Guidance to protect midwives from excessive nitrous oxide exposure has been published by the Health and Safety Executive (HSE).

The guidance is aimed at those responsible for ensuring the safety of workers and new mothers on maternity wards, which will include occupational health teams working within the NHS.

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More commonly known as ‘gas and air’ when mixed with oxygen, nitrous oxide is an invisible gas used widely in healthcare, including for pain relief during childbirth.

Depending on how well the exhaled gas from women in labour is controlled, midwives are at greater risk of exposure to higher levels of nitrous oxide because of the extensive time they spend working in labour rooms.

Over time, high levels of exposure can cause serious health effects including neurological problems and anaemia so it is important that levels are properly controlled.

The guidance has been developed by HSE together with NHS maternity specialists. However, it is also relevant for professionals working in other parts of the healthcare sector, outside of maternity wards, the HSE emphasised.

Nitrous oxide is subject to the Control of Substances Hazardous to Health Regulations (COSHH). It has a long-term workplace exposure limit of 100 ppm or 183 mg.m3 8-hour time-weighted average.

HSE advises that all hospitals using gas and air should carry out a COSHH risk assessment of each space in which it is used.

Helen Jones, head of HSE’s health and public services sector, said: “This is an essential piece of guidance. It should be taken on board by those responsible for managing health and safety in maternity units and for controlling the risks faced by staff who work with nitrous oxide. This should include consideration of workers who may be more vulnerable to the effects of exposure, such as those who are pregnant.

“Workers must also be fully consulted when it comes to monitoring how effective the control measures are, including how results are to be used. This will include how workers will be managed if results suggest their exposure should be reduced,” Jones added.

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