Entonox in Labour – When and How to Use

In many countries, entonox (gas and air) is used as a method to provide relief from labour pain. Gas and air do not provide relief from the pain of contractions, but reduce the tension and anxiety involved in the process. This approach to relieving labour pain is becoming popular now. To know more about it, read the following article!

What Is Entonox or Gas and Air?

Entonox is composed of equal amounts of oxygen and nitrous oxide. This mixture of gases is completely colourless and odourless. It is otherwise commonly called laughing gas. Entonox does not ease labour pain completely, but it helps a woman relax and stay calm during delivery.

In India too, many hospitals or maternity homes are using this method to help a woman deal with labour pain. In many hospitals, it is always made available in the maternity wards as entonox is mostly pumped through the central supply system.

Does Entonox Really Work?

As per a study conducted on women under labour, it was found that there is not much difference in the amount of pain experienced by women who were breathing gas and air from those who did not. Most women thought that they were breathing entonox, but only half of the women were actually breathing it. Hence, it cannot be said for sure that entonox is a surefire way to ease labour pain.

Should You Use Gas and Air for Labour?

Does gas and air help in labour? The answer is not certain because entonox does not provide relief from the pain experienced during labour. However, it helps reduce anxiety and helps a woman relax while giving birth. It is obvious for a woman to get nervous and panicky at the time of delivery. The more a woman panics, her pain increases. This pattern of cyclic behaviour is called “fear tension pain cycle.” To shorten this cycle, it is suggested that women should use entonox.

When Can You Use Gas and Air during Labour

Entonox is very simple to use, and it can be used whenever you wish once you are in labour. Your doctor or midwife will place the mouthpiece between your lips or teeth and ask you to take steady deep breaths. You may feel a little light-headed, and that is when you should take it off. You can also bite down your mouthpiece as this will help you cope with the pain experienced during contractions. You will feel normal again after some time.

How to Use Entonox in Labour

You can ask for entonox whenever you want during labour. You will be asked to breathe gas and air through a mouthpiece or a mask. Here is how you can use it:

• Place the mouthpiece in the middle of your lips or teeth. If it is a mask, then bring it up to your face.
• Hold it that way and take deep and even breaths. The mask or mouthpiece provided to you will be a two-way valve. This means that gas and air will be released for breathing, and the carbon dioxide you breathe out is taken away.
• Keep breathing. At one point you will start to feel slightly light-headed. When this happens, you can take the mask or the mouthpiece away.
• After some time, you will feel absolutely normal.

Some practice might be primarily needed for you to get the timing right. It usually takes around 30 seconds of breathing for this to take effect. This is because the gas has to build up in the bloodstream. However, unless you breathe entonox deeply for at least a minute, you may not get the desired benefit.

So it is better to start the process when the contractions start. If you wait for the pain to become extreme, then the effect will be carried out between contractions. Excessive intake of this might make you feel dizzy and tingly.

What Are its Advantages?

Following are the advantages of using Entonox during labour:

• It is flexible to use and really fast-acting.
• It is easy to handle and operate.
• A trained medical staff is enough to operate and provide this while other methods of pain relief have to be supervised by a trained anaesthetist during the entire process.
• Controlling this mask and using it is all up to you.
• This does not remain in your system. Whenever you stop breathing it, the gas is cleared out by the lungs, and all the side effects will discontinue.
• If you face any difficulty when using entonox, you can always ask for help from your attending nurse or your doctor.
• Your baby will not be affected by this. Therefore, it is completely safe to use.
• The oxygen present in this mixture and the effect of the analgesics might feel energizing to you.
• It can also be used in water if you are giving birth in a birth pool or a bath. However, the sensible option is to give birth in a hospital
• It is economic making it affordable to use.

What Are the Disadvantages?

Although entonox eases anxiety during labour, it has a few disadvantages to it:

• It may make one feel extremely light-headed or sick.
• Entonox may give one tingling sensation, and pins and needles. You may also get temporary muscle cramps or spasms especially in your wrists or ankle joints.
• If it is used for a considerably long time, your mouth might start to dry out.
• You might find it difficult to move around and position yourself comfortably while keeping a hold of your mask.
• You might begin to feel drowsier if you combine this with pethidine.

Who Shouldn’t Use Entonox?

Women with methylenetetrahydrofolate reductase (MTHFR ) should never use this, even while giving birth. The reason is that the nitrous oxide in entonox completely wipes out the vitamin B12 in the body. The use of this should be closely monitored as it interferes with folate metabolism and vitamin B12 in the body. It is harmful to deplete vitamin B12 from the body especially for a person with MTHFR.

Vitamin B12 and MTHFR enzyme play an important role in the body’s methylation process. If either one of them is lacking the whole methylation cycle would get affected. So for a woman with MTHFR, taking gas and air would cause more problems to the methylation cycle in her body than usual. Around 40% of the population has this variance in the gene; therefore, this possibility cannot be excluded.

Why Gas and Air May Not Be Good for You?

In the following conditions, you should not entonox:

• If you prefer an effective pain relief method, then entonox is not the one for you. It is very mild compared to epidurals.
• Many women feel sick and drowsy after using this. It could also make your mouth very dry if used for a very long time. So, if you fear that you will feel drowsy then you should avoid it.
• At least 30 seconds of deep breathing is required to get the gas and air into your system, and this could take you some time to get the timing right. So, if you don’t have enough practice, it is best avoided.

Although it is a popular practice, not everyone finds it comfortable. If this does not work for you while giving birth, you can always ask for other pain relief methods.

Also Read: Using Oxytocin during Labour