Pain relief in labour and birth

Labour can be painful, but there are different pain relief options available that you may find helpful. It’s good to know what they are before you go into labour.

It's helpful to know which pain relief options are available before the birth. If you know what you can have, you may find it easier to stay calm and try to relax as much as you can, which can mean an easier birth. If you are stressed and tense, your contractions may feel more painful and become less effective.

You may also find it helpful to:

Read more about positive ways to prepare for labour.

You may have very clear ideas about the pain relief you want or don’t want. This is helpful but try to keep an open mind. You may find that, for whatever reason, some methods just don’t work for you on the day. Don't feel bad about this, just do whatever is best for you at the time.

You may find that you are in the latent stage of labour for a long time before things really get going. Things can help include:

  • warm baths
  • back massages 
  • paracetamol
  • a TENS machine
  • moving around. 

Try not to worry about how you’ll manage when labour gets going. When it happens, every woman deals with it in her own way. Some find an inner calmness, some swear and shout, and others want to have all the pain relief they can. All these reactions are fine and normal, and your healthcare professionals have seen it all before!

Breathing and relaxation during labour

Slow rhythmic breathing will help you get into a relaxed state that should help you cope better with labour. 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. It's good to find out about these, whatever you decide to do when you go into labour.

Breathing and relaxation doesn’t affect your baby. You can use breathing techniques and also have pain relief.

Hypnobirthing

Hypnobirthing is a method of pain management that can be used during labour and birth. It involves using a mixture of visualisation, relaxation and deep breathing techniques.

Breathing exercises have been part of antenatal classes for a long time. Hypnobirthing also includes relaxation, visualisation and mindfulness techniques to help you concentrate on your body and the birth of your baby.

Hypnobirthing can be used with all other types of pain relief and can be added to your birth plan.

Find out more about hypnobirthing.

Alternative methods of pain relief

Some women may choose alternative treatments (complementary therapies) such as acupuncture, aromatherapy and reflexology.

Your midwife or doctor may offer these therapies [KP15] to you, although most of them aren’t proven to provide effective pain relief.

It’s important to talk to your doctor or midwife about this before you go into labour. Also make sure any practitioner you use is properly trained, experienced and insured.

Using a birthing ball

A birthing ball is an inflatable, burst-resistant ball – similar to an exercise ball. Gently bouncing or rocking on it may help you relax and ease pain.

Ask your midwife whether birthing balls will be available on your delivery ward or you could buy or borrow one before the birth. Just make sure you try before you buy because birthing balls come in different sizes.

  • Using a birthing 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.

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

Having a water birth

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

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. Your midwife will check your temperature every hour to make sure you are not getting too hot.

Tell your midwife as early in your pregnancy as possible if you'd like a water birth. 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 also use gas and air (Entonox). 

Cons

  • You can't stay in the water if you want to use a TENS machine.
  • You won’t be able to have any drugs for pain relief, such as 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 quickly you might not have time to use it.

Find out more about having a water birth.

TENS (transcutaneous electrical nerve stimulation) and labour

A TENS machine 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 of endorphins, which are your body's pain-relieving chemicals.

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

  • A TENS machine doesn't affect your baby.
  • You stay in control of it yourself.
  • You can use other pain relief at the same time.

Cons

  • If you only start using a TENS machine when you’re in established labour, it will not help with pain.
  • It may not 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

This is a mixture of oxygen and nitrous oxide gas. You breathe this in just as a contraction begins using a mask or mouthpiece, which you hold yourself. It works best if you take slow, deep breaths.

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.

Pros

  • It takes the edge off the pain.
  • It works quickly.
  • 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 lightheaded.
  • You may need to use other pain relief methods as well.

Pain relief using drugs

Diamorphine, pethidine and similar drugs (calledopioids) can be given as injections for pain relief. Each one works slightly differently.

Find out in advance what injections your hospital offers. 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.

Cons (these will vary depending on which drug you’ve been given)

  • They can cause nausea and vomiting (although you can be given other medication to help with this)
  • They can make you drowsy.
  • They may affect you baby’s breathing after the birth and they may be drowsy (which could affect breastfeeding).
  • You won’t be able to use the birthing pool for at least 2 hours after you’ve had an injection.

Epidurals

An epidural is a local anaesthetic that is injected into the spine and topped up as needed. You can only have an epidural if you are in an obstetric unit (labour ward), so if you are at home or in a midwife-led unit you will need to be transferred.

If you choose to have an epidural, you and your baby will need to be monitored more closely. Your blood pressure will be checked more often, and you will be put on a drip. Your baby's heartbeat will also need to be monitored using a machine (electronic monitoring) for the first 30 minutes after you have the epidural, and after each top‑up.

Once started, your epidural should continue until after your baby is born, your placenta is delivered and any stitching you need has been done.

Pros

  • You should be able to have an epidural at any point.
  • It is better at relieving pain than opioids.
  • It is not linked to a longer first stage of labour or an increased chance of having a caesarean section.
  • It is not linked to long‑term backache.
  • You may be able to have a type of epidural that you can top up yourself.

Cons

  • You may not be able to move around as much after you’ve had a few top-ups.
  • Epidurals are linked to a longer second stage of labour and an increased chance of an assisted birth.
  • You can only have it in hospital, because it needs to be given by an anaesthetist.
  • You will need to be monitored more closely in labour.
  • There can be side effects, including low blood pressure, loss of bladder control, itchy skin, feeling sick, headaches, infection and nerve damage.

Read more

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    Hypnobirthing is a method of pain management that can be used during labour and birth. It involves using a mixture of visualisation, relaxation and deep breathing techniques.

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    The ideal position for your baby to be in for labour and birth is head down, their back towards the front of your stomach.

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    At the end of your pregnancy, you may have some signs that your baby will arrive very soon, even though you may not go into labour for a little while yet.

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Sources

Li Y-H et al (2013) Effect of birth ball exercise combined with free maternal position on labour pain, sense of labor self-control and gestational outcomes. Chinese Journal of Nursing, (9): 011.

NICE (2014). Intrapartum care for healthy women and babies. National Institute for health and care excellence https://www.nice.org.uk/guidance/cg190

NHS Choices. Pain relief in labour. https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/ (Page last reviewed: 29/04/2017. Next review due: 29/04/2020)

NHS Choices. Epidural side effects. https://www.nhs.uk/conditions/epidural/side-effects/ (Page last reviewed: 28/02/2017. Next review due: 28/02/2020)

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    Last reviewed on July 5th, 2019. Next review date July 5th, 2022.

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