Pain relief options in labour

This article covers the following topics:

Position and movement

Water

TENS (Transcutaneous Electrical Nerve Stimulation) machine

Complementary therapies

Gas and air (Entonox)

Pethidine

Epidural

Do what feels best for you

Further information

What are your options?

There are many labour pain relief options available, ranging from nothing at all to an epidural. It may be helpful to find out more about your options and discuss them with your midwife and birth partner.

Research has shown that it's important for women in labour to have emotional support. This means encouragement, reassurance, a trusted person to listen to you and just be there. For some women this will be their partner, for others it will be a friend or close family member. Making sure that you have the right person to support you will help you cope with the pain and discomfort of labour more easily.

Position and movement

Gravity is a powerful force, so don't fight it it. Staying upright (for example, standing or kneeling) keeps labour hormones flowing and gives your baby maximum room to manoeuvre. You can lean forward to rest your weight on your partner, a bean bag, or any convenient surface at the right height. Movement – walking, swaying – also lends labour a helping hand.

Pros
Maximises your body’s ability to give birth.

Cons
No downside – you’re doing what comes naturally.

Water

Water soothes pain and, in a large birthing pool, supports you, enabling you to glide into any position. A hot shower on your back or a warm bath at home can help too. Women who labour in water need fewer interventions and are less likely to need other drugs. 

Pros
Drug-free.

Cons
Water’s great but sometimes it can slow down labour, particularly if you get in too early. Also make sure the water feels warm but not hot.

TENS (Transcutaneous Electrical Nerve Stimulation) machine

A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins.

Pros
Many women find TENS helpful, especially in early labour.

Cons
It is less effective in established labour. You also won’t be able to use it in water.

Complementary therapies

Various complementary therapies are available – acupuncture, aromatherapy, yoga, self-hypnosis and massage. On the whole, research has not proved the effectiveness of these treatments, but some studies show acupuncture is helpful and plenty of annecdotal evidence results about massage are promising. 

Pros
Your birth partner may help with massage.

Cons
Though many women find some therapies help, there is little research as to which are most helpful. With many therapies you may need someone else to apply it to you and, apart from massage, you need to find a registered practitioner for these therapies.

Gas and air (Entonox)

Breathed through a tube or a mask, this 50:50 mixture of nitrous oxide and oxygen takes 20–30 seconds to take effect. It takes most women a few contractions to get the hang of it, so don’t give up after one contraction. It makes you feel light-headed, so although it doesn’t remove the pain, it makes you less aware of it.

Pros
You control when and how deeply you breathe, and the effects wear off once you stop inhaling. Most women find it really helps.

Cons
It may make you feel sick and light-headed initially, before you get used to it, and the nausea usually passes.

Pethidine

This strong morphine-like analgesic is given by injection. It doesn’t alter the pain as it is not an anaesthetic. (Other opiates such as meptid, diamorphine and morphine may be offered, especially in Scotland.)

Pros
Pethidine changes awareness and may help you to relax.

Cons
You can’t control it. Once you’ve had the injection the effects last for up to four hours, so if you don’t like the sensation you can’t do anything about it. Pethidine passes through to your baby and can make babies slower to breathe at birth. If you take pethidine, your baby may also stay sleepy for several days, making breastfeeding harder to establish. For mums, pethidine may make you feel out of control, and make you feel sick. Opiates vary in their effectiveness and the extent to which they may make you feel sick.

Epidural

A local anaesthetic is injected into the space between two vertebra in your back. The local anaesthetic bathes the nerves in that area usually removing all pain and most feeling from the waist down.

Pros
It gives total pain relief in 90% of cases; partial pain relief in the remainder.

Cons
Depending on the mixture of drugs used, your labour may slow down as you’ll be less able to move around and you won’t feel the contractions or – later on – the baby moving down so there is an increased chance that you will need forceps or suction (ventouse) to help your baby out.

You’ll also need to be constantly monitored, you may have to have a catheter inserted to empty your bladder (as you won’t feel when you need to wee) and have a drip to stop your blood pressure dropping. Some low-dose (mobile) epidurals now contain less anaesthetic but a mixture of drugs which can cross the placenta and make the baby sleepy.

Do what feels best for you

Every labour is different and each woman should be able to choose whatever she needs to help her work with the pain of labour.

• Find out as much as you can about labour.
• Trust your own body and rely on your own self-help resources.
• Have supportive carers around to encourage you and minimise the fear. Studies show that the constant presence of someone giving emotional support helps women to cope and helps labour to progress well.
• Remember each contraction is taking you closer to your baby. Just focus on one at a time.
• Thinking about and acknowledging childbirth pain as a positive and necessary pain that will come to an end rather than a negative pain may help you deal with it. 
• A calm, relaxing, empowering environment can make all the difference.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Dads who are birth partners might find our online guides for them useful.

NCT Shop has TENS machines available for purchase or hire as well as a range of Natal Hypnotherapy books and CDs designed to help with pain relief.

The MIDIRS Informed Choice resource offers information on a range of subjects based on unbiased/objective summaries of the best available research evidence.

NHS Choices guide to pain relief in labour.

Research from the Royal College of Obstetricians and Gynaecologists (RCOG) about the use of water as pain relief in labour.

Information from NHS Choices about complementary therapies during pregnancy and labour.