Pain relief in labour and birth

There are quite a few pain-relief options available and it’s good to know what they are before you go into labour.

Many women wonder how they will manage when labour gets going. Try not to worry. When it happens, every woman deals with it in her own way. Some find an inner calm, some swear and shout and others want to have all the pain relief they can. All these reactions are fine and normal.

It's good to know your pain-relief options before the birth. If you feel in control, this will help you stay calm, which can mean an easier birth. If you are stressed and tense, your contractions may feel more painful and become less effective.

You may have very clear ideas about the pain relief you want - or don't want - to use. During your labour, though, your plans might change. Do what feels best for you at the time and don't feel bad if you want something that isn’t on your birth plan.

You may find that you are in early labour - called the 'latent phase' - for a long time before things really get going. Warm baths, back massages from your birth partner, paracetamol, a TENS machine and moving around may all help with early labour.

Drug-free pain relief in labour and birth

For hundreds of years, women in different parts of the world have used relaxation, breathing, self-hypnosis and other ways of coping with pain during labour and birth.

Being able to relax rather than tense up during a contraction helps your body manage labour better. Many antenatal classes cover relaxation and breathing techniques and it's good to find out about these, whatever you decide to do when you go into labour.

As well as pain relief for when labour is well under way (called 'established labour'), you may want to think about how you will manage pain and discomfort in the early stages as very early labour can go on for hours or even days.

Breathing and relaxation during labour

Slow rhythmic breathing will help you get into a relaxed state that should help you cope better with labour. If you’re interested in this, you should learn about breathing techniques for labour before the birth in antenatal classes.

  • Breathing and relaxation doesn't affect your baby.
  • You stay in control of it and you can use other pain relief at the same time.

Self-hypnosis

Self-hypnosis helps you reach a state of relaxation. If you decide to try this, visit a qualified practitioner well before your baby is due as you'll need to learn the techniques. Find a qualified practitioner or ask your midwife and other pregnant women or new mums for recommendations.

Pros

  • Self-hypnosis doesn't affect your baby.
  • You stay in control of it and you can use other pain relief at the same time.

Cons

  • It doesn’t work for all women.

Complementary therapies and labour

Complementary therapies include aromatherapy and reflexology, which may help you relax so you can cope better with labour. Talk to your midwife to find out about what you can do at your hospital and find a qualified practitioner or ask your midwife and other pregnant women or new mums for recommendations.

Pros

  • These therapies don't affect the baby.
  • You stay in control of it and you can use other pain relief at the same time.

Cons

  • Some complementary remedies are not advisable so talk to a qualified practitioner who knows which ones are safe and ask your midwife for advice.
  • You will probably not be allowed to burn candles or essential oils in a hospital labour ward.
  • You may need to use other pain relief methods as well.

Using a birth ball

A birth ball, which is similar to an exercise ball, is an inflatable, burst-resistant ball that comes in different sizes. Gently bouncing or rocking on it may ease lower backache and help you relax.

Ask your midwife whether balls will be available on your delivery ward or buy/borrow one in plenty of time for the birth. They are widely available to buy.

Pros

  • Using a birth ball doesn't affect your baby.
  • You stay in control of it and you can use other pain relief at the same time.
  • It's useful for support in different labour positions - for example, you can kneel on the floor and lean over it.

Learn more about how to use a birth ball in pregnancy and labour on the BabyCentre website.

Being in water during labour/having a water birth

Some women find that water helps them cope better with pain. The water provides support for your body so you can move freely and the warmth can help you feel relaxed.

You can hire a birth pool to use at home or there may be one available at your hospital or birth centre. A birth pool is larger and deeper than a bath so there is space to move in the water.

Tell your midwife as early in your pregnancy as possible if you'd like a water birth, as special arrangements may need to be made. If you're planning a home birth, your midwife may be able to recommend places to hire a pool.

Pros

  • Being in water doesn't affect your baby.
  • You stay in control of it because you can get out at any time.
  • You can use some other types of pain relief at the same time, such as Gas and air (entonox). 

Cons

  • You can't stay in the water if you want to use a TENS machine, or with pethidine or an epidural.
  • The birth pool may not be available if the hospital or birth centre is busy.
  • Birth pools take time to fill, so if things happen fast you might not have time to get in.

TENS (transcutaneous electrical nerve stimulation) and labour

This is a small machine that is attached to your back with sticky pads. It sends out tiny electrical impulses to block pain signals sent from your body to your brain. This means you are less aware of the pain. It can also trigger the release your body's pain-relieving chemicals, called endorphins.

You can hire or buy a TENS machine so you have it ready at the start of labour. Try it out before you go into labour (after you reach 37 weeks) so you can learn how it works. For the best results, start using it early in your labour.

Pros

  • Breathing and relaxation doesn't affect your baby at all.
  • You stay in control of it and you can use other pain relief at the same time.

Cons

  • You should use a TENS machine in early labour to get the best effect.
  • It doesn’t work for all women.
  • You can't use it in a birthing pool, bath or shower as there is a danger of electrocution.
  • You may need other pain relief methods as well.

Gas and air (Entonox) in labour

Using a mask or mouthpiece, you breathe in a mixture of nitrous oxide and oxygen as a contraction starts and while it lasts.

You don't need to do anything as gas and air will be available when you want it, although you could mention it in your birth plan.

You can have it while you’re having a water birth. If you're planning to have a home birth, talk to your midwife before the baby is due about using gas and air at home.

It is simple to use, quick to act and wears off in minutes.

Pros

  • It takes the edge off the pain.
  • It can be used at any time during labour.
  • It can be used with other forms of pain relief.
  • You are in control of how often and when to use it.
  • Gas and air doesn’t affect the baby.
  • It's easy to use.
  • You can stop using it at any point and the effects go away quickly

Cons

  • It doesn't get rid of all the pain.
  • It might make your mouth feel dry - sipping water or sucking ice cubes will help.
  • It may make you feel sick or light headed.
  • You may need to use other pain-relief methods as well.

Pain relief using drugs

Pain-relieving injections (meptids, diamorphine or pethidine)

These drugs are given by injection into your leg or bottom. Each one works slightly differently but they are strong painkillers from a group of drugs called opiates.

Find out in advance what injections your hospital offers and talk to your birth partner and midwife about the side effects, which are different for each drug.

Pros

  • They may help you cope better with contractions.
  • You may be able to sleep through contractions.
  • They can help you to relax.

The disadvantages vary depending on which drug you've been given, but all of them:

  • can cause nausea and vomiting so your midwife may suggest an anti-sickness injection.
  • can make you drowsy
  • may cause your baby to be slow to breathe after birth if they are given too close to delivery - if this happens, your baby will need immediate help to start breathing with stimulation and oxygen.
  • can prevent you from using the birthing pool for at least two hours after you’ve had the injection.

Having an epidural for labour and birth

This is an anaesthetic that goes into your back. It blocks pain messages to the brain by numbing the nerves in your lower back. The amount you get will depend on the stage of labour you are in and how much pain relief you want.

You will also have a drip in your hand with medication to prevent low blood pressure.

Pros

  • It gives complete pain relief for most women - around 90 percent.
  • Your mind stays clear.
  • It brings down high blood pressure.
  • It has little effect on the baby.
  • Sometimes you can have a lower dose, which gives you more movement or sensation.
  • In some cases, you may be able to control your dose (up to a safe limit) by pressing a button to get more anaesthetic.

Cons

  • You can't walk around in labour and will be less mobile.
  • You can only have it in hospital, as it needs to be given by an anaesthetist.
  • You won't know when your bladder is full so you'll need to have a catheter to drain the wee.
  • A very small number of women have a severe headache during and after the birth.
  • It can cause a drop in blood pressure, which is treated with extra fluid.
  • You will need to be monitored more closely in your labour
  • You are more likely to have a longer second stage of labour and you may need forceps or ventouse to help deliver the baby.

What to do next

Ask your midwife or the hospital whether there are anaesthetists on call day and night to give epidurals. Bear in mind that if the anaesthetist is with someone else, you may have to wait for your epidural until they are finished.

Ask whether you will be able to have a low-dose epidural, which will allow you some movement.

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Sources

  1. NICE (2014) Intrapartum care: care of healthy women and their babies during childbirth, Clinical Guideline 190 http://www.nice.org.uk/guidance/cg190/chapter/1-recommendations#pain-relief-in-labour-nonregional

 

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Last reviewed on April 1st, 2015. Next review date April 1st, 2018.

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