Fight climate change: get an epidural instead of gas and air

Global warming and climate change concept.

Below are the characteristics of two types of pain relief in labor. Guess which one is favored by midwives.


If you guessed “B,” you’d be wrong.

True, it is easily adjustable, non sedating, has no impact on memory or oxygen levels and crosses the placenta in miniscule amounts if at all. But it’s the dreaded epidural and it’s bad, bad, bad.

Nitrous oxide, released into the environment, contributes to climate change.

“A” is, in fact, favored by midwives and used extensively by midwives around the world at home and in the hospital. Indeed, many midwives believe it is perfectly compatible with natural childbirth despite the fact that it is most certainly a drug, marketed by a pharmaceutical company, is difficult to dose effectively, causes sedation and impaired memory, and readily crosses the placenta in large amounts where it sedates the baby.

What accounts for this paradox?

It’s simple: midwives can administer nitrous, but lack the skills and training to administer epidurals.

All the pious wailing about the effects of epidurals is nothing more than hypocrisy. It really makes no difference to midwives whether women use “drugs” in labor to relieve pain, even if those drugs limit ability to move in labor, alter consciousness, impair memory, decrease oxygen levels, readily cross the placenta and sedate the fetus … just so long as they can administer the drugs.

Now comes word of a new risk of nitrous. It contributes to climate change!

According to the Royal College of Nurses article Combating climate change – the view from maternity:

Certain parts of the health care system contribute disproportionately large amounts to the NHS carbon footprint. In particular, anaesthetic gases such as nitrous oxide and Desflurane used in surgery make a notable contribution to climate change. In 2017 this was estimated as equivalent to 470,000 tonnes of carbon dioxide per year – about the same as the annual commuting of all 1.3 million NHS staff…

In maternity settings, the main use of anaesthetic gases is through Entonox (nitrous oxide and oxygen) as pain relief in labour. Around three quarters of women use gas and air in labour, with maternity making up around a third of all NHS nitrous oxide emissions in England. The challenge is how to reduce the amount of nitrous oxide used in labour, without adversely impacting on childbearing women and their choices.

How to reduce the amount of nitrous used in labor? Isn’t it obvious? Offer women epidurals instead of nitrous!

It’s not obvious to the folks at RCN who are ruminating on ways to deprive women of nitrous.

There may be appropriate options to improve access to non-pharmacological pain relief, such as use of water in labour. Greater awareness of the impact of nitrous oxide could increase the popularity of these options.

Sadly, they are thinking inside the midwifery box, where all power is arrogated to midwives and aid offered by other medical specialists is demonized.

But apparently epidurals are safer for the environment than nitrous and therefore, all women should have easy access to epidurals in labor.

After all:

With a need to address our carbon emissions more pressing than ever, there is a unique and previously under-reported opportunity for midwifery and other professionals working in the maternity setting to engage with this as part of clinical practice.

Prevent climate change! Get an epidural instead of gas and air!!