimal and adverse outcomes to the health of care providers have not been demonstrated when scavenging equipment is properly used. It's an absolute shame that nitrous is not being more utilized when the risks of nitrous to the mom and baby is extremely minimal in comparison to the many many risks and complications associated with epidural use......

Anyways... the issue of scavenging is a really real issue. There is hard evidence that supports nitrous' detrimental impact on the health of workers who are regularly exposed to unscavenged nitrous specifically in regards to fertility. Significant fertility issues and increases in miscarriage rates have been demonstrated when exposure to unscavenged nitrous use exceeds 3 hours/week.

And while homebirth rates around here are still relatively low, hovering around 30-60% depending on the specific demographic area the midwife is working in if nitrous was used at home and was not scavenged the exposure would certainly add up over time.

Here a full time midwife will have 40 Primary Births + 40 Back Up births which is 80 births per year. The typical homebirth rate ranges from 30 to 60%, meaning 24 to 48 of women will choose homebirth (and that number would likely raise if nitrous was available at home). If lets say 75% opted for nitrous (the 98% quotes seemed way to high to me)that would mean 18 to 36 women would opt for the nitrous. As the time in which nitrous really varies, I'll average the exposure to 4 hours. This results in being exposed to 72 to 144 hours of unscavenged nitrous a year plus exposure to whatever minimal amounts remain in hospital despite the scavenging.... When rounded out it doesn't quite make it up to the 152 hours/year (or 3 hours/week) but I would still consider it to be too much unnecessary exposure.... Especially when that exposure starts accumulating over years... Eg Start midwifery school at 18, start clinical placements at 20, then be exposed to it on a continual basis until you decide to start a family at the average age of 29. So 9 years of exposure at 72 to 144 hours a week is 648 hours to 1296 hours of nitrous..... While some midwives may not be bothered by that... I would be.



Anyways, here's another interesting read on nitrous oxide in the US:
https://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2006.00150.x/full

 

[Mervs Mum]

It's really the MWs that are at risk then according to those sources isnt it Kandy.

Here's what another colleague (NHS senior MW) just sent me when I asked her.

As midwives a number of years ago we had monitors in the room picking up the amount of nitrous in the air. It was identified that there wasn't enough to pose a health risk to midwives who are exposed on a daily basis. We only have scavenging in the operating theatre. Exposure at a homebirth is negligible.

 

[KandyKinz]

There is certainly a cost element involved in the states.... Epidurals make anesthetists tons of $$$$ and it makes the drug companies lots of $$$$ too.....

There's also a very different mentality amoung workers in maternity care in the US.... Epidurals are the norm.... In some area I believe the epidural rates exceed the 80-90% mark. Completely ridiculous! And it has resulted in an atmosphere in which nurses and doctors do not know how to handle patients who are not immobile and sedated on their beds. With nitrous, it doesn't take away all of the pain... A certain level of labour support is still required which unfortunately many nurses don't and can't provide... either because that's just not their thing and they haven't been trained adequately in providing labour supprt or because they are simply caring for several other labouring moms as well and don't have the time to provide individualized attention. Then there's the fetal monitoring aspect. Many nurses outwardly acknowledge that they much prefer EFM of IA because it's so much easier on them.... EFM allows allows them to stay away from the "human" side of birth..... And despite epidurals not being an indication for EFM many many hospitals have incorporated epidurals as an indication for it.... Whereas with nitrous they are stuck with IA. Then there's the positional aspect of it.... Many American doctors don't even know how to catch a baby if the mom isn't flat on her back with her legs up in stirrups... Sad but true.... And epidurals keep the woman from moving around and god forbid start pushing on hands and knees!

In terms of composition. I don't see that as being an issue at all. Nitrous in America is always distributed in canisters containing 100% nitrous... Then it's just mixed with oxygen using a little tiny portable machine. The oxygen can be from a transportable canister or it can come from a hospital's central supply. The US still does use nitrous (just not at births) at several different concentrations depending on what they are using it for. So they are already accustomed to mixing it was oxygen... So I can't see that being a consideration for using it in the states.

Scavenging is an issue though.... Not so much in hospitals as all hospitals have the capabilities to suction. They would not be able to resuscitate or operate without it....
:/

 

[Mervs Mum]

Really interesting!!! Thanks so much for this Kandy!

 

[KandyKinz]

Yep, it's definilty more of a conern for individuals who are regularly exposed to nitrous oxide like health care workers then for anyone else.


Anyways, if anyone's interested in some more reading here is some links if you have not come across these articles already.

Occupational exposure of midwives to nitrous oxide on delivery suites:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740444/pdf/v060p00958.pdf
--- I thought this was an interesting one as it showed that the levels of nitrous these women were exposed to was far greater then the recommended "safe" level and thought it was even more concerning that some of the midwives showed detectable levels of nitrous in their urine even before they started their shifts.


And this one below just sums up several of the studies quite nicely:
https://www.birthinternational.com/...ducation/139-nitrous-oxide-no-laughing-matter

 

[lisaf]

Great thread!
I have to agree with the suspicions about nitrous in the US and the $ making aspect.

I want to go naturally in the hospital but I am quite afraid they won't know what to do with me
Epidurals are practically the default here! They kind of scare me and I dont' want to be limited on birthing position.
I've heard that hospitals like to keep you immobile anyway because they want that fetal monitor attached

 

[KandyKinz]

Great thread!
I have to agree with the suspicions about nitrous in the US and the $ making aspect.

I want to go naturally in the hospital but I am quite afraid they won't know what to do with me
Epidurals are practically the default here! They kind of scare me and I dont' want to be limited on birthing position.
I've heard that hospitals like to keep you immobile anyway because they want that fetal monitor attached

Many women still can and do work against the system and achieve the birth they want. It just takes a little more work and get your hubby well trained in labour support! Has he memorized "Birth Partner" cover to cover yet?!?! If not tell him to get his ass in gear