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Labour & birth

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Pain relief in labour: an overview

Expectant mums now have a wide range of choice when it comes to coping with labour, whether through medical relief, alternative therapies or both

Posted: 5 November 2009
by Maria Muennich

While there are many different kinds of birthing experience it's fair to say that, however labour pans out, it is usually an incredibly intense, emotional and eventually euphoric experience, but one that's rarely completely pain-free. It makes sense then, to have a good think about the various pain-relief options that may be available to you during labour well in advance.

Mums-to-be approach pain relief in labour with varying expectations, apprehensions and emotions. Some will want to take any pain relief that's offered if it will minimise the pain they experience, others will want to get some relief, but may be concerned about compromising their control over the birth, and yet others will be determined to go it alone and to feel every physical sensation that birth entails.

The good news is that advances in both medical technologies and alternative forms of pain relief mean that these days expectant mums have a range of pain relief choices, whether you are open to medical pain relief - such as gas and air, an epidural - or hope to rely solely on alternative therapies - for instance, water therapy, aromatherapy and massage.

Medical pain relief
When the topic of medical pain relief comes up, many people think immediately of epidurals or chemical pain relievers such as pethidine. However, increasingly popular now to take the edge off pain are both gas and air and TENS machines, which are less powerful pain relievers but leave you in more control over your labour and can be stopped at any time if you don't get on with them.

These are the most common forms of medical pain relief, in a nutshell. Click on the name or use the 'find out more' link for details and the advantages and drawbacks of each.

TENS - Transcutaneous Electrical Nerve Stimulation - you can see why they shorten it - sends electrical signals to nerve endings in your skin to block out the transmission of pain to your brain. Find out more...

Entonox, or gas and air - Called gas and air, but actually a 50-50 mix of oxygen and nitrous oxide (an anaesthetic otherwise known as laughing gas) inhaled through a mouth-piece. Dampens pain and may leave you feeling lightheaded and laughing. Find out more...

Epidural - A highly effective anaesthetic-analgesic mix delivered to the spine via a fine tube inserted under local anaesthetic which allows you to remain conscious while effectively blocking labour pains. Can be topped up throughout labour or used solely as a means of providing temporary respite. Find out more...

Spinal block - Similar to an epidural but faster to adminster and so may be used in emergencies or when time is otherwise tight. A local anaesthetic is injected into the spinal fluid using a fine needle. Unlike epidurals, spinals cannot be topped up. Find out more...

Pethidine (Morpine) - Derived from morphine, pethidine is an analgesic (pain killer) that also helps you relax. It is usually administered via injection but may also be given intravenously. Find out more...

Meptid - A pain killer that may be offered as an alternative to pethidine.

Local anaesthetics - Local anaesthetics may be used if you need an episiotomy or have a tear and require stitching down below.

'Alternative' pain relief
Non-medical pain relief is becoming increasingly widely accepted and promoted by birthing professionals in the UK. In many cases it is now used alongside medical pain relief to ease the experience of labour, and not just as a tree-hugging alternative. However, attitudes can vary widely and so can services offered: You may find your hospital offers acupuncture or a birthing pool, or their interest in alternative therapies may start and end with allowing you to burn aromatherapy oils in the labour room, if that!

Here's an overview of the most common alternative therapies:

Waterbirth / water therapy - Just as you use a long soak in the bath to relax your body and ease aches and pains, water can help ease pain and discomfort in childbirth. Depending on how labour is progressing you may be able to use water for early-stage pain relief or right through to birth. Find out more...

Aromatherapy - The power of essential oils as relaxants and stimulants is well-known. Various oils may be used to ease labour discomforts either burned in a vaporiser or directly applied to the body through massage. Find out more...

Massage - Massage can be of great help in helping deal with early labour pains, not least because of the sense of support and intimacy from your birthing partner giving the massage, but also because of the oils that can be used. Find out more...

Homeopathy - Some doctors in the UK dismiss homeopathy out of hand as 'quack medicine' others see it as highly complementary to traditional medicines. It can be used alone or in combination with other pain relief options. Find out more...

Acupuncture & reflexology - Acupuncture is becoming increasingly well respected in medical circles and works in a similar way to the TENS machine. Pressure is applied to different acupuncture points in order to block the transmission of pain. Advanced acupucture using needles can only be administered by a trained acupuncturist. Find out more...

Availability & expectations
It's important to be aware that exactly what pain relief options are open to you on the day will depend on where you choose to give birth. For example, an epidural requires the presence of an anaesthetist and so isn't an option for home births or most birthing centres, but is usually available at hospitals. Conversely a birthing pool or other alternative therapies may not be available in all hospitals, but birthing pools are common in birthing centres and can be bought or hired for home use. Likewise gas and air and TENS machines, though popular, aren't necessarily available on all labour wards, although TENS machines can easily be hired if one isn't available where you choose to give birth.

So, if you have your mind set on a certain form of pain relief, do check that it's available to you when you visit potential birthing places.

Whether you want to try and manage with only 'natural' pain relief or you're keen to sign up straight away for an epidural, it's worth remembering that women can have very different responses to the varying treatments and therapies: what's one woman's pain relief holy grail can leave another woman cold. It's a good idea to think about the options in advance and have preferences, but do try to keep a reasonably open mind in case your chosen methods don't provide the relief you expected, or in case they're not suitable for use as your labour progresses.

Previous article:
Depression in pregnancy: new report

Using TENS in labour

Discuss this story

Maria

That's a look at the main options for mums-to-be, but it'd be great to hear about your experiences with the different forms of relief on offer, whatever you used. If you have general observations on pain relief in labour then here's the place, if you want to add your experiences with specific medicines or therapies then please do comment in forum threads at the bottom of the specific articles.

Looking forward to hearing abour your experiences and opinions!
Posted: 13/02/2006 16:20

Sabrina

i found tens really good with my first baby, you just need to make sure that it sure that it stays on at all time and stays sucure. else it stops working.

good luck.
Posted: 20/02/2006 17:02

Laura Davies

I agree, I thought TENS was great for pain relief but you do need to get it on early otherwise it's more of an annoyance.
Posted: 21/02/2006 15:44

Bernice

I had gas and air but I just found it was a distraction. It's weird, because my mum had all three of us on gas and air at home! And my sister really found it good and didn't need anything else.
I liked TENS for the contractions etc but then I ended up having an epidural as well. At first I felt like I was giving in to pain relief, but my labour had been long and I needed to be able to rest. It didn't completely cut out the last stage pains, but it did let me rest a bit and get the strength to stay the course!
Posted: 23/03/2006 15:11

Libby

I also had a tens m/c which was good but my pains got quite bad and started using gas and air which I found helped (but it did make me feel and be sick) then after 11 hrs or so I had pethadin (which was great as I actually got a little bit of sleep during the day. My midwife saw me throughout the day and in the end she said I should have an epidural as she agreed it would be better for me. Unfortunately the doctor was really busy that night and I had to wait ages for it to be fitted but once it was the relief was fantastic. I could still feel what was going on but without the pain and I'm glad I had it. I hadn't set out to have all of it but sometimes thats just how it works out. My daughter was then born at 1.15am (after waiting for over 26 hrs to appear). The best bit was that I could sleep afterwards!! Hope this helps and hasn't put you off!
Posted: 23/03/2006 19:35

Lucy Beal

hi maria,

all i can say is you'll know when it happens what you want to have!

i was addiment i would NOT have an epidural but ended up having one!

i tried gas and air but it made me feel light headed and sick.

i also had a pethidine injection but i felt out of it and not in contol at all.

Don't feel like you have to take the pain, you don't win any medals for going through pain,

one thing no one had told me when looking at pain relief was that if you have an epidrual you can still have a pocket of pain, i had it in my right hip after having mine but later found that my baby's head wasn't engaged properly and was pushing it out.

i was upset at first i felt i'd let myself my partner and little mathew down because i had a c section but now i realise it wasn't my fault, just remember what you want to happen doesn't always come true.

4 months on and it was all worth it! hope this helps. x
Posted: 24/03/2006 20:30

linziNollie

I only had gas and air i thought it was amazing that good i couldnt feel contractions at all so when it was pushing time i had to be told when they were coming lol xxx
Posted: 21/04/2006 21:28

mummy

i think its impossible to plan ahead or completely rule something out. i thought i was just going to have gas and air but ended up having epidural-fantastic stuff, i wanted to bring some home, lol-seriously though it really hurt and i couldnt cope with the pain without epidural! and im planning to do it all again. i'm asking for epidural first next time.
x x x
Posted: 21/04/2006 22:14

mummyGoth

I tried gas and air- made me sick!

I had 2 shots of pethedine, The first injection managed to keep the contractions from getting worse, which was good, but I was hoping for more of a numbing effect! The second injection didn't do anything at all!

Then I had an epidural- which once they put it in right worked like a dream! So much so I fell asleep!!

I would be open minded with regards to pain relief in labour, you really don't know until it happens how well you will cope! And like Lucy said- you don't get any medals for putting yourself through agony!
Having a baby should be an enjoyable experience, if you want pain relief ask for it. Don't feel ashamed!
Posted: 22/04/2006 12:33

Ginny

I went in with an open mind. I had gas + air and spent some time in water although I opted for a "dry land" birth.

I am very fortunate to have an extremely high pain threshold and manage to get through mainly with positive thinking and mind-over-matter-type thoughts. Laughter, believe it or not, helped a great deal. The gas + air made me feel a bit sick and lightheaded and I had to stop using it because I kept slipping under the water!

This time I'm hoping to get through it just the same way - but again I'm keeping an open mind.

My only advice to anyone would be don't rule anything in as definite but don't rule anything out because each labour is different and you will not be able to tell what will work for you at that precise time.
Posted: 28/04/2006 16:10

Lisa Smith

I had a tens machine at home but found it next to useless (maybe I was using it wrong?) then gas and air when we got to the hospital, which I loved and wouldn't let go of!

The midwife broke my waters and the contractions intensified, so I asked for an epidural but by the time they'd moved me to another room and found an anaesthetist I was fully dilated so couldn't have it.

I was still in a lot of pain after the birth and had trouble delivering the placenta so was given pethidine, which did the trick but made me really spaced out - I remember laughing hysterically whilst being stitched up!

This time around I'm planning a home water birth and am hoping to feel more in control of the whole experience.

Just one more thing to say - within a couple of hours of the birth I absolutely knew that I'd do it all over again without any pain relief at all for such a fantastic result!

Posted: 30/04/2006 11:27

Harriet Harris

I used gas & air for most of my labour and then pethidine which knocked me out completely - I have no recollection of the last 4 cm's at all. Was mostly awake and with it during the pushing - which was a completely different sensation and I didn't use any pain relief for that part. Going to try water and g&a this time.
Posted: 02/05/2006 12:01

Melanie Pegler

I was etermined to have as few drugs as possible for the birth of Georgina, who finally arrived four weeks ago after being induced, I ended up having one of everything on offer during the worst fourteen hours of my life!
I would highly recommend a TENS machine, it works wonders and in the early stages of the labour helped me keep my mind off the pain whilst fiddling with the knobs, try and get one with a booster button too!
I had pethadine, witch did help the pain for a couple of hours, but it made me feel really drunk and i did seem to be drifting out of relaity a little, i guess it was not for me.
The gas and air was good but if you over do it you can feel aginquite drunk from the effects, but the fact it made my nose tingle was amusing at the time!, and again a distraction.
I also had a drug called Meptid which is a lot like pethadine but without the sickness effect, and i would say i highly recommend that although I understand its not available at every hospital as it is costly compared to pethadine, but it can be given much nearer the end of the labour as it has less affect on the baby too.

Finally I had an epidural, which I had really not wanted, All i can say about that is do your research before agreeing to one. Mine went wrong and left me with numb legs but a huge burning sensation all over my abdomen and the feeling that somone had dropped a house on me, and made the pain worse. I also ended up with a side effect called a dural tap, which is where the needle puncturse the spinal membrane allowing fluid to leak out causing terrible headaches for about a week meaning I was unable to look after my baby, Apparently this side affect can happen in up to one percent of cases, and is only cuarable by waiting for the effect to wear off or having a second epidural another day where they put your own blood into your spine to clot and plug the hole created, I had this done twice and neither worked. Epiduarals can also make the labour longer as you may have to wait for some of the effect to wear off before you can start pushing.
In retrospect I would advise try to use as few drugs as possible, stepping up to the next when you really feel you need it, but if at all possible, avoid epidurals, it may help during labour but it can cause loads of long lasting side effects which could ruin your first few days with your baby!
Posted: 05/05/2006 22:28

Lisa Smith

Melanie that's awful, I knew there could be side effects to epidurals but never realised the extent of them - you were so unlucky!
Posted: 06/05/2006 07:06

Melanie Pegler

I was unlucky to have the additional pain and the dural tap (The puncture of the spine causing the pain after) as these two effects are not necessaraly related, but the side effects are there and not widely known about. I was given no information at all from midwives or the hospital prior the the birth of Georgina. I don't want to scare anyone but I would have prefered to have been better informed, so I wanted to share my experiances.
Posted: 06/05/2006 22:00

Melanie+Bump

It's been really interesting to read this thread.

I'm due in 15 weeks time and already have a birth plan made up (in my head!), although I'm calling it more of a 'Birth Wish List' as if something doesn't go to my plan, I don't want to beat myself up over it.

Am hoping to get through with TENS, remembering what my Hypnobirthing cd's said and a sense of humour! Am open to gas and air but would ideally, after doing a lot of research, like to avoid pethidine and epidurals!

Mind you, let's just see what happens on the day!!
Posted: 10/07/2006 17:11

mosschops

Hello all ,i found this interesting as i have just had a met with my midwife and our practice nurse who both have quite different and definate ideas what a first time mother should have and consider,it left me feeling a little dazed,the only thing i can remember is that if i want an epidural i need to book a week in advance of my date.My poor partner was just as bogled as me!
Posted: 10/07/2006 18:04

Scribbler 9/5/06

Seeing what happens on the day is a good plan - can't believe they expect you to book an epidural in advance mosschops, how on earth are you supposed to know whether you'll need one or not?

My birth went nothing like how I had envisioned it, but in the end I was very pleased with how it was. I was in there for a long time and tried labouring in the birthing pool, all kinds of contraction intensifiers (including an enema- yuk!) and when I wasn't dilating at all after over 16 hours of intense contractions I had an epidural and then acupuncture and homeopathy to try to encourage dilation - it did work eventually. I didn't have pain relief apart from the birthing pool until the epidural as they don't use gas and air and tens here.

I was lucky and escaped a c-section (just) but I was fully prepared for the possibility mentally, and you just need to remember that the most important thing is that the baby comes out healthily and you're ok too, not whether or not you get the perfect birth you had envisioned before-hand.
Posted: 11/07/2006 09:02

Scribbler 9/5/06

Oh, I should say that it was after acupuncture and homeopathy and when they turned the oxytocin drip down that I eventually started to dilate and a natural birth became part of the picture again. I don't know what the homeopathic treatment was, but most of the midwives here are trained in acupuncture, homeopathy and aromatherapy and they seem to find them useful tools in childbirth - don't know if that's why they don't use gas and air, pethidine etc.
Posted: 11/07/2006 09:06

Melanie+Bump

Wow, it'd be fantastic if they did acupuncture, homeopathy and aromatherapy here instead of resorting to 'drug' drugs (if you know what I mean?).

How mad aswell that in some places you actually have to book an epidural in advance!! If I had an epidural in mind and hadn't ruled one out, I'd book it and see how you felt on the day, see if you really needed it or not. Better to have it and refuse it than need it and not have it available!
Posted: 11/07/2006 20:58

sarah jane

Hi everyone,

Has anyone had or planning to have a water birth? My partner thinks I'm crazy, but I'm really starting to think it's the best plan. I know it will never happen like I want it to, but I want the birth to be as quick and pain free as possible and from what I've read gas and air and a water birth are a good combination of pain relief, without slowing up the birth too much.

Alternative treatments also sound good Scribbler, but I dont think they offer them in my area.

Sarah
Posted: 19/07/2006 18:17

Katy Boyes

Hey everybody,

There were two things that i wanted when my son was born firstly i was adament i didn't want much pain relief and i wanted to breastfeed.

sooo... i had everything!! Why didn't anyone warn me that I am a wimp and labour hurts!! I was 10 days late and had to be induced as my son was a big baby (9lb 3oz to be exact!) i was induced at 6:45 am on tues 11th july and by 7 am i was having contractions every 2 mins! So they gave me some paracetamol. Then i had gas and air but made me feel so strange that it didn't seem to work (probably because i was sucking it when the contraction had passed!! Duh!!). My partner came up as soon as he could and put my tens machine on and that sensation mixed with the gas and air freaked me out so evey 10 mins i was saying take it off!! I then begged for a c section 2 hours in! What a wimp ay!! My excuse was i knew i wouldn't be able to have him normally. Ten i had pethadine which i didn't think worked but I'm sure my partner and my mum say different! I went on to labour ward and by now i had got used to the gas and air feeling but was still begging for a c section and an epidural! I had the epidural and to tell the truth the pain was so un bearale i don't really remember it (or prehaps that was the drugs!) however they didn't put it in the right place so they had to relocate it so I was in labour for 14 hours when they finally realised that the baby's head wasnt't dropping down and I'd have to have a c section! I told them 2 hours in how come no-one listens to you? I knew my body all the way through. I knew it was a boy, knew he'd be 9lb 3oz and i even knew I'd not have him naturally. However I'm quite glad I had so many drugs and it slowed the Labour down so much as my sons head was trapped at an angle and if I'd stuck to my guns and had no pain relief I'm sure it would have been a different story.
Posted: 12/08/2006 13:58

Katy Boyes

oh and if there is anyone out there who is as much of a wimp as me I'd definatly recommend an epidural as I even managed to get some sleep during labour! It really worked for me so then i was with it when my son was born and wasn't too tired

Posted: 12/08/2006 14:02

mosschops

Hello all I have opted for a water birth,some of my family think I'm nuts. I found wading through the choices with my partner and midwife a bit overwhelming,I think I eventually based my choice on my dislike of needles.I may end up having to have an epidural or some pain relief other than gas and air depends on how it goes I suppose.The baby will come out one way or another with 8 wks to go I'm not sure whether to be relieved it's almost over or panic in case it's going to really hurt!
Posted: 13/08/2006 13:34

Kerry Lockwood

I started off in the bath to ease my contractions once I got to hospital. Shortly afterwards I had the pethidine. I was still in pain but I couldn't be bothered to do anything about it. This was followed by the gas and air. I then had a mobile epidural which was topped up several times, which did nothing for me. I ended up with a full epidural but still had to use the gas and air as I was still feeling the contractions quite high up. I had to be told when to push - but by that time I was so tired that I didn't care. I am pregnant again and have got no idea what pain relief I want this time. I will just see how it goes.
Posted: 14/08/2006 10:36

R Gould

Hi, I too am fancying a water birth, but at my hospital it is on a first come first served basis, so knowing my luck somebody else will beat me to it! I am trying to keep an open mind about pain relief as am a wimp and usually faint if i'm in pain, so i'm going to have an intresting labour!!
Posted: 29/08/2006 13:46

haley15/8/06

Hi all,

well i had my baby 4 weeks ago (a boy keiran) and i was induced early because my body had been contracting for 7 weeks!

My babys birth happened really quick in the sense that the midwives weren't prepared.... my cervix was already flat against his head before i got the gel. i had 1mg at 8:20pm and by half past i was contracting very strongly, and because the midwives hadn't read my notes they didnt know about my cervix being fully efaced and gave me an injection of morphine to help me sleep at 10pm, well i got up at 3:30 am to pee and then they gave me another injection which just topped up the other one and made me totally out of it....and by 8am i was buzzing because the bed was soaking wet and baby was pretty much coming!

So my husband had only just arrived and i pushed baby out and hour later!!!

Personally the morphine did the trick because i slept through most of my contractions and had gas and air for the last hour or so when pushing.

To be honest if you cant handle pain well have morphine.... its good. But i wish i could have been more with it whilst contracting. So id say go for a water birth and gas and air!!!
Posted: 15/09/2006 14:25

Sandy

Hi has any1 experienced giving birth in a birthing pool? im due 29th sept with my 1st and am hoping to use 1 and was wondering what its like?
Sandy xxx
Posted: 18/09/2006 15:33

JULIA KELLY

Hi,
I wanted a very natural birth, including use of the birthing pool. That all went out the window when at 39 weeks my first decided to play up and my blood results were sky high, so abbey came by induction with an epidural after 4 hours, the pain was horrendous. I was induced at 37 weeks with sam due to unusual blood results again, the tablets didnt work so when the midwife put the second lot in she said i wouldnt be having him tonight, less then 45 minutes later sam was born, no time for pain relief, even though it hurt i think i was very lucky my contractions would last a minute with 30 seconds in between this lasted 7 minutes until sam was in my arms before my bed was put into place in my suite. I know the 3rd is going to be the same at least i did it once how i wanted, except the water part. I am not allowed to go into natural labour, but wish i could every time. On your birthing plans, list everythink you would like, if possible, also if someone else is using the hospital birthing pool you might not beable to cause i dont think they allow it to be used to many times a day because of cleaning it. I am putting down everything i would like such as an epidural, but things go out the window so dont set your heart on anything.
Posted: 18/09/2006 17:21

R Gould

Hi all, didn't get my water birth, charlotte decided to come 7 week early and I didn't faint, managed to do it all with gas and air, if I can do it anyone can, good luck all!!!

Posted: 20/09/2006 15:21

Melanie+Jack Oliver

Hiya all,

I didn't manage to get my natural birth that I wanted and had planned like a military operation for as I needed an emergency caesarean as I was in labour (didn't realise though!) and my little man was lying dangerously oblique and my waters were about to pop!

So, he was born through the sunroof, 5 days overdue on 2nd November 2006 weighing in at 9lbs 14oz!

The doctor thinks due to his size in comparison to mine I would've ended up in theatre anyway having a 3rd or 4th degree tear repaired so it was really the best option!

Maybe if I have any more I'll get my natural birth!! xxxxxxx
Posted: 18/11/2006 14:29

Danielle Mathias

Hi everyone. I am only 18 weeks (on friday) but i have decided already that i want an epidurual. My midwife said i can only have a mobile epidurual thou! and now im thinking because i have decided that i am having an epidurual that my birth plan is not going to go to plan and that the midwifes will turn me down for one!
Posted: 07/01/2007 23:00

michelle gilmour

Hi everyone

My son was due on the 26th August 06 and he decided that he was going to appear 3 weeks ealry. I was still at work, it was Friday 4th August i started getting cramps in the morning so phoned the Midwife to get an appointment to get checked out, plus i was seeing the Consultant later on that day as well. I meet with the Consultant and he told me that i was 3cm dilated.... So it was an Ambulance ride down to the Hospital in Paisley. Things progressed pretty quickly, i had a natural birth with gas and air.

I had thought out a birth plan aswell but things happened quickly for me that i just went with the flow.
Posted: 28/03/2007 20:04

Claza P

Gas & air made me be sick with first baby & could not have pethadine so I had a epidural for my 2 births. I am now 7 weeks & 4 days pregnant & plan to do the same this time. You can`t feel a thing from the waist down, why have pain when you don`t have to, but everyone is different.

Claire
Posted: 29/03/2007 14:51

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