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During labour and birth, there are various pain relief options available. The options available can all vary, depending on where you are planning to give birth. Each comes with their own advantages and disadvantages. The list below will hopefully help you to make your own informed decision about pain relief options during childbirth.

Entonox (Gas and Air)

This is a mixture of oxygen and nitrous oxide gas. You breathe in the gas and air through a mask or mouthpiece, just as a contraction starts.

Advantages Disadvantages
No harmful side effects for mother or baby Can make you feel lightheaded
It is quick to work and only takes 15-20 seconds to take effect, by taking slow deep breathes as the contractions start. Can make you feel sick, sleepy or find it hard to concentrate
The mother is in control, using it by themselves and can stop and start whenever they want. It only reduces the pain and does not fully take the pain away. Some women find that they need additional pain relief
Once you stop breathing in the gas and air, it leaves the body quickly. If you experience any negative side effects, this can quickly be resolved. The effects are short lived
An increase in oxygen from the mother can benefit the baby Can cause a dry mouth
Best to use Entonox when labour is fully established (when the cervix is 4cm dilated) and is not highly effective if used over a long period of time

Epidural

An epidural is a local anaesthetic and painkiller that is inserted into the back, using a fine tube. Spinal blocks are similar to epidurals and they are given in the same way, but they offer immediate pain relief. These are often used for emergency caesareans or complicated births.

Advantages Disadvantages
Particularly good at removing pain, by numbing the nerves. Only 1 in 10 women will need additional pain relief Takes about 10 minutes to administer and a further 10-15 minutes to work. Does not always perfectly work first time.
Only numbed from the waist down, so you are awake during labour Might not be suitable if you have pre-existing conditions, blood clotting issues, high blood pressure or a high BMI.
Does not usually make you feel drowsy or sick Can cause difficulties when passing urine after the epidural has worn off
Little or no effect on the baby Can cause a bad headache that can last for several days or weeks, if not treated
Useful during long, tiring and particularly painful labours Can cause a high temperature and maybe a sign of infection
Mobile epidurals or a lower-dose epidurals (only available in some hospitals), mean that you will still be able to have some sensation during birth and can move around, but this also means that you will still have some discomfort.

 

Unable to keep active during labour and will be assigned to the bed and monitored. Will need a catheter to drain the bladder and a drip to keep hydrated.
Severe complications (very rare)
Itchiness and depressed breathing
An increased risk of an assisted birth
Can slow labour down and might increase the need for synthetic oxytocin (drip) to make the contractions stronger
Higher chance of needing a caesarean
Can affect breastfeeding straight after birth if interventions or an assisted delivery is required.
Can cause temporary nerve damage (low chance)
Not suitable to be administered in very early labour or very late labour
Only suitable to be used in hospital
Sometimes a clip needs to be inserted into the vagina and attached to the baby’s head for extra monitoring.
Might make your legs feel heavy
Can cause blood pressure to drop, but this is rare
Can cause an area of soreness in the back, at the sight of the injection. This lasts about 1-2 days. Does not usually cause long-term backache.

General Anaesthetic

A general anaesthetic means that you will need to go to theatre and you will be asleep when your baby is born. General anaesthetic is usually only used for caesarean sections, when an epidural or spinal block is not suitable or it is an emergency.

Advantages Disadvantages
A quick acting pain relief and can be given in an emergency Your birth partner will not be able to be with you in theatre
An alternative anaesthetic to an epidural or spinal block (regional anaesthetic) You may feel sore or sick afterwards
  Be drowsy for a while
  Will miss the birth of your baby
  You will need strong pain killers as soon as you wake up
  Baby can be quite sleepy afterwards

Pethidine or Diamorphine

This is an injection of medicine, that is inserted into the thigh or buttock to relieve pain.

Advantages Disadvantages
Helps you to relax It can take 20 minutes to work
The effects only last 2-4 hours
Not recommended when the mother is close to the second stage of labour (ready to push)
Can make you feel sick, dizzy or forgetful
If given too late in labour and near to the time of delivery, it can effect the baby’s breathing.
It can interfere with the baby’s first feed

Paracetamol

Paracetamol can be useful in early labour.

Advantages Disadvantages
Can reduce pain in early labour
No negative effects on mother or baby

Water (Pool or bath)

Water births are a good natural form of pain relief. The water is kept at a comfortable temperature, not ever getting above 37.5 degrees and the mother’s body temperature is also monitored hourly.

Advantages Disadvantages
Helps the mother to relax, feel secure and make the contractions seem less painful If the mother develops a high temperature, pulse, blood pressure or vaginal bleeding, you will be advised to get out of the water. This also applies if the baby’s heart rate changes or meconium (baby poo) is found in the water
You can move easily, into a comfortable position and takes pressure off your back and pelvis You can not use epidurals, pethidine or TENS machine in water
You are in control and can get in and out of the water whenever you want  
Many women describe a water birth as a positive birth experience  
Less need for other pain relief options, as the pain threshold increases in water and water is likely to shorten the first stage of labour. If additional pain relief is required, Entonox can be used in water  
Your birth partner can give you a relaxing massage  
Baby’s are often born more relaxed and less traumatised when born in water, as the water can feel comforting and reminds them of the womb.  
Evidence to suggest a reduced risk of tearing  

Hot water Bottle/ Wheat bag

Hot water bottles or wheat bags are a great natural pain relief for women, when in labour. Hot water bottles should not be too hot, so do not fill them with boiling water and make sure that they are wrapped in a soft cloth or towel before using it.

Advantages Disadvantages
Warmth is a great way to relaxing aching, tense muscles. Not as effective in later stages of labour, when the contractions become stronger
Natural pain relief, with no side effects for mother or baby Will need to be regularly refilled when the water goes cold

Hypnobirthing/ Breathing Techniques

Hypnobirthing helps women get to a state of deep relaxation during labour, using positive visualisation, relaxation techniques and self-hypnosis.

Advantages Disadvantages
A natural form of pain relief, with no negative side effects to the mother or baby Works best if the techniques are practiced in advance of labour
Helps eliminate the fear of pain during childbirth Some mothers find it confusing or difficult to use structured breathing techniques
Less likely to need other forms of pain relief
Have a shorter labour and less likely to need interventions
Rhythmic breathing helps conserve your energy, feel calmer and ease any pain
Feel more in control, focused and can help mothers manage the pain better
Remain conscious and attentive throughout the birthing process and have a positive birth experience
Increases the release of endorphins and takes away the fear, tension, pain cycle
Increased oxygen for the baby, reducing any foetal distress
Can be used alongside any other forms of pain relief, including during epidurals or caesareans.

Massage

Massage is a great way to help keep you calm and cope with any labour pains. Your birth partner could massage the base of your lower back between contractions or your shoulders.  Some women find a foot massage or hand massage to be relaxing and calming too.

Advantages Disadvantages
A slow massage, with firm pressure will help stimulate your body to release endorphins and relax Can make some women uncomfortable and not want to be touched when in labour. It can distract them from being able to focus
Touch and massage are soothing, it promotes circulation and relaxation Birth partner might not apply the right pressure or have the correct technique to ease the pain
Can be used in conjunction with pregnancy approved essential oils Not as easy to do if the mother is in water or using a TENS machine
Immediate effect

TENS Machine (Transcutaneous Electrical Nerve Stimulation)

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

Advantages Disadvantages
Can be a good distraction from the pain and provides the woman with control, reducing anxiety Some women might find the machine irritating or dislike the sensation
Can be used by anyone, regardless of any other medical conditions Benefits are mainly seen in early labour and not as useful in later stages of labour (active labour)
No side effects for mother or baby Will need support from birth partner to apply the sticky pads and to have read the instruction manual in advance of labour, to know where to apply the pads and how to use the machine
Does not increase the length of labour or increase any risk of intervention Not possible to receive a back massage whilst the TENS machine is in place on the back

 

 

Can be stopped at any time if the woman does not like the sensation or would like to try another form of pain relief Cannot be used in water
Can be used alongside Entonox, pethidine, or diamorphine Need to be bought (can be expensive) or hired. Some hospitals can provide them, but only if there are some available
Allows the woman to remain active and move around It can take some time before the effects are felt. Around 20 minutes before endorphins kick in
Particularly useful for back pain in early labour

Active Birth Positions

Keeping active and upright during labour can help labour progress. During the first stage of labour, being active can help by using gravity to encourage your baby into the birth canal. Birthing balls, chairs, walls, mats, partners, and pillows are all useful tools to help progress labour. During the second stage of labour, remaining upright can also advance labour, by helping your pelvis to open and use gravity to encourage the baby out. Squatting and kneeling are good positions during the second stage.

Advantages Disadvantages
Rocking, swaying, walking and leaning forwards helps advance labour, by using gravity to move the baby into the birth canal. The pressure of the baby’s head on the cervix will promote the release of oxytocin and endorphins Can be tiring. Try not to overdo it. Try save your energy for when you are in active labour. Try taking a break, laying on your side for a while, using pillows to support you
A natural pain relief, with no side effects for mother or baby Might not be enough to reduce the pain
Less likely to need an epidural or caesarean Space might be limited
Mother remains in control
By staying off her back, this increases the amount of oxygen the baby receives, reducing the possibility of foetal distress