Is a positive birth possible with no gas and air?
How to have an empowered birth when your pain relief options are limited
The background:
Recent news reports have highlighted recurring instances of people being denied gas and air during labour, due to fears over midwife safety. This news is understandably concerning for the hundreds of thousands of expectant parents who are already facing anxieties over birthing during a midwife crisis.
However, midwife safety and well-being is also an urgent issue, and with three resident midwives at The Positive Birth Company, we are in full support of midwife safety being prioritised. With this in mind, it’s important that people are aware of other tools they can use in labour. Even with no gas and air, a positive birth is possible.
Need to know:
Gas and air is also known as Entinox, which is nitrous oxide gas mixed with oxygen. It’s been used in labour since the beginning of the 20th century. Many people like to use gas and air as a form of pain relief because it can encourage rhythmic, deep breathing, relax you and can be used for any stage of labour. You control how much of it you use, and it doesn’t stay in your system for very long. Plus, there are no known side effects for parent or baby. The NHS maternity survey found that in 2022, 76% of mothers and birthing people used gas and air during their labour.
While gas and air doesn’t have any short-term side effects, long-term exposure can affect vitamin B12 levels, leading to potential nerve damage and anaemia. Several hospitals have recently suspended gas and air to protect midwives and doctors from being exposed to unsafe levels of nitrous oxide. The Royal College of Midwives believes this has happened because of poor ventilation in delivery suites and labour wards, saying that its members at one hospital were considering legal action after being exposed to almost 30 times the legal workplace exposure limit for it.
“In the face of reduced availability of Entonox (gas & air) in labour it's important to ask your Trust some questions,” explains Christie, PBC resident midwife. “These include: Are you suspending the use? How long for? Are you able to effectively ventilate the air in certain spaces and allow for limited availability? Is it still available for homebirth? What alternative analgesics are there available? (Pethidine, Remifentamil, Epidural etc...)”
Christie explains that being informed about what the situation is in your area will help you alter your birth plan effectively, should you need to. “And please remember that the suspension of Entonox is only affecting some Trusts and even then it's only for short periods of time, aiming to minimise the impact on women and birthing people,” says Christie. “Be reassured that Entonox is not harmful during short term use and the reason for suspending its availability is to protect staff at risk of long-term exposure. “
Using hypnobirthing tools to prepare for a positive birth if there is no gas and air:
Tip 1: BREATHE!
“Breathing is the single most important thing you can do in labour, and Up Breathing is a key tool in the hypnobirthing toolkit.” explains The Positive Birth Company’s founder and author of our bestselling book Hypnobirthing: Practical Ways to Make Your Bi, Siobhan Miller.
“This is a breathing technique for the first of stage labour, where the uterus muscles draw up and the cervix softens and opens to fully dilated. Using Up Breathing will ensure you are bringing oxygen into your body, enabling your uterus muscles to work efficiently and comfortably. It will also help you focus your attention on your breath during each surge and, therefore, make the sensations of labour more manageable. This breathing technique can also be used to help people suffering from insomnia and anxiety, and it’s also used in mindfulness practice. It’s effective because it down-regulates the nervous system, slows the heart rate and helps you to relax, which aids the progression of labour. Ensuring oxygen is being delivered to your uterus muscles will also make labour feel more comfortable. At a time when the availability of gas and air cannot be guaranteed, this breathing technique will be invaluable, not only for ensuring you remain comfortable in labour but also for helping you manage any anxiety and worry you may experience in pregnancy.”
Tip 2: KNOWLEDGE IS POWER
The more aware you are of birth physiology and what your body is doing during labour, the more prepared you will be and the less likely you’ll be to panic as you experience the sensations of labour. Speaking to your midwife, understanding what your options are and devising a plan together can also help you feel more prepared and in control.
The Positive Birth Company hypnobirthing program is designed to empower pregnant people and their birth partners to create positive birth experiences, whatever your birth scenario. You learn about birth physiology, how your body works on a muscular and hormonal level, and what you can do to help make your birth easier, quicker, and more comfortable.
Tip 3: CREATE YOUR BIRTH SANCTUARY
Use your five senses (sight, sound, smell, touch and taste) as a checklist to help you create a birth environment that will aid relaxation during labour. Think about the things you want to see, hear, smell, taste and touch as you bring your baby into the world. Dim the lights, use a scented room spray, put on some calming music or play affirmations or meditations, wear something really comfy (or nothing at all!), and make sure you’ve got lots of things you like to eat or drink with you. All of these things will help you feel calm, safe and relaxed as you navigate your birth experience. The more relaxed and calm you are, the better your birth will be.
Tip 4: USE A VIRTUAL BIRTH PARTNER
A busy labour ward or an eager birth partner can sometimes be an obstacle for focus in labour, stealing your attention away from that all-important Up Breathing technique or disrupting a calm birth environment. A virtual birth partner, such as the Freya app, will help with this. It will coach you through each surge, helping you to focus on your breathing, reminding you what a great job you’re doing, until you’re holding your baby in your arms.
Click here to read more about the Freya App, or download below.
Need extra support? We offer UK residents a free 15 minute chat with a midwife when you purchase one of our eligible digital courses.
We understand how tough it is right now to get the care and support you might need from a midwife. If you’ve got questions, worries or are in need of advice, what you need is answers, reassurance and words of wisdom from a qualified professional - not to be spending hours on hold trying to get through to somebody who will listen! Here at The Positive Birth Company we want to help. It’s time to Call The Midwife! This is our *brand new* midwife-led informational support service. A confidential, FREE 1:1 call with our resident midwife where you will be listened to, receive guidance, signposting and be able to talk over any concerns you may have around pregnancy, birth and the postpartum period.