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.

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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!!

  • demodocus

    I went straight for the epidural the 2nd time around. No fooling around with other stuff. It wasn’t set quite right, but heck, that was one young doc. The main anest. redid it in the morning before the worst contractions started anyway.

  • Cartman36

    Is nitrous used in US hospitals for labor? I have heard of it being offered at birth centers and by home birth midwives but I have never of it in the hospitals here. I have that when I get cavities filled but they still using a numbing agent on the tooth.

    • rational thinker

      I have never heard of it being used in the US either.

    • Sarah T.

      I believe it is becoming a more prevalent option. I know it is offered at a few hospitals in the San Francisco Bay Area.

    • Lee McCain MD

      Actually used in our hospital in of all places Alabama. As skeptical as I was (and asking esoteric questions about pretesting for MTHFR gene mutations to vacuous stares) I will say I have been impressed with how well it works. Epidurals are by far and away a better option but still if a patient wants natural then a viable alternative to IV drug sedation.

  • rational thinker

    Correct as usual Dr Amy. If they cant administer it it is evil and bad for mom and baby.
    Does it affect the salary of the midwife if mom gets the epidural? Probably not so why does it bother them so much? I think it may have some sadistic origins. Even though this study was done in a completely different situation the behaviors are kind of similar. The Stanford prison experiment. Just replace guard with midwife and prisoner with patient. The mental origins of sadistic behavior is the same.

    • AnnaPDE

      Does it affect the midwife’s salary if the woman has an epidural? Not necessarily directly, but it threatens her job security if more women want the doctors-only goodies.