Pain relief in labour: Gas and Air

Here in the UK, gas and air (Entonox) is very commonly offered to women in labour. It is a gas made up of 50% oxygen and 50% nitrous oxide. It's sometimes called "laughing gas". It is usually available in hospital. It's also used during home births (the midwives bring cannisters of it with them).

How to use it effectively:

Gas and air is usually used during a contraction. You might also find it useful at other times, for example during a VE if that procedure is uncomfortable for you. It is important to use it intermittently, and get enough time not on it - more on this below.

It is usually offered via a mouthpiece. You put that in your mouth, seal your mouth around it, and breathe it in slowly and deeply. You exhale through the same mouthpiece.

If you prefer, you can request a mask, rather than a mouthpiece. If you use a mask instead, you breathe in slowly and deeply through your nose and blow out very slowly and softly through your mouth.

It makes you feel a little bit drunk, or high. It helps you relax, which helps with the pain. Keep in mind, it's not actually a painkiller in and of itself.

Once you have made the informed decision to use it, don't wait for a contraction to build. Begin breathing it in at the very start of the contraction. This is because it takes 15 seconds or so to begin working, and you want to be suffused with it (ie. fairly high) by the time the contraction becomes challenging.

Equally, try not to use it all the way to the end of the contraction if at all possible. Once a surge has reached the peak of intensity and started to taper away, stop using the gas as soon as you comfortably can. Continue using your breath to ride out the remainder of the contraction. This is because when your contractions become long and close together, you won't get enough of a break from the gas, and this can be quite unpleasant. (IE. you get a bit too high. That can mean you become disorientated, delirious, or panicky, or you don't know what is going on, struggle to understand what is being said, and possibly are less able to help your midwives help you. I supported one woman who thought she was on a bouncy castle, surrounded by gazelles. Might sound funny after the fact, but in the moment, not so much. Remember, the gas is supposed to help you relax, not freak you out 👍)

Once your contraction has finished, have a drink. Just a few sips is fine! This is because all that huffing and puffing can leave you with quite a dry mouth. But you need to keep drinking throughout labour anyway - and after each contraction is the perfect time.

Water is OK, but honeyed water, or a sports drink, or juice - even better! If you don't take in enough fuel and fluids, you'll feel worse. One sign that you haven't been eating and drinking enough is ketones in your urine - your midwife will be checking your urine periodically, and if this happens, they will probably encourage you to eat or drink something.

We tend to carry a lot of residual tension in our shoulders. After offering you a drink, your birth partner can rub your shoulders to help you release that tension. Let your whole body slump. Relax as deeply as you can. You need this rest. Notice where in your body you feel any tightness, and breathe it away. Consciously soften it.

Listen deeply to your body. As soon as the next contraction begins, at the very first sign of it, begin again with the gas and air. This rhythm (with or without the entonox) can carry many women a long way through their birth process. NB. Finding a rhythm that works for you is just as important as finding the right pain relief.

The advantages:

• It does not cross the placenta. As far as we know, it has no effect on the baby.
• The side effects for the labouring woman are usually mild.
• It leaves the body quickly, so if you don't like those side-effects, you can stop using it and be back to normal a few deep breaths later.
• It is self-administered, which gives you a sense of control. This has a powerful psychological effect and helps a great many women to cope with the intensity of birth.
• It relaxes you.
• It "takes the edge off".
• It helps you to focus your breath, which, in itself, is a powerful tool for managing labour sensations.

The disadvantges:

• It is not a painkiller. It will not take away the pain completely.
• It can leave you feeling quite high, which some women find unpleasant. This can be mitigated by using it judiciously, as described above. Birth partners: if she is becoming panicky or delirious, gently coach her to use it well.

• You can get a dry mouth from using it, so remember to keep sipping after each surge. Birth partners: offer a drink after each contraction, and encourage her to go to the loo about every hour. In the later stages, offer that drink wordlessly, to minimise unwelcome distractions for her. As Michel Odent says,

Dont wake the mother!

• If using a mouthpiece, rather than a mask, there is a tendency to bite down on it. This creates tension in your body, which makes the sensations worse, and makes it harder for your body to open. Request a mask instead, or concentrate hard on keeping your jaw soft while you use it. Birth partners: gentle reminders to breathe deep and keep the jaw soft.

• There can be a risk to health care staff with prolonged exposure to it. This is something your hospital should manage with proper ventilation and filtration etc. If you are concerned about whether entonox will be available during your labour, have a chat with your midwife.
• It can be a bit of a gateway to other pain relief with stronger side effects, higher risks, and further intervention. (Pethidine is a prime example - I'll post about this another day!) Of course, that's completely fine if that is the type of labour you are hoping for. This is only a disadvantage if you prefer less intervention, in which case, just hold off on the Entonox until later in the process if you possibly can 👍

Thank you for reading! If this was useful or interesting for you, please let me know in the comments. If you are not a member on Vocal, join the conversation on Facebook instead!

If you feel I missed something, let me know about that, too. Please do pass it along to pregnant women, particularly women who won't have used Entonox for pain relief in labour before (for example, first time mums). If you are currently pregnant (congrats!) show it to your birth partner, so they also have the knowledge to be able to support you through the process.

Wise ones - did you use gas and air? What was your experience?

(Apologies Unsplash didn't have an image of a woman actually using entonox!)

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