Reducing the NHS Maternity Care Carbon Footprint: Strategies for Lower-Emission Births

Overview

The Conversation UK unpacks the carbon footprint of maternity care within the NHS, highlighting emissions from pain relief, travel, and disposable equipment, and showcasing early wins from service redesigns that cut emissions while preserving quality of care.

• Emissions from maternity care constitute a notable portion of England's healthcare footprint, with Entonox contributing a large share.
• Real-world pilots show how shifting delivery models can cut emissions without limiting care options.
• Ethical considerations emphasize avoiding added burdens on labouring people while pursuing greener maternity services.
• Hospital system changes, waste reduction, and lower-emission technologies offer tangible paths to greener maternity care.

Author: The Conversation UK, Alice Craggs

Introduction

The NHS carries a substantial carbon footprint, with maternity care receiving comparatively little attention despite its central role in family health. A Royal College of Obstetricians and Gynaecologists (RCOG) 2025 report estimated that selected maternity care activities in England generated about 205,000 tonnes of CO2e in 2022–23, while the NHS as a whole accounted for an estimated 4% to 5% of England’s greenhouse gas emissions. CO2e is a standard way to express the warming effect of different greenhouse gases as an equivalent amount of carbon dioxide.

Importantly, the footprint presented in the report excludes some maternity services, suggesting the true emissions are higher. Among the studied activities, Entonox (gas and air) emerged as a major contributor, representing nearly 29% of emissions in the cohort analyzed. When used for four hours during regular contractions, Entonox has an estimated warming effect of about 237 kg CO2e. Travel to antenatal appointments also adds to emissions, with an analysis at the Whittington hospital in north London estimating an average return journey of 1.23 kg CO2e per patient.

Key Emission Sources in Maternity Care

The article identifies several major sources of emissions in maternity care: Entonox usage, travel to appointments, and disposable equipment used in hospitals, such as ready-to-use formula bottles and teats, cups, and clinical waste containers. It also discusses the broader system-level factors that shape emissions, including how care is organized and delivered, the culture of waste, and demand for single-use products. CO2e accounting is limited by scope, and a more comprehensive footprint would likely be higher.

Ethical and Practical Considerations

Reducing emissions in maternity care raises ethical concerns about placing responsibility on birthing people. The UK maternity system is under pressure, with high-stakes safety concerns highlighted by the Ockenden review and the Birth Trauma Inquiry. The Conversation cautions against using carbon targets to restrict access to pain relief or cesarean birth, arguing instead for a patient-centered approach that respects informed choice.

Many expectant parents want environmental information, but a study with 12 nitrous oxide users during labour found that most wanted information rather than feeling compelled to alter their care decisions. They also viewed emissions reduction as primarily the health system's responsibility rather than an individual burden on those in labour.

Success Stories and Practical Steps

Several NHS teams are experimenting with service redesigns to lower emissions while enhancing care access. At Norfolk and Norwich University Hospitals, a project introduced virtual ward support and home-based care for severe pregnancy sickness, reducing hospital stays and cutting emissions by an estimated 538 kg CO2e in one month, with projected annual savings if scaled. Newcastle Hospitals NHS Foundation Trust implemented technology to capture exhaled nitrous oxide and destroy it while enabling continued use during labour, thereby lowering its environmental impact without removing a preferred pain relief option.

Other strategies focus on purchasing and waste: reducing disposable formula packaging waste, rethinking single-use equipment, and replacing plastic waste with greener alternatives have shown emission reductions and cost savings. The article argues that design changes to service delivery—rather than expecting clinicians to improvise greener options—are more effective for achieving lower carbon footprints.

Better Care, Lower Emissions

The Green Maternity Challenge, an initiative led by the Royal College of Obstetricians and Gynaecologists, brought together NHS teams to test emission-reducing strategies that also improve access to treatment and shorten hospital stays. The overarching message is that better care and lower emissions can go hand in hand when hospitals examine emission sources and equip staff with the tools to reduce them, including changes to purchasing, waste, and the adoption of lower-emission technologies while protecting patient autonomy and informed choice.

Conclusions and Forward Path

Birth will always carry an environmental footprint, but the paper argues for shaping maternity services around lower-carbon care. The path forward includes systematic measurement of emissions, redesigning care pathways to minimize unnecessary hospital stays, and adopting practices that reduce waste without compromising access to essential pain relief, formula, or cesarean birth when clinically indicated. The focus should be on institutional changes—purchasing decisions, waste management, care delivery models, and technology adoption—so that sustainability becomes an intentional feature of maternity services rather than an accidental by-product.

Author: The Conversation UK, Alice Craggs