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Nitrous oxide - potential dangers for midwives

The article that I wrote about the hazards of nitrous oxide to midwives and women in labour wards was published in the March issue of MIDIRS.

I have now added it to our website so that it can be read more widely. The exposure of midwives and other staff to high levels of nitrous oxide in labour wards is a health and safety tissue that has been largely overlooked. It is especially important in the UK, where this gas is almost routinely used at labours, even during waterbirths and home births. Few other countries use it in the same way, and in countries like Australia, where most labour wards are air conditioned (and therefore have actively circulating ventilation) there should be less of a problem if the gas is used.

Just the other day I mentioned this issue at a workshop and a midwife said to me that she had just been diagnosed with a Vitamin B12 deficiency (which can lead to pernicious anaemia). She was now wondering if her long exposure to nitrous oxide in her workplace might be a factor underlying her problem. Her maternity unit was old and the gas has been used freely for many years. She took a copy of the article and was going to take it up with her employers.

If this article alerts other midwives to the possible health hazards of this gas, then it will have served its purpose. Although the gas can be safely used in conditions that are similar to operating theatres, perhaps it is time to consider other less invasive means of easing women through the later stages of labour, when nitrous oxide has been the traditional standby. Alternatives such as water and heat combination (showers, hot wet towels etc), verbal encouragement, positioning and movement are cheaper and more readily available.

Women too should be aware of the potential problem if they are giving birth in unventilated, enclosed spaces where the gas has been used for previous births. There are suggestions that the chronic fatigue experienced by some midwives (and perhaps women postnatally) may also be linked to exposure to nitrous oxide.

This issue is a good example of how “traditional” practices can often be taken for granted and assumed to be safe when proper analysis and investigation may prove otherwise.

Posted by andrea at May 03, 2006 10:05 AM