# No Entonox



## bubbamummy (Feb 25, 2009)

Can someone enlighten me as to why US maternity wards/birthing centers dont allow the use of Entonox (gas and air) for use during labour? its common place in England and allowed me to have a natural delivery with no epidural or IV's. Im almost thinking of going back to the UK to give birth so I can have it when #2 comes along


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## wbg (Mar 28, 2008)

:

I am dying to know the answers to this!!!

I had prenatals in the UK and 3 Aussie births and entonox was my best friend! I had a home water birth here in the US and was so desperate for the entonox I half heartedly considered finding some on the underground market.










Still I surprised myself by doing just fine without the gas but have always wondered what the reason is that it is not used here in the US. It seems odd because they commonly prescribe many meds to Mamas and bubs that would not be advised where I come from but do not use the one thing that is commonly used and which helps many Mamas avoid epis/ pethadine etc etc.

So very curious. Have been meaning to look into it but had not had a chance! So I eagerly await a more informed response!


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## neverdoingitagain (Mar 30, 2005)

Quote:


Originally Posted by *sophieslion* 
Can someone enlighten me as to why US maternity wards/birthing centers dont allow the use of Entonox (gas and air) for use during labour? its common place in England and allowed me to have a natural delivery with no epidural or IV's. Im almost thinking of going back to the UK to give birth so I can have it when #2 comes along









I tried to use gas with birth #1, but I couldn't breath properly. I'm in Canada, it was definately an option here. Perhaps a bit of cross border travel is in order?


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## cristeen (Jan 20, 2007)

Most likely because no big pharma company has bothered to repackage it, jack up the price and market it to the hospitals as an alternative to epis. As it stands, compare the cost of an epi vs. the cost of nitrous oxide - the hospital is going to do the one they can charge more for.


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## AlexisT (May 6, 2007)

It is partly availability, but it's more than that. Apparently there are a lot of liability concerns, and theoretical risks over the nurses being exposed all the time, which would be more of a problem in the US since our hospitals don't have the pipes set up like British ones do. Also, the rules here mean that anesthesia would have to hang around just in case--and if you have to pay them to do that it stops being cheaper.

I know someone who did manage to track it down (it is made in the US, apparently) and her hospital would not permit it.


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## Quindin (Aug 22, 2003)

I had gas in Denmark with my first, but it left me drunk and kinda out of it.
I don't know what they have in their gas there, but I did not like it.

With my last baby, a homebirth here in the UK, they brought two canisters with entonox.
I accepted it in the end because I was having a hard time focusing on relaxing for being so exhausted after days of prodromal labor.
I ended up using it for only 5 minutes before DD was born.
It was SO great! Just enough to take the edge of the pain, but out of my system as soon as I stopped breating it in.


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## monkaha (Jan 22, 2004)

Because that How We've Always Done It. And we don't do things like follow evidence based medicine, especially when that evidence would affect a change.







:


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## nashvillemidwife (Dec 2, 2007)

I'd say it has to do with the FDA research and approval process. It can be a long, expensive process to get approval with little money to be made off it.


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## bubbamummy (Feb 25, 2009)

Thanks, interesting to find out some reasons!

I loved it ....I even looked into having it for recreational use







but then I read that prolonged exposure does something to bone marrow


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## cristeen (Jan 20, 2007)

Quote:


Originally Posted by *nashvillemidwife* 
I'd say it has to do with the FDA research and approval process. It can be a long, expensive process to get approval with little money to be made off it.

It's already approved - it's used in dentistry in the US.

Besides - since when does the medical community shy away from using a drug off-label? Cytotec, anyone?


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *cristeen* 
It's already approved - it's used in dentistry in the US.

Besides - since when does the medical community shy away from using a drug off-label? Cytotec, anyone?


Quote:

Because that How We've Always Done It. And we don't do things like follow evidence based medicine, especially when that evidence would affect a change. :

Quote:

Most likely because no big pharma company has bothered to repackage it, jack up the price and market it to the hospitals as an alternative to epis. As it stands, compare the cost of an epi vs. the cost of nitrous oxide - the hospital is going to do the one they can charge more for.








: to all of those. They're not going to market a cheaper drug that has less complications when they've got the one that they can charge more for and then "Save" the baby when it causes complications. (and then charge more for it) They've got the "Cadillac" of drugs, why would they need a bicycle?


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *monkaha* 
Because that How We've Always Done It. And we don't do things like follow evidence based medicine, especially when that evidence would affect a change.







:

Exactly what I was going to post.

I've never even heard of this!


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## BoringTales (Aug 1, 2006)

Quote:


Originally Posted by *cristeen* 
It's already approved - it's used in dentistry in the US.

Besides - since when does the medical community shy away from using a drug off-label? Cytotec, anyone?

Its not approved for use in dentistry in pregnant women though.


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## cristeen (Jan 20, 2007)

Quote:


Originally Posted by *BoringTales* 
Its not approved for use in dentistry in pregnant women though.

Cytotec is not approved for use on pregnant women, either. In fact the manufacturer has warning labels all over it that say "not for use by pregnant women" or something along those lines. Doctors still use it on pregnant women, though.


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## BoringTales (Aug 1, 2006)

Quote:


Originally Posted by *cristeen* 
Cytotec is not approved for use on pregnant women, either. In fact the manufacturer has warning labels all over it that say "not for use by pregnant women" or something along those lines. Doctors still use it on pregnant women, though.

I'm not saying I approve of that, at all. I'd never take it for labor induction.

Its a bit hard to compare a pill though to a gas. US hospitals are not set up for nitrous delivery. It isn't as simple as dragging in a can of gas with a mask on it. There needs to be proper ventilation, and currently hospitals don't have what is needed in most labor and delivery units.

I wish it was available! I think it would be so helpful to a lot of laboring women...me included. I'd much rather have Nitrous for a while than an IV drug. I understand why it isn't though after talking to some labor and delivery nurses and having them inquire about it as well. Makes sense.


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## Quindin (Aug 22, 2003)

Quote:


Originally Posted by *BoringTales* 
I It isn't as simple as dragging in a can of gas with a mask on it. .

Actually, my midwife did just that for my homebirth: she had two cans with masks on them in her bag! They bring it to all homebirths apparently.
So yes, it is pretty simple.


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## AlexisT (May 6, 2007)

Yep, that's what they do in the UK, but apparently it's not as simple once we're talking a hospital and multiple women giving birth at once. AIUI (I gave birth in the UK but had an emergency CS before I went into labor, so I didn't get to check personally







) Entonox is specially piped into L&D and there are special mouthpieces, not masks. It becomes a much bigger logistical problem then, in terms of delivery, ventilation, and exposure.


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## Belle (Feb 6, 2005)

Quote:


Originally Posted by *AlexisT* 
Yep, that's what they do in the UK, but apparently it's not as simple once we're talking a hospital and multiple women giving birth at once. AIUI (I gave birth in the UK but had an emergency CS before I went into labor, so I didn't get to check personally







) Entonox is specially piped into L&D and there are special mouthpieces, not masks. It becomes a much bigger logistical problem then, in terms of delivery, ventilation, and exposure.

No. Why couldn't they just use a portable can and a mask too? Its pretty simple.


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## BoringTales (Aug 1, 2006)

Quote:


Originally Posted by *Belle* 
No. Why couldn't they just use a portable can and a mask too? Its pretty simple.

You have to have a system to recycle and get rid of the exhaled gasses, somewhere other than into the regular room air. That system just isn't set up here in the US.

Have one laboring mother in a home using it isn't a big issue, having a labor ward full of patients huffing nitrous with no system in place to get rid of the exhaled gas is a BIG problem. Not only for the other patients, but especially for the staff working there who would be exposed to that in potentially dangerous concentrations every day that they work.

A portable can and mask don't provide the necessary gas disposal to make wide-spread use feasible in a hospital or even in a birth center setting.


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## Quindin (Aug 22, 2003)

Honestly? I bet that the expenses to set up this system are negligeble compared to what is spent on frivolous things in US hospitals.
Really... seeing what UK hospitals are and how utterly basic all the amenities, services and supplies are, one has to conclude they would not be using entonox on the wall if it cost them a fortune to set it up.
It is just that there is no interest in the US for it - epidurs are a better business.


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## bubbamummy (Feb 25, 2009)

I went into hospital while I was in transition (and a LOT of pain) I was BEGGING for an epidural, literally sobbing and my midwife said 'my dear, youre almost there you CAN do this without have some gas&air' (I guess its the opposite in the UK, the NHS tries to save money rather than try and spend it which seems to be more the case here!) Anyway shorty after this he was born and I am SO glad I was denied the epi and SO SO glad I had the gass and air (that was delivered from a wall unit via a mouth piece-and doesnt the body metabolise the gasses so any 'exhaled' are no longer potent?) I would imagine there'd be uproar in UK hospitals if midwives were being put at risk daily?!


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## MelW (Jan 13, 2005)

I worked in L&D in Canada at a hospital that offered Entonox. We had a built in system that captured the extra gasses. But we also had portable tanks that could be used if a woman was labouring in the tub or another place in the room where the tubing didn't reach. It that case we hooked up some extension tubing to the wall suction and captured it that way.

I once forgot to hook up the suction while a client laboured in the small bathroom with the door closed. We noticed when the woman's husband and I both starting making stupid jokes and our giggling annoyed her. I then opened the door, took a deep breath and my head cleared. Hooked up the suction, and no more problems









I think I was more at risk for injury trying to help position and move women who were frozen from epidurals than I ever was from the entonox. Epidurals are a HUGE injury risk for L&D nurses!


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## bubbamummy (Feb 25, 2009)

yeah, Id never thought about the risk to labor and delivery staff when it came to epidurals, but that would make sense!


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## Delicateflower (Feb 1, 2009)

Quote:


Originally Posted by *AlexisT* 
Apparently there are a lot of liability concerns, and theoretical risks over the nurses being exposed all the time, which would be more of a problem in the US since our hospitals don't have the pipes set up like British ones do. Also, the rules here mean that anesthesia would have to hang around just in case--and if you have to pay them to do that it stops being cheaper.

This is what I've been told, too, by a midwife.


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## Penny4Them (Mar 10, 2009)

Interesting thread. I've heard that pure O2 can make you feel good--I'm thinking of O2 bars in California.

Has anyone asked for JUST oxygen while laboring naturally? Might this be a help to moms? Would an anesthesiologist have to come in to give it?


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## flapjack (Mar 15, 2005)

I know someone who was given just O2 in labour because the student midwife got her pipes mixed up, and it didn't make much difference, apparently.
Personally, I think that the liability concerns could be easily addressed, should a hospital choose to do it. The advantage of going straight to epidural is that it's the same anaesthesia for both a normal vaginal delivery and a caesarean birth, and so it can seem more cost-effective from an insurance POV- also,the disadvantage of the high c-section rate associated with the loss of mobility is not a disadvantage if a doctor/hospital/community do not perceive high c-section rates to be negative: and epidurals are somewhat of a known quantity. Epidurals can be great: in particular, I know a few women who have had safe vaginal deliveries because the epidural lowered their blood pressure- but the more choice women have, the better. I'm surprised that the freestanding birth centres and HB midwives aren't embracing the technology more fully, to be honest.


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## cristeen (Jan 20, 2007)

Quote:


Originally Posted by *Penny4Them* 
Has anyone asked for JUST oxygen while laboring naturally? Might this be a help to moms? Would an anesthesiologist have to come in to give it?

I was on O2, but it was because I was de-satting. Honestly I found it more of an annoyance than anything. I didn't give a crap that my blood ox was dropping (it never got below 90), the mask was one more thing tying me to the bed. It did nothing for the pain.


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## marge234 (Nov 1, 2008)

Quote:


Originally Posted by *Quindin* 
Honestly? I bet that the expenses to set up this system are negligeble compared to what is spent on frivolous things in US hospitals.
Really... seeing what UK hospitals are and how utterly basic all the amenities, services and supplies are, one has to conclude they would not be using entonox on the wall if it cost them a fortune to set it up.
It is just that there is no interest in the US for it - epidurs are a better business.

ITA. It's about priorities. More and more US hospitals have fountains, gardens, plush waiting areas, sculptures etc.... Then there's all the extra equipment--every hospital has all it's own fancy diagnostic or other stuff (cath labs) to max profits. Not to mention what executives are paid. Of course they're "non-profits," use volunteers and regular employees don't have great pay or benefits. They're short staffed, not cleaned the way they should be but a lot of them are built up to look like fancy malls. It's ridiculous.


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