Pain relief in labour

Overview

Before labour starts it’s worth thinking about how you’ll manage the pain.

Preparation

Make sure you know well before birth how pain relief works and how long it can take to have an effect. You may have to make choices when you’re in labour when it’s harder to think clearly.

Your birth plan will include your choice of pain relief. Your birthing partner should also know what you want, so they can help you make these choices.

Types of pain relief

You can choose to use:

• self-help techniques – most women use breathing and relaxation techniques, whether they decide to have pain-relieving drugs or not
• pain-relieving drugs (gas and air, morphine and opioid drugs or an epidural)
• a combination of these

Your midwife can tell you about the different types of pain relief. You’ll be able to talk about your choices in antenatal classes too.

Self-help techniques

Self-help techniques are non-drug pain relievers. The most common of these are breathing and relaxation techniques, which you can learn in your antenatal classes.

Other methods of non-drug pain relief include:

• TENS (transcutaneous electrical nerve stimulation) machines
• complementary therapies
• hypnobirthing

If you don’t want to use drugs when you’re in labour, then these types of pain relief could be a good choice. They also put you in control which can give you a feeling of empowerment.

Breathing and relaxation techniques

Breathing and relaxation techniques help you cope with pain, but not be overwhelmed by it.

Pain often feels worse when you’re tense and anxious. When you’re relaxed, your body releases its own hormone-like pain relievers called endorphins.

By learning some relaxation techniques you can help to prevent pain becoming too intense. That way, you’ll be fully conscious and in as much control of your labour as you want to be.

Birthing pools and lying in water can also help.

TENS (transcutaneous electrical nerve stimulation) machines

TENS machines:

• are safe to use and don’t affect your baby
• work best if you use them early in your labour

To use a TENS machine:

• you place pads onto specific areas on your lower back
• the machine runs a gentle electric current through the pads – this gives you a tingling feeling which eases the pain
• you use a handset to control and adjust the current as your contractions get stronger

If you want to use TENS, ask your midwife where you can hire or borrow a machine.

Complementary therapies

Some midwives are trained to use aromatherapy in labour. If you want to use acupuncture or acupressure during labour you can. Your midwife will respect your wishes.

You may need a specialised practitioner or equipment to help you with some kinds of complementary therapy pain control.

Hypnobirthing

Hypnobirthing is a mixture of:

• visualisation
• relaxation
• mindfulness
• deep–breathing techniques

It doesn’t work for everyone, but can help you focus on your body and the birth of your baby.

Gas and air

Gas and air helps to ease the contraction, and the pain relief lasts as long as you keep breathing the gas.

Gas and air is a mix of 2 gases – nitrous oxide and oxygen. You might hear it called Entonox® or Equanox®.

You can have gas and air wherever you’re giving birth.

How it works

Gas and air:

• comes with a tube and a mask or mouthpiece that you breathe through when you need it. For it to work well you need to breath it in as soon as you feel a contraction starting.
• starts to work about 15 to 20 seconds after you first breathe it in – you keep breathing it until you start to feel a little light-headed

Pros

Gas and air:

• is safe to use throughout labour – there’s no danger of having too much
• leaves your body quickly
• won’t stop you using other pain relief
• won’t affect your baby as very little will reach them

Cons

Gas and air:

• can make some women feel sick when they use it
• doesn’t give long-lasting pain relief
• only works well if you start breathing it at the very beginning of the contraction, so that it’s working fully when you’re at its peak

Morphine and opioid drugs

Morphine and opioid drugs are strong, effective painkillers.

You can have these drugs wherever you’re giving birth. However, because they can sometimes have side effects for your baby, they’re less likely to be used if you’re having a home delivery.

How they work

Morphine and opioid drugs are usually given as an injection into a big muscle, such as your buttock or the top of your leg, and:

• take about 15 minutes to work
• last for between 2 and 4 hours

Pros

Morphine and opioid drugs work quickly and last for a few hours.

Cons

Morphine and opioid drugs can:

• make you feel sleepy and not in control
• make you feel sick, so an anti-sickness medicine’s usually given at the same time
• affect your baby’s breathing when they’re born
• make your baby sleepier and less interested in feeding for the first 24 hours

Baby’s breathing

Opioids can affect your baby’s breathing when they’re born, particularly if you have them too close to the birth. If you’re about to give birth your midwife or doctor might suggest you don’t have them for this reason.

Sleeping and feeding

Opiods can make your baby sleepier and less interested in feeding for the first 24 hours. You may need to wake them to feed.

If you have opioid drugs 4 or more hours before the birth:

• the effects have a better chance of wearing off for you
• the effects on your baby can last for up to 48 hours after the birth

Patient-controlled opioid analgesia

You can have opioid drugs given by a pump connected to your drip, which you control yourself with a button. It has a safety lock to reduce the chance of any side-effects. This is called patient-controlled analgesia (PCA).

Some hospitals offer it:

• when you’re in labour
• if you can’t have an epidural

You may need some extra monitoring as it can:

• slow down your breathing
• lower your oxygen levels

The effects of PCA wear off very quickly though. Because you’ll be attached to monitors and a drip, you may not be able to move around as freely.

Epidural

An epidural is a small tube inserted into your back to deliver pain-relieving medicine.

The aim of an epidural is to ease the pain of labour while still letting you:

• move around the bed
• push when your baby’s being born

An epidural can work well but it’s also the most complicated pain relief and needs to be put in by an anaesthetist. That means you can only have an epidural in an obstetric unit in a hospital.

How it works

During an epidural medicines are put through the tube and into the area around your spinal nerves (the epidural space). This blocks the feeling of pain in your lower body, but you can still feel:

• someone or something touching you
• the pressure as your baby’s being born

You’ll also have:

• a drip so that you can have fluids and other medicines if you need them
• your blood pressure checked regularly once the epidural is in
• your baby’s heartbeat monitored but sometimes this can be done wirelessly

Who can have an epidural?

Most women can have an epidural. But you may not be able to have one if:

• you’ve health conditions such as clotting issues
• you’ve had some kinds of back operation

Your midwife or doctor might suggest an epidural if:

• you’ve had a long labour
• you’re overweight
• you’ve high blood pressure or other medical issues

Talk to your midwife about speaking to an anaesthetist if you want to find out more.

Pros

An epidural:

• is the best form of analgesia available
• doesn’t make you sleepy
• takes away the pain of contractions and may take away the pain of birth too
• is safe for your baby and you can breastfeed as normal when they arrive
• can usually be topped up to give pain relief if you need a ventouse or forceps delivery, or caesarean section

More about epidurals and anaesthetics in labour

Cons

About 1 in 10 epidurals don’t work perfectly at first. If yours doesn’t work, you may need to have it adjusted or replaced.

An epidural can:

• cause your legs to feel numb or heavy which can make it harder to push
• make it difficult for you to pass urine on your own, so your midwife may need to put a tube called a catheter into your bladder
• cause bad headaches for a few days or weeks after the birth in about 1 in 100 cases – this can usually be treated with painkillers and fluids but sometimes needs special treatment
• cause a long-lasting nerve injury, such as a numb patch on your leg or a slightly weak leg. This is very rare.
• cause other side effects, such as itching and some soreness in the place where the epidural goes into your back

Assisted delivery

If you’ve had an epidural you’re more likely to need an assisted delivery with forceps or ventouse. This is because:

• you may not feel the urge to push as strongly
• you’re less likely to be able to push well

More about helping your baby to be born

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