Your pain relief options
Labour is painful, so it’s important to learn about all the ways that you can relieve the pain. It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you. Ask your midwife or doctor to explain what's available so that you can decide what's best for you.
Write down your wishes in your birth plan, but remember that you should keep an open mind. You may find that you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery. Different ways of relieving the pain are listed below. You can read them all or use the links below to go straight to any topic:
Self-help
The following techniques can help you to be more relaxed in labour, which can help you to cope with the pain.
- Learn about labour: this can make you feel more in control and less frightened about what's going to happen. Talk to your midwife or doctor, ask them questions and go to antenatal classes.
- Learn how to relax, stay calm and breathe deeply.
- Keep moving: your position can make a difference, so try kneeling, walking around or rocking backwards and forwards.
- Bring a partner, friend or relative to support you during labour, but if you don't have anyone, don't worry – your midwife will give you all the support you need.
- Ask your partner to massage you (although you may find that you don't want to be touched).
- Have a bath.
Hydrotherapy (being in water)
Water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature but it won't be above 37.5C, and your temperature will be monitored.
The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have produced a joint statement on labour and birth in water. The National Childbirth Trust also has information on using water during labour and birth.
Gas and air (Entonox)
This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain but it can help to reduce it and make it more bearable. Many women like it because it's easy to use and they control it themselves.
How it works
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. You'll probably practise using the mask or mouthpiece if you go to an antenatal class. The gas takes about 15 to 20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.
Side effects
There are no harmful side effects for you or the baby but it can make you feel light-headed. Some women also find that it makes them feel sick, sleepy or unable to concentrate. If this happens, you can stop using it.
If gas and air doesn't give you enough pain relief, you can ask for a painkilling injection as well.
Injections
Another form of pain relief is the intramuscular injection (into the muscle of your thigh or buttock) of a drug, such as pethidine or diamorphine. This can help you to relax, which can lessen the pain.
How it works
You are given an intramuscular injection. It takes about 20 minutes to work and the effects last between two and four hours.
Side effects
There are some side effects to be aware of:
- It can make some women feel woozy, sick and forgetful.
- If it hasn't worn off towards the end of labour, it can make it difficult to push: you might prefer to ask for half a dose initially to see how it works for you.
- If pethidine or diamorphine are given too close to the time of delivery, it may affect the baby's breathing: if this happens, an antidote will be given.
- The drugs can interfere with breastfeeding.
TENS
This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire your own machine. TENS has not been shown to be effective during the active phase of labour (when contractions get longer, stronger and more frequent). It's probably most effective during the early stages when many women experience low back pain.
TENS may be useful if you plan to give birth at home or while you're at home in the early stages of labour. If you're interested in TENS, learn how to use it in the later months of your pregnancy. Ask your midwife to show you how it works.
How it works
Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.
TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord.
Side effects
There are no known side effects for either you or the baby.
Epidural anaesthesia
An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour, or who are becoming distressed.
An anaesthetist is the only person who can give an epidural, so it won't be available if you give birth at home. If you think you might want one, check whether anaesthetists are always available at your hospital.
How it works
To have an epidural:
- A drip will run fluid through a needle into a vein in your arm.
- While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic and numb a small area with some local anaesthetic.
- A very small tube will be placed into your back near the nerves that carry pain from the uterus. Drugs, usually a mixture of local anaesthetic and opioid, are administered through this tube. (An opioid is a chemical that works by binding to special opioid receptors in the body, which reduces pain). It takes about 20 minutes to set up the epidural, and another 10 to 15 minutes for it to work. It doesn't always work perfectly at first, so may need to be adjusted.
- After it has been set up, the epidural can be topped up by a midwife, or you may be able top up the epidural yourself through a machine.
- Your contractions and the baby's heart will need to be continuously monitored by a machine: this means having a belt around your abdomen and possibly a clip attached to the baby's head.
Side effects
There are some side effects to be aware of:
- An epidural may make your legs feel heavy, depending on the type of epidural.
- An epidural shouldn't make you drowsy or sick.
- Your blood pressure can drop; however this is rare because the drip in your arm will help you to maintain good blood pressure.
- Epidurals can prolong the second stage of labour, when you push and your baby is born: if you can no longer feel your contractions, the midwife will have to tell you when to push. This means that instruments such as forceps may be used to help you deliver your baby (instrumental delivery). However, when you have an epidural, your midwife or doctor will wait longer before they use instruments as long as your baby is fine. Sometimes, less anaesthetic is given towards the end so that the effect wears off and you can push the baby out naturally.
- You may find it difficult to urinate as a result of the epidural: if so, a small tube called a catheter may be put into your bladder to help you.
- About one in 100 women gets a headache after an epidural: if this happens, it can be treated.
- Your back might be a bit sore for a day or two but epidurals don't cause long-term backache.
- About one in 2,000 women feels tingles or pins and needles down one leg after having a baby: this is more likely to be the result of childbirth itself rather than an epidural. You'll be advised by the doctor or midwife when you can get out of bed.
Alternative methods of pain relief
Some women prefer to avoid the types of pain relief listed on this page, and choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. However, most of these techniques don't provide effective pain relief.
If you'd like to use any of these methods, it’s important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals don't offer them for pain relief during labour. If you want to try an alternative technique, make sure that the practitioner is properly trained and experienced. For advice, contact the Institute for Complementary Medicine.
