Pain relief

You might be keen on having your baby at a birth centre (midwife-led unit) but you’re unsure about the pain relief options. Here’s what you can expect

For lots of women, midwife-led units or birth centres are the ideal places to give birth. They’re less ‘medical’ than a hospital but with more support and back-up than you might think you’d get at a home birth.

It's also worth knowing that:

  • Women who plan to give birth at home or in a birth centre have higher rates of vaginal birth, even when they're transferred to hospital (Scarf et al, 2019).
  • Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births and nearly six times as high in planned home births (Homer et al, 2019).

You’ll probably want to know exactly what pain relief is available at midwife-led units. And whether you can get more if needed. Or is it too late by then because you’ve not opted for a hospital? We break it down for you.

Epidurals

They aren’t available outside of hospitals because there needs to be an anaesthetist around to give you an epidural. Midwife-led units and birth centres are staffed 100% by midwives.

It might be a good idea to chat through epidurals with your midwife before you give birth. This might help you to decide whether the lack of epidural option makes a difference to you or stresses you out (NHS, 2015).  

Another option is to have your baby in an alongside birth centre, if you have one available near you. Alongside birth centres are on the same sites as hospital labour wards. That means you can be transferred easily if you do need or want an epidural (Which?, 2018).

If you’re not in an alongside unit, you can be transferred from any midwife-led unit or birth centre to hospital for an epidural too. Your midwife might even phone ahead so you get it as soon as possible.

Gas and air (Entonox)

You inhale gas and air through a mouthpiece and it’s available readily at midwife-led units or birth centres. While it might not take the pain away completely, for a lot of women it dials it down a rung or… eight.

Gas and air also has the benefit of having no risks for you or the baby. On the other hand, it can make you a bit lightheaded or sick (OAA, 2018).

Pethidine and other injected opiates

These drugs are also available at midwife-led units or birth centres. They relax your muscles and can make you feel sleepy, confused or like you’ve had one too many glasses of wine.

Some women love it and feel less anxious. Others find it doesn’t do that much for their pain and can make them feel nauseous, helpless or out of control.

Pethidine and other opiates might also make your baby sleepier and slower to start breastfeeding after they’re born. Talk to your midwife about whether these drugs are the right pain relief for you (OAA, 2018).

Water in a birth pool

Hopping into a birth pool during labour can be a brilliant pain reliever (Cluett et al, 2018) and it can be beneficial to birth your baby in the water too. One study found that birthing in water made it less likely that babies would need to be admitted to special care and women were less likely to suffer perineal tears (Sidebottom et al, 2020).

It can help you chill out and it’s just as safe as giving birth out of water (Cluett et al, 2018; OAA, 2018, Sidebottom et al, 2020). Just check out whether your midwife-led unit or birth centre has birthing pools before you go in. They should be well equipped for water births.

TENS (transcutaneous electronic nerve stimulation) machine

Passes a gentle electric current through pads on your back that can help to reduce pain (NHS, 2018).

You can happily use TENS at midwife-led units or birth centres but not all of them have them. Find out in advance whether they have TENS machines although you can always buy or hire one.

Complementary therapies

Bonus: some birth centres offer complementary therapies like acupuncture or acupressure which have been shown to provide significant pain relief during labour (Raana & Fan, 2020, Smith et al, 2020). This can help you chill out, make contractions feel less painful and reduce the likelihood of you needing stronger pain relief (Smith, 2006; OAA, 2018).

Birth centres are also likely to support hypnobirthing, aromatherapy and reflexology. You might need to arrange for some training in advance and/or a therapist to be with you in labour (OAA, 2018).

A review of these sorts of hypnosis-based interventions during pregnancy found that they improved the childbirth experience, by alleviating fear and pain and enhancing a sense of control.

They improved women's emotional experience and outlook towards birth with less anxiety, increased satisfaction, fewer birth interventions, more postnatal wellbeing and a better childbirth experience overall (Catsaros, 2020). Other research has found that levels of fear and anxiety around birth are lower in women who use hypnosis techniques (Downe et al, 2015).

Self-help techniques

At a midwife-led unit or birth centre, you’ll also be encouraged to use self-help techniques to manage your pain when you’re in labour.

These can include:

  • using different positions to get comfy
  • movements like swaying, walking, dancing, circling your hips, and other upright positions that can help your baby’s head to come down
  • focusing on breathing out very slowly, panting or blowing
  • singing, moaning or humming
  • distractions like TV or listening to music
  • massages (step forward birth partners)
  • relaxation techniques.

Some of these are most useful in the early stages. Other self-help techniques like warm water, movement and focusing on your breathing can work all the way through (Lawrence, 2009; Cluett, 2018; Smith, 2018).

This page was last reviewed in April 2021.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 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.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

The NHS Maternity unit search (NHS, 2020) can help you to find services, contact details and information. You can contact each unit directly to find out how to book a tour of your birth centre if they are offered, where you can ask questions about what kinds of pain relief are available.

Catsaros S, Wendland J. (2020) Hypnosis-based interventions during pregnancy and childbirth and their impact on women’s childbirth experience: A systematic review. Midwifery. Available at: https://doi.org/10.1016/j.midw.2020.102666 [Accessed 23rd March 2021]. 

Cluett E, Burns E, Cuthbert A. (2018) Immersion in water in labour and birth. Available from: http://www.cochrane.org/CD000111/PREG_immersion-water-labour-and-birth [Accessed 1st April 2021].

Downe S, Finlayson K, Melvin C, Spiby H, Ali S, Diggle P, et al. (2015) Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG. 122(9):1226-1234. Available at: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.13433 [Accessed 23rd13th September March 202118]. 

Homer C, Cheah S, Rossiter C, Dahlen H, Ellwood D, Foureur M, Forster D, McLachan H, Oats J, Sibbritt D, Thornton C, Scarf V. (2019) Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study. BMJ. Available from: https://bmjopen.bmj.com/content/bmjopen/9/10/e029192.full.pdf [Accessed 1st April 2021]. 

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. (2009) Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. (2):CD003934. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003934.pub3… Cochrane Database of Systematic Reviews [Accessed 1st April 2021].

NHS. (2015) Where to give birth? Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/ [Accessed 1st April 2021].

NHS. (2018) TENS (transcutaneous electrical nerve stimulation). Available from: https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/ [Accessed 1st April 2021].

NHS. (2020) Find Maternity services services. Available from: https://www.nhs.uk/Service-Search/other-services/Maternity%20services/LocationSearch/1802 [Accessed 1st April 2021]. 

OAA. (2018) FAQs pain relief. Available from: http://www.labourpains.com/UI/Content/Content.aspx?ID=29 ] [Accessed 1st April 2021].

Raana & Fan (2020). The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice 39: 101126 

Sidebottom et al (2020). Maternal and neonatal outcomes in hospital-based deliveries with water immersion. Obstetrics & Gynecology 136(4): 707-15. 

Scarf V, Rossiter C, Vedam S, Dahlen H, Ellwood D, Forster D, Foureur M, McLachan H, Oats F, Sibbritt D, Thornton C, Homer C. (2018) Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery. Available from https://www.sciencedirect.com/science/article/pii/S0266613818300974. [Accessed 1st April 2021]. 

Smith A, Collins C, Cyna A, Crowther C. (2006) Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev. (4):CD003521 Available from:https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003521.pub2… [Accessed 1st April 2021].

Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. (2018) Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. (3):CD009514. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009514.pub2/full]  [Accessed 1st April 2021].

Which? (2018) Pain relief during labour: what’s available? Available from: https://www.which.co.uk/birth-choice/coping-with-pain-in-labour/pain-relief-during-labour-whats-available [Accessed 1st April 2021].

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