Environmental impact of pain relief for labour

Like all healthcare, maternity care has an environmental impact. The equipment, medicines and gases used to provide pain relief all have a carbon footprint. The NHS and maternity services have a responsibility to reduce this impact wherever possible, while continuing to provide safe and effective pain relief.

Some people may want to know how the environmental impact of different methods of labour pain relief compares. This information is for those who want to learn more. You should feel able to choose the pain relief that best meets your needs, and you should not feel under pressure to limit pain relief because of its environmental impact.

Comparing the global warming effect of labour pain relief options

To help illustrate the warming effects of some different options for pain relief, we have worked out the carbon dioxide emissions (CO2e) of using them over a four-hour period during labour.

Entonox (gas and air)

The warming effect of using Entonox depends on how much of it is breathed out. So, using it all the time will have a greater warming effect than only using it intermittently. If you are having regular contractions and only using it during a contraction then four hours of pain relief with Entonox produces 237kgCO2e, equivalent to driving 1,400km (870 miles) in an average car.

Epidurals

The carbon footprint of epidurals mainly comes from the single-use equipment needed to place them. Four hours of pain relief with an epidural produces 1.2kgCO2e, equivalent to driving 7km (4 miles) in an average car.

Epidural analgesia has a lower carbon footprint than prolonged use of nitrous oxide (Entonox). Environmental impact is only one aspect of different pain-relief options and should not determine whether you choose an epidural.

Remifentanil PCA

Remifentanil PCA is a type of pain relief where a short-acting pain-relieving drug is given via a drip that’s connected to an electronic pump you control with a button. The drug itself has a very low carbon footprint compared to the plastic syringe, drip tubing and oxygen tubing that is needed to give it. Four hours of pain relief with a remifentanil PCA would produce 0.75kgCO2e, equivalent to driving 4km (2.5 miles) in a car.

Opioid injections

Opioids are a group of pain-relieving medications (morphine, diamorphine, pethidine, meptazinol) that may help relieve labour pain. They can be given via an injection into your muscle. The drugs themselves have a very low environmental impact compared to the syringe needed to give them. As an example, two injections of morphine would emit 0.08kgCO2e, equivalent to driving 0.5km (0.3 mile) in an average car.

Is there a way that Entonox can be more environmentally friendly?

Machines can break down the greenhouse gases in Entonox into harmless gases (catalytic destruction). To do this, the Entonox you breathe out has to be captured and then passed through the machine. These are not routinely available in birthing units but will hopefully become more widespread over time.

If using Entonox with a capture device, it helps to form a good seal between your mouth and the mouthpiece or mask when you breathe out. This reduces the amount that leaks out into the environment, minimising the greenhouse gas impact.

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