Pain Relief During Labour

Every labour is different, and there is no “right” way to manage labour pain. Some women use breathing and relaxation techniques throughout labour, while others choose medical pain relief such as Entonox, pethidine or an epidural. Many women use a combination of different methods.

Your midwife and doctor will discuss the options available to you and help you choose the pain relief that best suits your needs. Remember, you can change your mind at any stage of labour.

Natural Pain Relief

Many women find that simple techniques can help them cope with labour, particularly during early labour.

Breathing and Relaxation

Learning breathing and relaxation techniques during pregnancy can help you stay calm and work with your contractions.

Benefits include:

* Helping you stay relaxed
* Reducing anxiety and tension
* Conserving energy during labour
* Helping you cope with contractions

Slow, steady breathing and focusing on relaxing your muscles may make contractions feel more manageable.

Many women find that antenatal classes can help them practise these techniques before labour begins.

Movement and Position Changes

Remaining upright and changing positions during labour can help you feel more comfortable and encourage your baby to move down through the pelvis.

You may find it helpful to:

* Walk around
* Rock gently
* Lean forward during contractions
* Kneel or use a birthing ball
* Change positions regularly

Your midwife will support you in finding comfortable positions during labour.

Massage and Touch

Gentle massage, particularly of the lower back, shoulders or legs, can help reduce tension and encourage relaxation.

Some women also find that holding their birth partner’s hand or receiving reassuring touch provides comfort during contractions.

Warm Water

Depending on your maternity hospital and your labour, a warm bath or shower may help you relax and ease discomfort during early labour.

TENS Machine

A Transcutaneous Electrical Nerve Stimulation (TENS) machine delivers small electrical impulses through pads placed on your lower back.

These impulses may help reduce the pain signals reaching your brain and encourage your body to release natural pain-relieving chemicals (endorphins).

When is it most effective?

TENS works best when started in early labour before contractions become very strong.

Benefits

* You remain mobile.
* You stay alert.
* You control the strength of the stimulation.
* It can be used alongside other pain relief methods.

Things to know

TENS does not completely remove labour pain, and many women choose additional pain relief as labour progresses.

Not all maternity hospitals provide TENS machines, so you may need to hire or purchase one before your due date if you wish to use one.

Entonox (Gas and Air)

Entonox is a mixture of oxygen and nitrous oxide (“gas and air”).

You breathe it in through a mouthpiece or mask during contractions.

How does it work?

Gas and air works quickly and leaves your body quickly.

For the best effect, begin breathing it in just before a contraction starts.

Benefits

* Easy to use.
* You control when you use it.
* Works quickly.
* Leaves your body rapidly once you stop breathing it.
* Can be used throughout labour.

Possible side effects

Some women experience:

* Light-headedness
* Drowsiness
* Nausea
* A dry mouth

These effects usually disappear quickly once you stop using the gas.

Gas and air does not usually affect your baby.

Pethidine

Pethidine is a strong opioid pain-relieving medicine given by injection into your thigh or buttock.

It can help reduce the intensity of labour pain and help you relax.

Benefits

* Can help you rest if labour is long.
* May reduce anxiety.
* Can be useful during the early stages of labour.

Possible side effects

Pethidine may cause:

* Drowsiness
* Nausea or vomiting
* Dizziness

Because it crosses the placenta, if it is given close to the time of birth it may make your baby sleepy and temporarily affect their breathing or feeding. For this reason, it may not be recommended if birth is expected soon.

Your healthcare team will consider the timing carefully before recommending pethidine.

Epidural

An epidural provides the most effective pain relief available during labour.

It involves an anaesthetist placing a small tube (catheter) into your lower back. Pain-relieving medication is then given through the catheter to numb the nerves carrying pain from the uterus and birth canal.

Benefits

An epidural can:

* Provide excellent pain relief.
* Allow you to remain awake and alert during labour.
* Be topped up throughout labour if needed.
* Be used if an assisted birth or caesarean section becomes necessary.

Things to know

An epidural may:

* Reduce sensation in your legs.
* Limit your mobility.
* Require continuous monitoring of you and your baby.
* Increase the likelihood of needing assistance with birth, such as forceps or vacuum (ventouse).

Some women may also need a urinary catheter while the epidural is working.

Are there risks?

As with any medical procedure, there are potential risks and side effects. These include:

* A drop in blood pressure
* Headache (uncommon)
* Inadequate pain relief requiring adjustment of the epidural

Serious complications are rare.

Your anaesthetist will explain the procedure, discuss the benefits and risks, and answer any questions before asking for your consent.

Can I Change My Mind?

Yes. Many women begin labour planning to use one type of pain relief and later decide to use another.

Your midwife and doctor will support your choices and discuss the options available as your labour progresses.

The most appropriate pain relief may depend on:

* How your labour is progressing
* Your medical history
* Your preferences
* Your baby’s wellbeing

Key Points

* Every woman experiences labour differently.
* Breathing, relaxation and movement can help many women cope with labour pain.
* TENS is most effective in early labour and may be used with other pain relief methods.
* Entonox (gas and air) works quickly and can be used throughout labour.
* Pethidine is an opioid injection that can help reduce pain and aid relaxation but may make both you and your baby sleepy if given close to birth.
* An epidural provides the most effective pain relief but may reduce mobility and increase the chance of an assisted birth.
* Your midwife and doctor will help you choose the most appropriate pain relief for you and your labour.