October 16, 2003

Entonox link to pernicious anaemia

Another Active Birth workshop started today - this time in Burton on Trent. The local hospital is Queens Medical Centre where they have around 4,000 births per year and there is also a small midwifery unit, The Victoria, in Litchfield, which is near by. We have midwives from both of these units int the group, plus community based midwives and midwifery assistants. It is a lively group, with much camaraderie that stems from knowing each other very well and all being of a similar age.

There was a very lively debate about the use of TENS and Entonox - and of course I stated my view that neither of these props are necessary or desirable during labour. This was a bit of a shock for this group, who had been promoting TENS and using Entonox liberally as an alternative to pethidine and epidurals, especially in the midwifery unit.

One midwife told me that she had been diagnosed with pernicious anaemia which she had investigated and found was linked to exposure to nitrous oxide. The research she discovered was from the US, and was done in relation to its use in dentistry. She showed this evidence to her Occupational Heath and Safety Unit, but it was dismissed as “not relevant” because it was done in the US and did not involve exposure during labour and birth. This midwife had asked for a scavenger unit to be installed in the labour ward but this was not forthcoming.

I was disturbed by this disclosure. Many hospitals have now installed scavenger units because of the known effects on staff of nitrous oxide in the air they breath, often for many hours during a labour. In addition, most OH & S units are very diligent (sometimes to the point of losing all common sense) in protecting the health and well being of staff, yet in this case they have shied away from dealing with a staff safety issue. I will be suggesting to this midwife tomorrow that she investigate what other units have done about this problem of staff exposure to gases and also to check out the research on this problem I know has been published in the UK.

Meanwhile, the obvious answer is to reduce the reliance of British midwives on Entonox. If it is having this effect on staff, what can it be doing to women and their babies?

Posted by andrea at October 16, 2003 04:19 AM

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Posted by: blackjack on January 19, 2004 10:23 AM

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I was one of the inventors of Entonox in 1963-4, and the same question was raised then. The conclusion was that there was then a higher proportion of other oxides of nitrogen as impurities in nitrous oxide which had been made in the USA as opposed to the UK. It was to these other oxides that anaemias were attributed.

Posted by: Colin Wilton-Davies on March 10, 2004 08:49 PM