Pain relief in labour

Pain relief in labour

Find out about the different options available for pain relief in labour, including epidural, pethidine, TENS and other means of reducing discomfort before and during childbirth.

This article covers the following topics:
Position and movement in labour
Water and birthing pools in labour
TENS (Transcutaneous Electrical Nerve Stimulation) machine in labour
Complementary therapies
Gas and air (Entonox) in labour
Painkilling drugs in labour 
Epidural
Do what feels best for you
Further information

When it comes to giving birth, most women want to know: how much is it going to hurt and will I be able to cope with the pain? Unfortunately, you can’t answer either of these questions with certainty. But what you can do is improve your ability to cope with pain during labour, as well as understand your options for pain relief and their impact on you, your labour and baby.

Your birth partner(s) will make a huge difference to how you feel during labour. Emotional support, such as encouragement and reassurance from somebody you trust, can really boost your confidence and ability to cope with pain when you need it most.

Here we look at the different pain relief options that are available during labour.

Position and movement in labour

Lying on your back can make your contractions slower and more painful. Movement, such as rocking, swaying and leaning forwards, maximises your body’s ability to give birth as it helps ease your baby along the birth canal.

Pros

  • Maximises your body’s ability to give birth.
  • No lasting side-effects for you or your baby

Cons

  • Try not to overdo it; saving energy is also important. Lying on your side for a while or sitting up supported by lots of pillows can help your body to work really well while you conserve energy.

 

Water and birthing pools in labour

Water soothes pain and, in a large birthing pool, supports you, enabling you to glide into any position. 

Pros

  • You can combine it with other options, such as Entonox (gas and air) and massage.
  • Women who labour in water need fewer interventions and are less likely to need other drugs.
  • No lasting side-effects.

Cons

  • Water can sometimes slow down labour, particularly if you get in too early.
  • You won't be able to use TENS (see below), pethidine (or other injectable drugs) or an epidural while you're in water.
  • Birthing pools might not be available or an option everywhere.

 

TENS (Transcutaneous Electrical Nerve Stimulation) machine in labour

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

Pros

  • You can keep moving and it won't directly interfere with your labour.
  • You can use it for as long as you want.
  • There are no lasting side-effects for you or your baby.
  • It doesn't need an anaesthetist, doctor or midwife.
  • It can be used at a home birth and in hospital. 

Cons

  • You’ll probably need someone to help you to position the pads.
  • It may only help in the early stages of labour. 
  • It may have to be removed if your baby's heart has to be monitored electronically.
  • You can use TENS before you get into water, but not when you’re in the water.
  • It might make it more difficult for your birth partner to massage your back.
  • The clinical evidence in support of TENS is lacking though many women say that it helped them.

 

Complementary therapies

Various complementary therapies are available, such as acupuncture, aromatherapy, reflexology, yoga, self-hypnosis and massage. 

Pros

  • Some studies show acupuncture is helpful.
  • Massage or pressure on the lower part of your back can help reduce levels of stress and ease discomfort, too.
  • You can learn self-hypnosis techniques for labour by attending a course or using CDs; you don’t have to have a hypnotherapist with you in labour.

Cons

  • There is little research proving the effectiveness of these treatments though lots of women say that they found these techniques useful.
  • Apart from massage and self-hypnosis, you will need a registered practitioner to perform the therapies.

 

Gas and air (Entonox) in labour

Entonox is a colourless, odourless gas made up of half nitrous oxide and half oxygen. You'll probably be given gas and air through a mouthpiece and told how to breathe it in. 

Pros

  • You can control it and the effects wear off very quickly once you stop inhaling.
  • It’s fast-acting (taking effect after 20 to 30 seconds).
  • Your baby doesn't require extra monitoring while you're using it.
  • You can use it in a birthing pool.
  • It should be available wherever you give birth, including birth centres and at home.  

Cons

  • It may make you feel sick and light-headed initially but the nausea usually passes. 
  • It can dry your mouth out if you use it for long periods.
  • Keeping hold of the mask or mouthpiece may stop you from moving around and getting into a comfortable position.
  • It can take a few contractions to get the hang of it so that it's effective at the peak of contractions.
  • If used with pethidine or diamorphine, it may make you feel even drowsier.

 

Painkilling drugs in labour (opioids such as pethidine, diamorphine, meptid and remifentanyl)

Pethidine, diamorphine and meptid are pain relieving drugs given by injection into the thigh. Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine.

Pros

  • Opioids may help you to relax and get some rest; especially if your early labour has been long and uncomfortable.
  • Pethidine, diamorphine and meptid can be given by a midwife, so there's no need to wait for a doctor although they may have to prescribe the drug. Remifentanil infusions are set up by an anaesthetist.
  • These drugs don’t appear to slow labour down, if you're already in established labour.
  • They may help you to postpone or avoid having an epidural if you're finding your contractions hard to cope with.
  • Not all opioids are available at a home birth so talk to your midwife about what you could have if you’re planning to give birth at home. In some areas, drugs like these are prescribed in advance by a GP. Remifentanil is not available at home or in a midwife led unit/birth centre.
  • It is possible to still use a birth pool or bath during labour, but not usually within two hours of a single dose of an opioid, or if you feel drowsy. Protocols vary so it’s good to check with your midwife if you are considering using a painkilling drug in labour.

Cons

  • Once you’ve had an injection of an opioid the effects last for up to four hours, so if you don’t like the sensation you can’t do anything about it. For instance, it may make you feel out of control, and feel sick. (This is not the case with remifentanil, as the drip can be turned off and the effects fade away more quickly.)
  • All opioids pass through to a baby and can occasionally make them slower to breathe at birth. This is particularly if your labour progresses more quickly than expected and your baby is born within two hours of you having the drug. (Effects on babies are less likely with a remifentanyl infusion than they are with the other opioids because remifentanil is active in the body for a much shorter amount of time.)
  • Your baby may also stay sleepy for several days, making breastfeeding harder to establish.

 

Epidural

Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back. It usually removes all pain and most feeling from the waist down.

The combined spinal epidural (CSE) injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. At the same time, the anaesthetist will insert a catheter into your bladder. When the mini-spinal injection starts to wear off, your anaesthetist will pass the epidural solution through the tube to give ongoing pain relief. 

Pros

  • It gives total pain relief in 90% of cases; partial pain relief in the remainder.
  • Top-ups can usually be given by an experienced midwife once the epidural is in place so you don’t need to wait for an anaesthetist.
  • You may still be aware of your contractions, and have a clear mind, but you'll feel no pain.

Cons

  • Epidurals are only available in obstetrician-led maternity units.
  • Labour may slow down as you’ll be less able to move around.
  • It takes about 20 minutes to insert and set up and another 20 minutes to work once injected. 
  • You may not feel contractions or – later on – the baby moving down so there is an increased chance of needing forceps or suction (ventouse) to help the baby out.
  • Having an epidural will mean increased monitoring for mum and baby. 
  • A catheter might need to be inserted to empty the bladder (as you won’t feel when you need to wee) and have a drip to help if your blood pressure drops.
  • Some low-dose (mobile) epidurals now contain less anaesthetic but include a small amount of fentanyl, an opioid drug. The fentanyl makes the epidural really effective without taking away all of your mobility but the fentanyl might cross the placenta and make baby sleepy. It’s hard to say how much of a problem this is but there have been studies showing different feeding behaviours in babies born after low-dose epidurals were used. 

 

Do what feels best for you

Every labour is different and each woman should choose whatever she needs to help her work with the pain of labour.  Most importantly, have confidence that you can do it.

Further information

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

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

NHS Choices guide to pain relief.

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 before birth.