Craig, R; O'Carroll, J; Bampoe, S; Odor, PM; Kamming, D; (2025) Environmental and occupational risks with use of nitrous oxide (Entonox®) for labour analgesia: a qualitative analysis of midwives’ attitudes in the United Kingdom. International Journal of Obstetric Anesthesia , 62 , Article 104359. 10.1016/j.ijoa.2025.104359.

Text YIJOA-D-25-00040_R1 (2).pdf - Accepted Version Access restricted to UCL open access staff until 30 March 2026. Download (3MB)

Abstract

Background: Nitrous oxide carries significant environmental impact and has been linked to harm related to occupational exposure. In the United Kingdom, midwives are primarily responsible for administering nitrous oxide in the form of Entonox®. The aim of this study was to understand midwives’ perceptions related to the effects of nitrous oxide and barriers to change in the pursuit of net zero emissions. // Methods: This qualitative study was conducted at a single teaching hospital. An interview guide was developed for the conduct of this study with thematic analysis conducted using an inductive approach to determine common themes. A total of 10 participants consented and participated in semi-structured interviews. // Results: Three themes were identified; mixed awareness of environmental and occupational risk; midwifery culture as a barrier to change; and the identification of drivers for innovation and change. // Conclusions: Efforts to mitigate the environmental and occupational effects of nitrous oxide may require focused early educational policies and engagement with midwives to co-design demand- and supply-side mitigations to reduce harmful emissions from Entonox® delivery.

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