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Pain relief in labour: options for a more comfortable birth
Discover pain relief in labour options, from self-help and water to gas and air, pethidine, and epidurals, to support a more comfortable birth.
Labour is often referred to as one of the most intense experiences of a person's life, to feel nervous about the pain involved is completely understandable.
However, there is no need to be worried as these days there are lots of different options available to cope, from various different holistic therapies to medical options.
Doing a little bit of research into the different options available, can really help you with feeling empowered, in control and supported during birth.
You are in the driving seat when it comes to choosing an option, there is never a right or a wrong decision. The goal is to help you make informed, confident choices that are right for you and your baby.
This blog post will help you discover pain relief in labour options, from self-help and water to gas and air, pethidine, and epidurals, to support a more comfortable birth.
Understanding pain during labour
Labour pain is a complex mix of physical and emotional factors. Knowledge is power and knowing what to expect can help in minimising fear and providing the skills to manage pain when labour starts.
Physical causes of labour pain
Contractions are the most well-known causes of pain in labour, as the muscles of the uterus tighten and shorten. This process helps to dilate (open) the cervix and move the baby down and causes pain which is often described as being similar to severe period cramps. The intensity of the pain can vary depending on the stage of labour.
For example, early dilatation might only be felt as mild cramping whilst dilatation in the later stages of labour can feel like severe period cramps, as the baby is being helped to pass through the birth canal.
A common question from expectant mothers is can labour pains be in your back? The answer is yes - some people can experience intense pressure in their backs. This can be caused by the baby's head pressing on the bladder, bowel or pelvic nerves. This can also be caused by the baby being in the occiput posterior position (when the baby is facing upwards, often referred to as sunny side up).
Another source of pain is from the perineum and vagina being stretched, as the baby moves through the birth canal during the birth. It is important to remember that everybody's pain threshold and experience of labour is different, and someone’s experience of labour pain may not be the same as yours.
Emotional factors and pain intensity
There is a link between emotions (such as fear and anxiety) and pain. Having an understanding of this relationship can be helpful in trying to self-manage emotions and the experience of pain.
There is a phenomenon known as the ‘fear-tension-pain cycle’. This is when the fear of pain can cause muscle tension, which in turn can cause pain to intensify, creating a self-perpetuating loop. When we are frightened, we trigger our body’s fight or flight response, causing adrenaline to be released.
All this extra adrenaline causes muscle tightening, reduces blood flow to the uterus and can cause pain to intensify. When there is fatigue layered on top, which often occurs during labour, this can make everything feel more arduous and can lower your pain threshold.
Self-help techniques for early labour
Self-help techniques are brilliant for coping during the early stages of labour at home or upon arrival at the hospital. The following techniques won't take the pain away, but they can help manage pain and make it feel a lot more “doable”.
Firstly, breathing exercises including slow, deep, rhythmic breathing helps keep you relaxed, provides oxygen to your muscles, and helps you cope with the intensity of contractions.
Second is the role of gentle movement. This includes changing positions, walking, rocking, or leaning over a birth ball which can help gravity assist the baby to move through the birth canal and can reduce discomfort.
Relaxation techniques can conserve energy during labour and will be personal to you. Examples include visualisation, playing calming music, or creating a peaceful environment. An additional technique is trying to relax all your muscles between contractions and even during them, which can be helped with slow, deep breathing.
Taking a warm bath or shower can be soothing and relaxing, with the warmth helping to ease muscle tension and reduce pain.
Having a birth partner, doula, or supportive friend nearby can be a gamechanger. Feeling supported will go a long way in helping you to cope. Speaking to your support person before labour about relaxation or movement techniques you might like to try can be helpful, as they can be prepared and remind, or encourage, you to use your strategies.
Natural and non-medical pain relief options
These methods are designed to help you cope with pain without medical intervention. In my experience how effective they are can vary greatly from person to person. I know mums to only use these and nothing else to successfully support them through labour. Equally, I’ve known mums say that they only found them somewhat helpful or not helpful at all.
Water birth and warm baths
How it helps: Laying in warm water is incredibly soothing. It can help your body to release natural pain-relieving hormones (endorphins) and lessen the intensity of contractions.
If your pregnancy is classed as low risk, you can opt to have a pool birth. You can give birth in a pool at home or in a hospital.
TENS machines
How it works: A Transcutaneous Electrical Nerve Stimulation (TENS) machine uses four small pads placed on your back.. Two pads are placed along the bra line and two are placed along the panty line. These pads deliver mild electrical pulses which block pain signals from reaching the brain and stimulate the release of your natural pain relieving hormones (endorphins).
The effectiveness of TENS machines for pain management during labour is highly individual. Based on my experience, some women find them to be effective throughout labour, while others report feeling no benefit at all.
Hypnobirthing and guided relaxation
How it works: Hypnobirthing teaches techniques like deep relaxation, controlled breathing, and positive affirmations. The aim is to focus on instilling calm and confidence, thereby increasing your pain threshold and encouraging a more relaxed state.
Massage and physical touch
How it works: Any form of touch can be incredibly powerful during labour. In the first instance it can provide great comfort and emotional reassurance. Massage is brilliant at reducing muscle pain especially in the lower back. It also provides a great opportunity for your partner to actively support you.
Many women report that the smell of essential oils, such as lavender or frankincense, can be soothing. These oils may be used in a diffuser or applied to a tissue to smell. The aim is to encourage relaxation and create a feeling of wellbeing.
Acupressure and birth combs
How it works: The goal with these techniques is to draw your attention away from the pain of the contraction. One option is Acupressure, this involves applying pressure to particular points on the body. Using a birth comb is a great way to apply this technique. The comb is gripped tightly in the hand, stimulating pressure points during a contraction. It works well as a distraction, taking your focus away from the pain of the contraction.
Medical pain relief options
These pain relief options are evidence based and are widely used throughout maternity settings in the UK. You can find out more about your options for pain control in labour, asking how they work, their benefits and risks, by attending a birth preparation class or asking your midwife or doctor.
Gas and air (Entonox)
Entonox is a mixture of oxygen and nitrous oxide gas. You breathe the gas through a mouthpiece at the start of a contraction. It works quickly (within 15-20 seconds) to take the edge off the pain, but the effects wear off just as fast.
Sensations and Side Effects: It doesn't stop you from feeling the pain entirely but it does help you manage it. It can cause you to have a dry mouth, feel sick or feel dizzy, and is safe for the baby.
Opioid injections (pethidine or diamorphine)
Opioid Injections as the name suggests are opiate based medications, used to treat severe pain and are administered via an intramuscular injection. They relieve the pain by making you feel less aware of it. They are usually offered in established labour when other forms of medication haven't worked or can't be tolerated.
Side Effects: They can make you feel sleepy, lightheaded, or nauseous. They can also cross the placental barrier to the baby. If they are given close to the time of birth they can cause the baby to be drowsy, affect their breathing and ability to feed after birth. Your midwife or doctor is aware of this and will always try to avoid this happening.
Epidural
An epidural is a local anaesthetic medication administered through a thin tube (catheter) placed into the epidural space in your lower back. It numbs the nerves that carry pain signals from the uterus and cervix to the brain, providing almost complete pain relief.
Epidurals are highly effective for pain relief. It can allow a person to relax and sleep or recover during a long or difficult labour. It can also be useful to manage high blood pressure.
There are some considerations with having an epidural such as a significant drop in blood pressure. This is an anticipated risk and can make you feel sick and shaky. A drop in your blood pressure can, in turn, cause your baby's heart rate to drop. Your medical team is prepared to manage this if it occurs, but it necessitates more frequent blood pressure checks. If you choose to have an epidural, your baby's heartbeat will need to be continuously monitored, and you will need IV fluids to help maintain adequate blood pressure.
It is likely your movement will be significantly restricted, and some people experience intense itching all over their body. The epidural can sometimes make it difficult to feel the urge to push, potentially requiring assistance with delivery, such as forceps or a ventouse cup (kiwi cup).
Choosing the proper pain relief for you
As previously mentioned, when it comes to pain relief options, ‘knowledge is power’. It's so much easier to make an informed decision when you know what all your options are.
The key to a positive experience is to consider what matters most to you and to incorporate your preferences into a birth plan.
Questions you might like to ask yourself could sound something like:
“What matters to me most?” “Do I want to cope as naturally as possible?”“Do I want the strongest pain relief going?” “Do I want to wait to see how I feel on the day?”
Flexibility is key! None of us can guarantee how things will play out. It's always worthwhile considering all eventualities so as to better manage your expectations.
And finally remember that there is no single “right” choice. The best choice is the one that allows you to feel safe, supported, and most able to cope during the birth.
FAQs around coping with labour pain
The main categories of pain relief include:
- Self-Help: Breathing, movement, and relaxation.
Natural Techniques: Water immersion (baths/pools), TENS machines, and massage. - Medical Options: Gas and air (Entonox), opioid injections (like pethidine), and epidurals.
Options available to you can vary depending on where you chose to give birth. Often, these options can be combined.
Coping well with labour pain involves several factors: mindset, preparation, and support. Key coping strategies include:
- Natural Coping: Using rhythmic breathing, changing position frequently, focusing on relaxation between contractions, and using water or massage.
- Medical Relief: Choosing options like gas and air (Entonox) or an epidural when natural methods are not working or are no longer effective.
There really isn't a one size fits all solution. What may work well for another person may not work for you. The key is to find what's going to work best for you.
An epidural is generally considered the most effective form of pain relief during labour, offering almost total relief from contraction pain. It works by blocking pain signals in the spine.
The National Childbirth Trust (NCT) does not administer pain relief itself. It is a charitable organisation that provides antenatal education. Its antenatal classes provide education to expectant parents on all available pain relief options. including both medical and natural methods. The aim of NCT classes is to empower you to make informed and confident choices around pain relief options.
