Pain relief in labour
Your pain relief options
Some women will describe contractions as uncomfortable whilst some others report labour can be painful. It can be of benefit 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 to find out ways in which they can how they can support you.
You may ask your midwife or doctor to explain what's available so you can decide what's best for you.
We recommend you write down your wishes in your birth plan. You may fond it helpful to keep an open mind. Once in labour, you may find you are coping well with little help when you originally planned to use pain relief or you may find you want more pain relief than you'd planned. Your doctor or midwife may also suggest more effective pain relief to help with the pain.
Watch this short film to explain the different options we offer for pain relief.
Self-help in labour
You're likely to feel more relaxed and empowered in labour 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
- keep moving – your mobility and position can make a difference, so try kneeling, going on your hands and knees (all fours), walking around, or rocking backwards and forwards
- bring a partner, friend or relative to support you during labour, but don't worry if you don't have one – your midwife will give you all the support you need
- ask your partner to use techniques to massage you – it is ok if you feel you don't want to be touched
- have a bath.
TENS machines
This stands for transcutaneous electrical nerve stimulation. TENS machines can be hired or purchased from reliable retailers.
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 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.
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.
Gas and air (Entonox) for labour
This is a mixture of oxygen and nitrous oxide gas. Gas and air may not take the discomfort away, but it can help reduce pain and make it more bearable. Many women like it because it's easy to use and it keeps them focussed on their breathing when using gas and air.
You breathe in the gas and air through a 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. Your midwife will give you clear instructions and explain this further.
Side effects
- there are no harmful side effects for you or the baby
- it can make you feel light-headed, but the effects disappear soon after you stop using it.
- some women 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 alternative methods of pain relief.
Pethidine injections
This is an injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax.
It takes about 20 minutes for the medication to work after the injection. The effects last between two and four hours. If you're getting close to the pushing (second) stage of labour, we may not recommend pethidine but will be happy to offer an alternative pain relief.
Side effects
There are some side effects to be aware of:
- it can make some women feel woozy, sick and forgetful
- pethidine crosses the placenta and passes to the baby which can at times make the baby sleepy at birth
- if pethidine is given too close to the time of delivery, it may affect the baby's breathing, tone and this may mean that the baby may require some stimulation and assisted breathing at birth
- the drugs can interfere with the baby's first feed.
Epidural
An epidural can provide good pain relief during labour. Epidurals are administered by an anaesthetist.
How does an epidural work?
To have an epidural:
- A drip with fluid will be connected into a vein in your arm using a sterile cannula
- Whilst you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area in your back with some local anaesthetic, and then introduce a needle into a specific area on 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 usually takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. Epidurals don't always work perfectly at first and may need adjusting by the anaesthetist. Epidurals are run continuously through an infusion pump at a dose that will take the discomfort away.
- If necessary, the epidural can be topped up by a professional or you may be able to top up the epidural yourself through a machine that allows you to do so safely.
- Your contractions and the baby's heart rate will need to be monitored continuously. This means having a belt around your abdomen and in some instances 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). Your body alongside the fluid given through the drip in your arm usually helps maintain good blood pressure.
- Epidurals can prolong the second stage of labour. Because of this, you can no longer feel your contractions. The midwife will guide you in telling you when to push if necessary. Forceps or a ventouse may be needed to help with delivery (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), for 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 pass urine as a result of having an epidural. Because of this, a small tube called a catheter is inserted into your bladder to help you.
- About 1 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.
Read more about the pros and cons of epidurals.
Alternative methods of labour pain relief
- Some women may choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. There is limited evidence with regards to how effective these treatments are in relieving pain.
- 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.
- If you opt to pay privately to have any of these techniques, make sure the practitioner is properly trained and experienced to treat pregnant women.
