Moves to dump common birthing pain relief due to carbon footprint

Women giving birth may be steered towards using opioids instead of nitrous oxide, “laughing gas”, because environmental activists are concerned about its carbon footprint.

A push to stop giving women in labour “laughing gas” for pain relief due it its carbon footprint – and instead give them opioids – has won support from an Adelaide study.

Nitrous oxide (N2O), or laughing gas, is used by more than 50 per cent of Australian women to relieve pain during childbirth, followed by epidurals (40 per cent) and opioids (12 per cent), according to the Australian Institute of Health and Welfare.

The study authors note there is a heated debate in medical circles, as many obstetricians argue pain relief should be the priority but others say climate change is more important.

The Australian and New Zealand College of Anaesthetists is advocating for a reduction in N2O use to improve environmental sustainability in anaesthesia.

A recent report in Australasian Anaesthesia journal estimated using nitrous oxide during a four-hour labour creates a carbon footprint equivalent to driving an average car for 1500km, while an epidural is equivalent to driving 6km.

“By educating medical staff and pregnant women about the carbon impact of N2O … we can reduce greenhouse gas emissions from the labour ward and help to mitigate the effects of climate change,” it says, with estimates that N2O accounts for 6 per cent of global gas emissions, and health care use accounting for 1 per cent.

Prof. Bernd Froessler who led the study about pain relief in labour. Picture: Supplied

All the labour… for this. Picture: iStock

The Adelaide study by anaesthetist Professor Bernd Froessler and colleagues from the University of Adelaide and University of South Australia says there is “debate in medical circles whether N2O should be replaced with other methods of pain relief.”

The pandemic has brought the debate to a head as some hospitals shun the gas for fear the aerosol may help transmit the Covid virus.

The study of medical notes of 243 women who gave birth at Lyell McEwin Hospital in March-April 2020 compared outcomes of the half of this group who did not have access to the gas.

The researchers found although opioid use “significantly increased” when the gas was withheld, there was no increase in epidural use and no change in labour duration, caesarean section rates, birthing complications or newborn alertness.

UniSA statistician and researcher Dr Lan Kelly said the results should reassure women that pain relief other than nitrous oxide does not compromise their or their baby’s health.

Prof Froessler said the findings show other forms of pain relief are safe options.

“Obviously no-one wants to deprive labouring women of adequate and easy pain relief but given there are other analgesic options including epidurals and opioids, perhaps these could be considered,” he said.

Nurse Hayley Duff with new baby Scarlett, just 16 days old. Image/Russell Millard

But principal midwifery officer at the Australian College of Midwives Kellie Wilton has warned that mothers should not be made to feel guilty about their pain relief choices.

Nitrous oxide was introduced for labour relief in the 1960s and is commonly used in the UK, Canada, Finland and Australia.

Adelaide ICU nurse Hayley Duff, 21, gave birth to her and husband Doug’s first child Scarlett 16 days ago at the Women’s and Children’s Hospital and gladly used nitrous oxide for pain relief as well as an epidural during labour.

“Definitely pain relief for the mother and the wellbeing of the baby are the most important things and should come before any other consideration,” she said.

Nitrous oxide is also used during other medical and dental procedures, as well as by women in labour.

The study was published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

Originally published as Moves to dump common birthing pain relief due to carbon footprint