Breathe in, breathe out. It’s the simplest thing a person can do, even in moments of extreme duress, requiring little to no effort. Perhaps this simplicity is why Entonox – a blend of nitrous oxide and oxygen, often called gas and air – is such a popular form of pain relief for women in labour. Inhaled through a mouthpiece or mask during contractions, Entonox is used in virtually every birth setting across the UK. Or at least, it was, until recent investigations revealed dangerously high ambient levels of Entonox in some NHS labour wards. At the time of writing, gas and air has been withdrawn from at least five English maternity units, including those at Basildon and Watford, where Entonox levels were found to be thirty and fifty times the safe limit, respectively.
Service users have understandably been frustrated and upset by the sudden disappearance of Entonox from their local labour ward, and rightly so: gas and air is effective and easy to use during births that are short or long, straightforward or complex. So why are health boards taking such drastic action?
While a person inhaling a reasonable amount of Entonox during, say, a 12-hour labour will not suffer any ill effects, research has shown that excessive exposure to gas and air has been linked to vitamin B12 deficiency, neurological problems, infertility and miscarriage. While some places where Entonox is used, such as dentists’ surgeries or operating theatres, have been fitted with sophisticated ventilation and scavenging systems, labour wards – often in ageing NHS hospitals – have not usually been fitted with such mechanisms. Compounding the risk, midwives in these birth rooms often work 12-hour shifts, several days or nights in a row, usually with the door closed to protect patient privacy. Some health boards have now realised – perhaps too late – the resulting occupational hazards.
[See also: Labour ignores young women’s health at its peril]
Media response to the situation has been predominantly focused on the distress of pregnant women who must now consider other, possibly riskier or less appealing, forms of pain relief. Glamour UK asked: “when *will* women’s pain be taken seriously?” This is, of course, an important question, especially in a broader landscape of medical gaslighting and structural misogyny. However, what this approach fails to address is the fact that midwives, too, are mostly women (full disclosure: I include myself in both those categories, as a midwife for ten years and a woman for 45) and all of us are human. We don’t leave our personhood at the labour suite door; our health, too, must be taken seriously. Our job may be perceived as warm and fuzzy, and we are often idealised as self-sacrificing angels. Both notions are wrong. Our role is complex and challenging, and our health matters just as much as that of the women and families we serve.
We’re worried, too. I’ve received a deluge of messages this week from midwives who are scared, confused and outraged. Many cited fertility issues, pregnancy losses and B12 deficiencies that began during work in labour wards and only resolved when they moved to other areas. Some railed against what they saw as negligent or ineffective health boards; a midwife from Basildon noted that management had detected dangerously high levels of Entonox last summer, but only made staff aware of the risk in October. Another midwife from a different trust said, “I’ve worked in the labour ward for 13 years. We’ve had scavenger systems installed and are supposed to be getting personal monitors, but what if the damage is already done?”
For many staff, this unfolding crisis – which may yet reach a much larger scale as units across the UK rush to monitor their own Entonox levels – is the straw that could break midwives’ backs. After years of understaffing, safety scandals and struggles for fair pay and working conditions, it is disheartening to think that even the air we breathe has done us harm. As one midwife wrote to me, “I’m angry that midwives are expected to sacrifice their own health and well-being for others. We already give so much, and with an ever-evolving maternity crisis, if midwives continue working in unsafe environments, it will only contribute to others leaving.”