gms | German Medical Science

Background: Nitrous oxide (N₂O) is a highly potent greenhouse gas that is about 300 times more harmful to the climate than CO₂. It also destroys the ozone layer more than any other substance since the strict regulation of CFCs. Nevertheless, especially in the Anglo-Pacific and Scandinavian countries, but for several years now also increasingly in some obstetrics clinics in Germany, N₂O is offered as an analgesic during childbirth. With this procedure, obstetrics contributes to the climate and environmental crisis. Besides of the previously established indicators for quality in health care (such as evidence), with Germany’s commitment to implement the Kyoto Protocol and the UN Agenda 2030, health care measures must also be measured by their sustainability.

Aim/research question: The aim of this article is to carefully reconsider the use of N₂O analgesia in obstetrics and its further dissemination in Germany and to reflect on alternative options for high-quality care. How effective is N₂O for pain reduction? What are the advantages and disadvantages of this method, and how does its carbon footprint compare to other pain therapeutic methods.

Methods: To answer these questions, the current state of research on the efficacy as well as the advantages and disadvantages of N₂O as an obstetric pain therapy was recorded by means of a comprehensive literature search. In addition, an application study conducted by Pinder et al. (2022) on the so-called “nitrous oxide cracking technology”, which aims to reduce the climate- and health-damaging effect of N₂O, was critically examined. Furthermore, the CO₂ footprint of different obstetric pain management procedures was compared using life cycle analyses.

Results: N₂O is the most climate-damaging solution even despite the use of new cracking methods and has not sufficiently demonstrated its analgesic efficacy in clinical trials. Consequently, the use of inhaled N₂O during childbirth is not recommended. There is a need for compassionate, humane, evidence-based, effective and sustainable care of parturients and newborns by the accompanying midwifes and obstreticians.

Relevancy: The climate and environmental crisis has multiple and serious consequences for reproductive health. The FIGO (International Federation of Gynecology and Obstetrics) and the ICM (International Confederation of Midwives), as well as numerous other influential institutions, are calling for health systems to be made sustainable without delay. In this respect, it is also imperative for health actors in obstetrics to avoid climate-damaging methods of care and treatment and to use effective alternatives.

Recommendations/conclusion: Midwives and obstreticians as well as pregnant women and parturients should be informed about the effectiveness, the side effects and the climate- and ozone-damaging effect of N₂O. It is recommended to completely avoid N₂O. The corresponding guidelines, information sheets and SOPs in the maternity hospitals should be adapted to this current state of knowledge. In case of a contraindication to the use of an epidural and remifentanil PCA in individual situations, the duration of N₂O use should be reduced to the minimum and the nitrous oxide cracking technology could be used if necessary.

Ethics and conflicts of interest: A vote on ethics was not necessary. The research was financed by own resources. There are no conflicts of interest.