Your pain relief options
Labour can be painful – it can help to learn about all the ways 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 you can decide what's best for you.
Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.
Self-help in labour
You're likely to feel more relaxed in labour and better placed to cope with the pain if you:
- 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 do not worry if you do not have a partner – your midwife will give you all the support you need
- ask your partner to massage you – although you may find you do not want to be touched
- have a bath
Gas and air (Entonox) for labour
This is a mixture of oxygen and nitrous oxide gas. Gas and air will not remove all the pain, but it can help reduce it and make it more bearable. It's easy to use and you control it yourself.
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.
- there are no harmful side effects for you or the baby
- it can make you feel lightheaded, sick, sleepy or unable to concentrate, but if this happens you can stop using it
If gas and air does not give you enough pain relief, you can ask for a painkilling injection as well.
Pethidine injections in labour
This is an injection of a medicine called pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a medicine called diamorphine is used.
It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so would not be recommended if you're getting close to the pushing (second) stage of labour.
There are some side effects to be aware of:
- it can make you feel woozy, sick and forgetful
- if pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing – if this happens, another medicine to reverse the effect will be given
- these medicines can interfere with the baby's first feed
Remifentanil goes into a vein in your arm. You control it yourself by pushing a button.
It works quickly and wears off after a few minutes. You can use it up until your baby is born.
You’ll need a small clip on your finger to measure your oxygen levels, as remifentanil can make you feel breathless or need oxygen.
Remifentanil can make you feel sleepy, sick, dizzy or itchy. These stop once you stop taking the medicine.
Like pethidine, remifentanil can affect the baby’s breathing but this usually wears off quickly.
In most cases, an epidural gives complete pain relief. It can be helpful if you are having a long or particularly painful labour.
An anaesthetist is the only person who can give an epidural, so it will not be available at home. If you think you might want one, check whether anaesthetists are always available at your hospital.
How much you can move your legs after an epidural depends on the local anaesthetic used. Some hospitals offer "mobile" epidurals, which means you can walk around.
However, this also requires the baby's heart rate to be monitored remotely (by telemetry) and many hospitals do not have the equipment to do this. Ask your midwife if mobile epidural is available in your local hospital.
An epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that 1 in 10 who have an epidural during labour need to use other methods of pain relief.
How does an epidural work?
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, numb a small area with some local anaesthetic, and then introduce a needle into your back
- a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It does not always work perfectly at first and may need adjusting
- the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine
- your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby's head
Side effects of epidurals in labour
There are some side effects to be aware of.
An epidural may make your legs feel heavy, depending on the local anaesthetic used.
Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.
Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby (instrumental delivery).
When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you'll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.
You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
You may get a headache after an epidural. This happens in about 1 in 100 cases and can be treated.
Your back might be a bit sore for a day or two, but epidurals do not cause long-term backache.
You may feel tingles or pins and needles down one leg after having a baby. This happens in about 1 in 2,000 cases. This is more likely to be the result of childbirth itself rather than the epidural. You'll be advised by the doctor or midwife when you can get out of bed.
Read more about the pros and cons of epidurals.
Using water in labour (water birth)
Being in 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 not above 37.5C, and your temperature will be monitored.
The National Childbirth Trust has information on using water during labour and birth.
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 you may have lower back pain.
TENS may also be useful while you're at home in the early stages of labour or if you plan to give birth at home. 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 TENS machines work
Electrodes are taped on to 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 sent to the brain by the spinal cord.
Side effects of TENS machines
There are no known side effects for either you or the baby.
Read more about TENS.
Alternative methods of labour pain relief
You may choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques are not proven to 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 do not offer them for pain relief during labour.
If you want to try any of these techniques, make sure the practitioner is properly trained and experienced. Learn more about complementary and alternative medicines and how they're regulated.
Video: what pain relief will be available in labour?
In this video, a midwife outlines what pain relief options there are during labour.
Media review due: 20 March 2023