Pain relief in labour
You have various choices for pain relief during labour, your midwife can talk through the options for you. Antenatal classes can also provide more information to help you understand the choices. Watch the video from or read about pain relief options below.
Using relaxation, breathing, moving about and having a partner to support and massage you can all help you to have a satisfying birth experience. Fear can make pain worse, and many people feel frightened of what they don’t understand or can’t control.
- Try different positions during labour and birth as moving can make a real difference. Being upright, particularly walking around helps labour to progress. Some women like to kneel, or rock backwards and forwards. Some women like to be massaged, whereas others don't like to be touched.
- Feeling in control of what is happening to you is important. Ask the midwife supporting you if you need to have things explained.
- Having a partner, friend or relative you can ‘lean on’ and who can support you during labour certainly helps. We know that a supportive birth partner reduces the need for extra pain relief. If you don’t have anyone, don’t worry – your midwife will support you.
- Try to relax, listen to your body and keep calm
- Warm water really helps
Gas and air (Entonox)
This is a mixture of oxygen and another gas called nitrous oxide. You breathe it in through a mask or mouthpiece that you hold yourself. Gas and air reduces the level of pain you are experiencing, and helps you to regulate your breathing. Many women use entonox because you control it yourself. The gas takes 15–20 seconds to work, so you breathe it in just as a contraction begins. There are no harmful side effects for you or the baby, but it can make you feel light-headed. Some women also find that it makes them feel sick or sleepy or unable to concentrate on what is happening. If this happens, you can simply stop using it.
This stands for Transcutaneous Electrical Nerve Stimulation. It lessens the pain for many, but not all, women. There are no known side effects for either you or the baby, and you can move around while using it. Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator known as an obstetric pulsar. You hold the pulsar and can give yourself small, safe amounts of current. It is believed that TENS works by stimulating the body to increase production of its own natural painkillers, called endorphins. It also reduces the number of pain signals that are sent to the brain by the spinal cord. For best effect, it is recommended to start use in early labour. You will need to arrange to hire/purchase a TENS unit to use.
Choosing to give birth in water can increase relaxation and reduce the need for medical intervention. Women who have complex pregnancies may need an individual discussion about having a water birth, often with the consultant midwife, to help them in their birth planning choices. At Hillingdon, the birthing pool is located on the ground floor. The pool water is maintained around body temperature (36.5-37.5°C). You can choose whatever position works for your body. Your midwife will monitor you and your baby whilst you are in the pool and you can have the support of your birth partner with you.
Pethidine is a synthetic, narcotic drug, which is similar to morphine. It is a form of pain relief used for pregnant women and is administered by injection, taking about 20 minutes to work and the effects last between two and four hours. It can help you to relax, and some women find that this lessens the pain. You can also use gas and air in conjunction with pethidine. After administration pethidine can cross the placenta, however research shows that if it is going to affect the baby’s respiratory system, this is most likely to occur if the dose is administered 2-3 hours before birth. Pethidine can make you feel sick, dizzy and drowsy.
Meptid is the brand name for meptazinol, a synthetic opioid, less commonly used than pethidine and not as strong. The dose varies on your weight and you can have similar side effects to pethidine for you and your baby.
Epidurals reduce the pain of labour more than any other treatment. However, epidurals are also the most complicated method of pain relief and must be administered by an anaesthetist - a doctor specially trained to provide pain relief. Once you are in established labour (regular, frequent contractions, and cervical change/dilation) you can request an epidural. Many women choose to try other forms of pain relief prior to an epidural. If the birth is imminent it may not be safe to administer an epidural, the anaesthetist will discuss this with you. There are sometimes reasons why an epidural is recommended or contra-indicated, these will be discussed with you during your pregnancy or when you are in labour if the situation has changed.
Prior to the epidural there will be an assessment from the anaesthetist and you will need to have intravenous access (a cannula inserted into a vein in your arm). Your anaesthetist will then carefully inject local anaesthetic underneath a small area of skin in your lower back (lumbar area) before inserting the epidural needle. Once the right position is found with the epidural needle, an epidural catheter (very thin plastic tube) is passed through the needle.
The needle is then taken out and only the epidural catheter is left inside your back. The epidural catheter is looped over your shoulder and fixed in place against your back with tape, so that you will be able to move around freely, this will depend on the effect the epidural has on you. It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give good pain relief.
Labouring with an epidural
Our aim with labour epidurals is for you to move around or mobilise as much as you want, so long as it is safe! Nowadays it is usually possible to reduce the pain of labour without making the lower part of your body very numb or making your legs feel weak (a ‘mobile epidural’). If you feel able to get out of bed to go to the bathroom or walk a little, that is usually fine, but always take the precaution of having someone support you as you do so, to avoid any risk of losing your balance. You may find it more difficult to pass urine after an epidural and a small bladder tube (catheter) may be needed to help empty your bladder and stop it getting too stretched.
It tends to take longer to push your baby out after an epidural compared to without an epidural because you no longer have an automatic urge to push as the baby comes down the birth canal; your midwife will monitor your contractions and you will still be able to use your pelvic muscles to push when the midwife tells you to.
Once your baby has been born the epidural catheter is removed from your back, and the anaesthetic effects will normally wear off within a couple of hours. You will still be able to breastfeed your baby right away if you have had an epidural.
For more information about epidurals we recommend the website of the Obstetric Anaesthetists’ Association (OAA) – see www.labourpains.com or www.oaa-anaes.ac.uk – where there are also links to the relevant scientific references.