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Key takeaways

• Labour pain is unique and different for everyone.
• Many options exist, from drug-free methods to medical relief.
• Discuss your pain relief choices with your midwife.
• Be flexible with your birth plan, as needs can change.

Understanding pain in labour

Labour pain can be difficult to manage, and everyone deals with it in their own way. There are many pain relief options available to help you, including self-help techniques and pain-relieving drugs.

Breathing and relaxation techniques can help you cope with pain. When you are relaxed, your body releases its own natural pain relievers called endorphins, which can help prevent pain from becoming too intense.

It is helpful to learn about all the ways you can relieve pain and write down your wishes in your birth plan. Remember to keep an open mind, as you and/or your baby’s needs might change during labour, and your midwife or doctor may also suggest different pain relief options.

Role of a supportive birth partner

It is helpful for your birth partner to know about the different pain relief options. They can support you and help you make choices. If you do not have a partner, your midwife will give you all the support you need.

Drug-free comfort measures

Self-help techniques are non-drug pain relievers. They can give you a feeling of empowerment during labour.

Breathing and relaxation techniques

Breathing and relaxation techniques help you cope with pain. They can prevent you from feeling overwhelmed.

Pain often feels worse when you are tense and anxious. Being relaxed helps your body release natural pain relievers (endorphins).

You can learn these techniques in your antenatal classes. Try breathing slowly in through your nose while counting to four. Then breathe slowly out through your mouth while counting to eight.

These techniques do not affect your baby. You can also use them alongside other pain relief methods.

Hypnobirthing

Hypnobirthing uses visualisation, relaxation, and deep breathing techniques. It helps you focus on your body and your baby's birth. Hypnobirthing can be used with all other types of pain relief. Some antenatal classes may teach some hypnobirthing techniques. If you are interested in this and would like more practice, you can go to specific classes that teach hypnobirthing.

Movement and changing positions

Moving and changing positions during labour can make things easier. Lying on your back is not always the best position. It may even slow labour down.

Moving around can help shorten your labour. It can also help you feel less pain. You may feel more in control of your labour.

Upright positions in the second stage of labour can shorten pushing time. Your midwife will support you to try different positions.

Birthing ball

A birthing ball is an inflatable, burst-resistant ball. Gently bouncing or rocking on it may help you relax and ease pain. Ask your midwife if birthing balls are available in your maternity unit.

You can use a birthing ball with other pain relief. It is useful for support in different labour positions.

Massage

Your birth partner can massage you during labour. Rubbing your back can help relieve pain. However, you may find that in different stages of your labour, you may not want to be touched.

Water immersion (bath or shower)

Being in water can help you relax. It can make contractions seem less painful. Ask your midwife if a bath or birth pool is available for your birth.

The water will be kept at a comfortable temperature, not above 37.5C. Your temperature will also be monitored.

Warm water feels soothing and makes it easier to move around. Labouring in water is advised if you and your baby are healthy. If you have had opioid pain relief, you will likely be advised to wait for the drugs to wear off before using a birth pool (see below).

TENS machine

You can use a small machine that sends gentle electrical pulses to your body to help with pain (transcutaneous electrical nerve stimulation, or TENS).

TENS machines deliver small electrical currents through pads placed on your back. This is believed to encourage your body to produce more natural pain relievers (endorphins). It also reduces the number of pain signals sent to your brain.

You place pads onto specific areas on your lower back. The machine runs a gentle electric current through the pads, giving you a tingling feeling that eases the pain. You use a handset to control and adjust the current.

TENS effectiveness and considerations

• TENS is most effective in the early stages of labour and may help with lower back pain.
• It is safe for you and your baby, with no known side effects.
• You can move around while using TENS and use other pain relief at the same time.
• You may need to hire or buy your own TENS machine; for best results, start using it early in your labour.
• You cannot use a TENS machine in a birthing pool, bath, or shower.
• It may not work for everyone.

Medical pain relief options

Gas and air (Entonox)

Gas and air is a mixture of oxygen and nitrous oxide gas. You breathe this in through a mask or mouthpiece. You hold the mask yourself.

Breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

• It takes the edge off the pain.
• It can help to regulate your breathing during contractions.
• It works quickly, in about 15 to 20 seconds.
• You are in control of it.
• You can use it at any time during labour.
• It can be used with other forms of pain relief.
• It does not affect your baby.
• You can stop using it, and the effects go away quickly.
• You can have it during a water birth.
• It does not get rid of all the pain.
• It may make your mouth feel dry.
• It can make you feel lightheaded, sick, or sleepy.
• Using it for more than 24 hours can reduce vitamin B12 levels.

Opioid injections (pethidine or diamorphine)

Opioid injections, such as pethidine or diamorphine, are strong painkillers. They are usually given as an injection into a large muscle, like your thigh or bottom.

They take about 15 to 20 minutes to work. The effects last between two and four hours.

• They may help you cope better with contractions.
• They can help you relax.
• You may be able to sleep through contractions.
• They are not suitable for late stages of labour.
• They can make you feel woozy, sick, and forgetful.
• You can be given other medication to help with sickness.
• They can sometimes make your baby a bit sleepy and affect their breathing right after birth. Your midwife will be watching for this and can give your baby help if needed.
• Your baby may be a bit drowsy after the birth, which can make getting started with breastfeeding a little tricky. Your midwife will be there to give you extra support.
• You cannot use a birthing pool for at least two hours after an injection.
• Your midwife or doctor might suggest not having them too close to the birth.

Epidural

An epidural is an injection of local anaesthetic into your back that numbs the lower part of your body. It numbs the nerves that carry pain messages to your brain.

This blocks the feeling of pain in your lower body. You can still feel someone touching you and the pressure as your baby is born.

An epidural is given by a specialist doctor called an anaesthetist. You are usually awake during the procedure. Before the procedure, you will often require a drip (also called a cannula) placed in your arm to give you fluids if required.

During the placement of an epidural you will likely be asked to sit down with your back as straight as possible so that a very thin tube (epidural catheter) can be passed into your back. Pain relief medicines are then given through this tube.

It takes about 10 minutes to set up the epidural. It then takes another 10 to 15 minutes for it to work.

The effect should continue until after your baby is born and any stitching is done. You can only have an epidural in an obstetric unit (labour ward).

• It is considered the most effective form of pain relief.
• It does not make you sleepy.
• It is safe for your baby.
• You can breastfeed as normal.
• You can usually have an epidural at any point. However, if you are in the very final stages of your labour it may not be logistically possible for you to get this on time.
• It is not linked to a longer first stage of labour.
• It is not linked to an increased chance of a caesarean section.
• It is not linked to long-term backache.
• You and your baby will need to be monitored more closely.
• Your blood pressure will be checked regularly.
• Your contractions and your baby's heartbeat will be monitored continuously.
• About 1 in 10 epidurals do not work perfectly at first.
• It may need adjusting or replacing.
• It can make your legs feel numb or heavy, which in turn can make it harder for you to push during the second stage of labour..
• It can make the second stage of labour last longer.
• You may need a tube (catheter) to help you pass urine.
• Your blood pressure can drop, but this is rare.
• In about 1 in 100 cases, it can cause a severe headache that may need treatment.
• A long-lasting nerve injury is very rare.
• Some hospitals offer mobile epidurals, which may allow you to walk. Remote monitoring of your baby's heart rate is required.
• Ask your midwife if mobile epidurals are available at your hospital.
• You may not be able to have an epidural if you have certain health conditions. Your midwife or doctor might suggest an epidural if you have a long labour, high blood pressure, or other medical issues.

Making your pain relief plan

It is worth thinking about how you will manage pain before labour starts. Learn how pain relief works and how long it takes to be effective. This is helpful when making choices during labour when it is harder to think clearly.

Talk to your midwife or doctor about what is available and ask them questions. It is helpful to go to antenatal classes as pain relief options are discussed there. Write your preferences in your birth plan, and ensure your birth partner also knows what you want.

It is important to keep an open mind about your plan, as you and/or your baby’s needs can change during labour. Remember that it is completely fine to change your mind during labour or find that you want more pain relief than you had planned.

Do whatever is best for you at the time. Being calm and relaxed can lead to an easier birth, while stress and tension can make contractions feel more painful.