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Pain Relief in Labour

Your options, from breathing to epidural

There are many ways to manage the pain of labour, ranging from techniques you can use yourself (breathing, movement, water) to medicines and regional anaesthesia. Most women use a combination over the course of their labour, and many change their plans as labour progresses. There is no right or wrong choice.

This page describes the main options. It is worth reading about all of them, even those you do not currently plan to use, so that you can make an informed decision on the day.

Methods of pain relief

Each method has its own benefits and trade-offs. Talk through what appeals to you with your midwife or in your antenatal class.

Mind-body techniques

What it is: Approaches that use positive thinking and an understanding of labour to help you feel in control.

Includes: Visualisation, meditation, positive affirmations, conscious relaxation, breathing techniques, vocalising or repeating a mantra, and hypnosis (hypnobirthing).

Advantages:

  • No side effects on you or your baby
  • Can be used throughout labour, alongside any other method
  • Helps reduce fear, which often reduces pain
  • Builds confidence and a sense of control

Disadvantages:

  • Most techniques require pre-labour preparation and practice to be effective
  • Alone, they may not be enough for everyone
  • Easier to apply in early labour than in established labour

What it is: Spending time in a warm bath or birthing pool during labour.

Advantages:

  • A simple, drug-free way to ease the intensity of contractions
  • Often helps you relax and move freely
  • Reduces the need for other pain relief in many women
  • Can also be used for birth (waterbirth) in suitable pregnancies

Disadvantages:

  • Not suitable if continuous monitoring is needed
  • Cannot be combined with TENS, pethidine (after a short time), or an epidural
  • Availability of pool depends on the unit and circumstances on the day
 

What it is: A small handheld device that sends mild electrical pulses through pads stuck to your back, helping block pain signals.

Advantages:

  • May offer immediate relief
  • Self-administered, so increases your sense of personal control
  • May allow you to postpone or avoid an epidural
  • You can move around with it
  • No known adverse effects

Disadvantages:

  • May not be strong enough for established or extreme labour pains
  • Cannot be used in water
  • You need to rent a TENS machine in advance (usually from around 38 weeks). Please contact the Parentcraft Department on (091) 544210 for information.

What it is: A mixture of nitrous oxide and oxygen that you breathe in through a mouthpiece during contractions.

Advantages:

  • Available instantly
  • You are in control and self-administer it
  • Works within 30 to 40 seconds, with no lasting effect after you stop
  • Can be used throughout labour, without affecting contractions or progress
  • No known ill effects on the baby

Disadvantages:

  • Does not remove the pain, but helps you relax through it
  • Timing can be tricky at first; your midwife will guide you
  • Some women feel sick, drowsy, dizzy, or light-headed
  • May give a dry mouth (ask for sips of water between contractions)
  • May affect your memory of events during labour

What it is: A pain-relieving injection given into your thigh or buttock.

Advantages:

  • Can be given within 5 minutes of asking for it
  • Usually works within around 20 minutes; effects last a couple of hours
  • Should not slow down progress in established labour
  • Can help you relax and rest

Disadvantages:

  • Research shows it is much less effective than an epidural
  • May make you feel sick, drowsy, dizzy, or light-headed
  • Can limit how much you move around
  • Less suitable late in labour, as it can affect the baby’s breathing if given close to birth
  • Can affect your memory of events around the birth

What it is: A regional anaesthetic injection given into the space around the nerves in your back, to numb the lower body.

Advantages:

  • The most effective pain relief available in labour
  • Generally well tolerated
  • Suitable for most women, including for caesarean delivery if needed
  • Does not slow down the first stage of labour and is not associated with an increased chance of caesarean

Disadvantages:

  • Takes around 20 minutes to insert and another 20 to work
  • You will be in bed for the duration of your labour
  • Continuous monitoring of contractions and the baby’s heart rate is needed
  • Possible side effects: heavy legs, shivering, nausea, vomiting, itching
  • About 20% of women may have temporary low blood pressure
  • About 1 in 100 women get a headache afterwards (treatable)
  • A bladder catheter may be needed

A separate page covers the epidural in detail, including how it is inserted and when it may not be suitable.

Positioning, comfort, and progress for women with an epidural

A peanut ball is a birth ball in a peanut shape (a smaller circumference in the middle, larger at each end). It is used during pregnancy, labour and the postnatal period, particularly for support and positioning. The peanut ball is at its most useful when used by women who have had an epidural and are labouring in bed, where movement is otherwise restricted.

Other approaches: acupuncture

Acupuncture is used by some women as an additional approach in labour. It involves the use of fine needles inserted at specific points along the body to stimulate lines of energy (called channels) flowing beneath the skin. Acupuncture in labour has been shown to reduce the need for pethidine and epidurals, and may also induce relaxation.

If you are interested in acupuncture, arrange this with a qualified practitioner before labour, and discuss it with your midwife at an antenatal visit.

Making your choice

A few honest points to keep in mind as you decide:

  • You don’t have to choose in advance. Many women combine methods, starting with the lighter options and adding others as labour progresses.
  • You can change your mind. A plan to avoid an epidural is not a contract; if labour is harder than expected, an epidural is still a good choice.
  • Equally, a plan for an epidural does not commit you. Many women find they cope well with breathing, movement and gas and air, and never use it.
  • Your midwife and the anaesthetist are there to advise you on the day, based on how your labour is progressing.

Include your pain-relief preferences in your Birth Preference document, and discuss them at your antenatal visits.

For more information, please visit: labourpains.org