Pain relief in labour - what options are there?
You can choose what pain relief you want during your labour and birth. We assess the main options for drug-based and drug-free pain relief in the UK to help you make an informed decision. Our midwives and mums share their views, too...
When you're thinking about what kind of birth you want, and especially when putting together your birth plan, it's really helpful to know what (drug and drug-free) pain relief options are available to you during labour.
We've listed 4 key drug options here:
And 5 key drug-free options here:
If you're not at all interested in learning more about the drug options, you can skip ahead to read about drug-free pain relief options.
However, we'd recommend you give everything below a good read. Giving birth is unpredictable, and its not often a birth plan goes completely to plan.
Really, it's just useful to be as informed as poss about all the different options you've got.
Here's what you need to know about your pain relief options during labour - plus where you can learn more about each one...
How an epidural works as pain relief in labour:
An epidural is an injection into your spine numbs your body from the waist down. It sounds pretty scary - so we think it'll help to know exactly how the procedure works...
- You lie on your side or sit on the edge of the bed while an anaesthetist injects a local anaesthetic into your lower back.
- A hollow needle is inserted through the skin, then a fine, soft plastic tube is threaded through this hollow needle. The needle is then removed.
- Anaesthetic is injected through the tube for as long you need it. This might be a continuous infusion, or it can be delivered by top-ups.
- As the anaesthetic travels around your body, it feels like liquid ice, numbing your tummy, bottom and legs and deadening the nerves that carry pain signals from your uterus.
Who can have an epidural?
Most women are able to have an epidural - you should discuss whether you're definitely a candidate with your doc and midwife while working on your birth plan.
However, some women are advised to avoid epidurals: those who have a blood-clotting disorder, women who had back problems before they were pregnant and those who’ve had a caesarean and want a vaginal delivery.
How effective is an epidural?
Epidurals are pretty effective as a form of pain relief during labour. They're considered 'very good pain relief' in 90% of cases.
What do MFM mums say?
"I had an epidural...IT WAS FANTASTIC! It was a long labour, so I was just so tired and felt it was the only option for me in the end... the needle didn't hurt much at all and the relief was beyond words!" says MyGirlAndI
"My sister is a nurse and she tells me epidurals can be fabulous if they are done properly. Problem is, an awful lot are NOT done properly.
"If it's done correctly, you should still be able to feel a little pain and discomfort and feel to push.
"However so many are botched jobs and numb the area which means you can't feel to push, labour slows down and then you end up either with forceps / VT or c-section," adds mum BabyVogue.
How pethidine works as pain relief in labour
Pethidine is an opiate. It's pretty similar to morphine and heroin. It’s usually given by injection into the thigh or your bum cheeks, though it can also be given intravenously.
It takes around 20 minutes to take effect and lasts for 2 - 4 hours. You can have several doses, but as pethidine can have an affect on your baby, it's worth being a bit wary.
How does pethidine affect your baby?
We know that there are a few potential effects that pethidine, or too much pethidine, can have on your baby.
We've listed them below not to scare you in any way, but just to make you aware of what's possible...
- Pethidine crosses the placenta and can make your baby sleepy, even after the birth. Some babies whose mums had pethidine are slow to suck, which can mean early issues with breastfeeding.
- Some newborns develop breathing difficulties from pethidine use and will need an injection to reverse the effects.
- There’s some evidence (though not conclusive) that babies who receive an opiate drug through their mum’s bloodstream are more likely to have an addiction problem later on in life.
Who can use pethidine during labour?
When using during labour, make sure your midwife knows of any medical conditions you have. That way, if pethidine's not the best option for you, they'll be able to let the anaesthestist know.
How effective is pethidine as pain relief?
Honestly, it depends on when it’s given and on the amount administered. The normal dose is 50-100mg.
Many mums-to-be find it more effective nearer the beginning of labour when their contractions are not at their strongest.
What do MFM mums say?
"I did not like gas and air, and when asked for epidural midwife could not complete the internal... so I opted for some pethidine and it was very good.
"It did not take the pain away, but made me able to rest in between contractions. I still remember everything, I know what I said and when I said it. If needed I will use it if there is ever a second time." - breighlin
"No, No, No, I had it with my first and was sooooo sick, out of it and baby was so sleepy when born he turned in to a little screaming devil 3 hrs later when it wore off. It didn't take the pain away either(he was back to back), TBH I would say don't have it." - babs4
3. Gas And Air (aka Entonox)
How gas and air works as pain relief in labour
Gas and air, or entonox, is a pain-relieving gas made up of 50% oxygen and 50% nitrous oxide (also known as ‘laughing gas’).
It comes from a gas cylinder and you administer it yourself, taking it in through a mouthpiece - as shown in the pic above.
Who can use gas and air?
Most women can use gas and air - and most, if not all, hospitals here in the UK have the option.
You might be told not to use entonox in the very early stages of labour, on the chance you've still got hours or even days to go.
How effective is gas and air?
The effectiveness of gas and air ranges really varies from person to person. Some women swear by it, but others say it did little other than make them feel like they’d had too much to drink!
What do MFM mums say?
"I had gas and air when baby was coming, it doesn't make the pain go away but it does take the edge off it," said mum MisoSoup36989.
While mamapink thought: "With my second I tried some gas and air and absolutely hated it. It made me feel dizzy and awful and as I stopped concentrating on my breathing the pain got even worse."
4. Spinal block
How a spinal block works as pain relief in labour
A spinal block is very similar to an epidural. A local anaesthetic-analgesic mix is injected directly into the cerebrospinal fluid in the small of your back using a very fine needle in a single injection.
it's faster to administer than an epidural - but on the other hand, a spinal block is like a one-shot deal, as it can't be 'topped up'.
Who can use a spinal block?
Some women aren't suitable candidates for a spinal block. It's definitely worth talking it our with your midwife and the anaethestist at the hospital.
Typically, if you've got a blood-related infection or disorder, need to take blood thinners or have had allergic reactions to local anaesthetic in the past - this won't be right for you.
How effective is a spinal block?
Pain relief is as effective as with an epidural, but with the advantage that it sets in more quickly.
However, once the effect wears off, which can be anywhere between 2 - 4 hours, the spinal block can't be topped up.
What do MFM mums say?
"I had to fight for my spinal block for my c-section. They automatically wanted to give me an epidural.
"I think they only really use the spinal if it is an emergency one or there are medical reasons (as with me) that mean the mother can't have the epi.
"With the epi you just go numb, and it takes a bit longer, but the spinal makes your feet etc go all hot b4 it numbs it. Odd feeling apparently. Also the recovery of feeling is quicker with a spinal," wrote MrsElsbethDaykin.
"I had a spinal block topped up with an epidural. The spinal block took effect instantly, whereas I think an epidural can take up to 20 mins to kick in.
"I think a spinal is given as a one-off dose though, whilst an epidural can be topped up regularly.," said niblet.
Are there any other drug options out there?
The 4 above are typically the options offered by most hospitals, though there are a few drugs that aren't routinely offered, such as:
All 3 are opioid drugs and are pretty similar to pethidine - though each has their own set of pros and cons, which you can explore by clicking the links above.
We should also note that in the very early stages of labour, we have heard of women taking different versions of paracetamol such as co-codamol or codeine.
Obviously, if you end up doing so, make sure your midwife knows before moving on to the heavy stuff...
If you'd like to give birth without drugs, the first step is to explore alternative pain relief options (like the ones below) - one or more of which will form the basis of your birth plan.
There are lots of options to consider if you'd like to go drug-free, including physical pain-easers like water births and TENS machines, as well as mind-over-matter techniques like hypnobirthing.
Remember that a birth plan is just that: a plan. So, keep in mind that plans can change, and don't feel too disheartened if you do end up needing drug-based painkillers.
All you can really do to work towards a drug-free birth is know your options, prepare yourself mentally, and do what you can to remain positive.
Check out all of the drug-free pain relief options for labour...
5. Water birth / birthing pool
How a water birth works as pain relief in labour
Tense muscles stop your body from releasing endorphins, the body’s natural painkiller, so the ability to relax the muscles is important in labour.
Just as a warm bath can help you to relax on a normal day, so being in water during labour can help you not tense up as the pain hits. This relaxation enables you to ‘pace yourself’ so you can conserve your energy for when you really need it
Who can use a birthing pool?
Every situation is different, so it's hard to say - but generally, you may be advised against a water birth if your baby is more than 3 weeks early, a history of pregnancy and birth complications, have mobility issues or suffer from epilepsy.
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If you want to have a water birth, the best thing to do is talk to your midwife about your options.
How effective is a water birth?
No one would claim that it overcomes all the pain. But for many women who've tried it, it certainly seems to take the edge off. Others will still use breathing techniques or even gas and air in the water.
Some women choose to labour in water and then get out for the actual birth, though many end up staying put as they find they’re more comfortable in the water.
What do MFM mums say?
"I'm currently pregnant with my 5th and previously had 3 water births and hopefully have another one! I highly recommend it as its really more comfortable and relaxing.
"Babies are born much calmer and warm. Plus the water takes the weight off your back so it's soothing," said Gem26.
Whereas things worked differently for Goldfish: "I laboured for about 4 hour in the pool with no 1 - but he got stuck so I had to get out and on to the bed to actually give birth.
"The water was fantastic for pain relief though and so much more comfortable than being on a bed as you can move around and float.
"I wasn't wearing anything by the time I had to get out (SO not dignified lol!) but you don't really care by then and it's ideal for skin to skin after giving birth."
6. Hypnobirthing / hypnotherapy
How hypnotherapy works as pain relief in labour
Hypnotherapy is a form of self-hypnosis that enables you to ‘tune out’ other distractions and focus on positive supporting drives within you. This enables you to get rid of fear, tension and pain and replace them with relaxed concentration.
It’s based on the accepted notion that if you go into birth feeling frightened, your system will respond accordingly. The fear will lead to increased levels of adrenaline in your body, which causes increased tension in your muscles and your cervix.
Fewer ‘contraction’ hormones are then produced, so your uterus has to work much harder to flex and tighten. This subsequently makes contractions far more painful.
Hypnotherapy doesn’t rely on forces imposed from outside, like stage hypnotism, but on your own resources.
This is why women usually have classes beforehand, where you learn visualisation and breathing techniques. These are sometimes done with the birthing partner.
How effective is hypnotherapy?
Hypnotherapy can work very well, simply by enabling you to feel relaxed. It doesn’t promise you a pain-free labour or perfect birth, but it can make the experience a very positive one by enabling you to remain in control and free from fear.
HypnoBirthing is based on the work of Dr Grantly Dick-Read who wrote Childbirth Without Fear. He believed that it’s fear and tension that cause pain for 95% of labouring women.
If he’s right, then taking these away would drastically reduce, if not eliminate, pain.
Hypnobirthing classes, usually undertaken in mid to late pregnancy, enable you to learn techniques that you can practise at home and implement easily in labour.
What do MFM mums say?
"I didn't do a course. I read the Marie Mongan book and listened to her affirmations. I didn't get much time for anything else during labour, I think it helped - certainly made me relax and focus when I'd listen to it towards the end of pregnancy despite her slightly annoying voice!
"I've heard really good things about Lazy Daisy classes which I think use this kind of approach." - Sshh
"I had a book and DVD and too be honest I found it a little bit too hippy-ish for me although fundamentally liked the philosophies.
"I used a book called Birth Skills that gives lots of ways to manage pain using your body, mind and breathing and I found that loads more practical and did actually use a couple of the techniques." - sweetpeamumdrum2
How massage works as pain relief in labour
For most people, touching and being touched is comforting and that’s essentially why massage is so soothing when you’re in labour.
Touch makes us feel nurtured and cared for which, in turn, helps us to feel at ease. Tense muscles stop your body from releasing its natural painkillers (endorphins), so the ability to relax the muscles is important in labour.
There’s also a suggestion that picturing your birth partner’s hand massaging you as he or she does it helps your body release oxytocin, which keeps the contractions coming.
How effective is massage?
One study showed that women who were massaged during labour were less anxious, experienced less pain, had shorter labours and were less likely to suffer from postnatal depression than those who hadn’t used massage.
Research also shows that even touch - such as stroking your brow, patting and handholding - improves your ability to cope.
Relatively little research has been done on the effectiveness of massage in labour, compared with medical pain relief techniques, but many women do find it helps a lot.
Still, a lot of women who love the idea of being massaged don’t like to be touched when they’re having a contraction – probably because it’s distracting or too stimulating.
But once a contraction has passed, they can enjoy the soothing touch again – your partner needs to understand that!
What do MFM mums say?
"The midwife massaged my back with lavender oil when I was in labour. It was amazing and they provided the oil." - MissisB.
"From my aromatherapy guide book it advises a jasmine or rose massage oil to be massaged gently into your back aiding contractions and pain relief and giving pleasing aroma (of course these 2 oils are also most costly).
"To help relax everybody 2-3 drops of lavender or chamomile in room burner or vaporiser will help to cleanse the air and calm the nerves." - KazzieM.
8. TENS machine
How TENS works as pain relief in labour
TENS stands for Transcutaneous Electrical Nerve Stimulation. It’s a small battery-operated stimulator that transmits gentle electrical impulses through your skin, via four self-adhesive pads positioned on your back.
These impulses stimulate your body to release endorphins, its own natural painkillers. By stimulating the nerves, pain signals are blocked before they reach the brain.
Who can use a TENS machine in labour?
Most women hoping to use a TENS machine to ease labour pains should be able to - unless they're hoping for a water birth.
Those with epilepsy, a pacemaker fitted in their heart or anyone with a heart rhythm disorder should definitely steer clear of these machines.
How effective is TENS?
Research shows that TENS machines are most effective when they’re introduced in early labour. They enable you to stay mobile, which helps the baby’s head to move lower, and encourages contractions.
What do MFM mums say?
"I…had a TENS machine on my back all the way through (apart from the pushing bit) - my back was killing me and when I put that on after a while didn't feel the pain at all.
"Whether it was… a distraction I don't know but really helped as I ended up giving birth within 7 hours on gas and air and TENS machine only and it was my first baby, and had no tears or stitches." - MamaBridger
"I second that the Tens was a distraction more than pain relief but it was the only pain relief I used up until pushing," - Sharmy.
How reflexology works as pain relief in labour
Reflexology is an alternative medicine practice which involves applying pressure using your thumbs, finger and hands to the feet – in order to stimulate different parts of the body.
Usually, this would be done by a trained practitioner, to help stimulate the pituitary gland in order induce hormones that can ‘speed up’ labour. These sessions can continue into labour in timed intervals, in order to help keep the soon-to-be mum calm, or ease a little bit of pain.
Sometimes, reflexology can also be done by your partner – but only if they’ve spent a good amount of time training and learning to do it properly.
Who is reflexology suitable for during labour?
During pregnancy, reflexology is not suitable for women with a history of miscarriage, a risk of pre-eclampsia or other pregnancy complications. We’d say the same applies for labour, too.
Always check in with a medical professional like your GP or midwife before starting any alternative medicine treatments.
This is important, too: youcan’t have reflexology if you have DVT (deep vein thrombosis) or any other blood-clotting issue. It can put you at risk of the clot travelling to your heart. It’s also not suitable if you have any sort of foot injury.
How effective is reflexology at easing labour pain?
Well, there’s not a lot of evidence out there to give you a big stat all about how expert foot-rubbing is going to take away the pain of giving birth.
But it has been reported that in some cases, it seems to promote a shorter, easier labour.
We’ve also heard it said that the calming and pain-easing effects of reflexology in labour kick in after about 2 mins, before the full effect takes hold at around 15 minutes.
We have come across a couple of very small studies and reviews, though, that do suggest that reflexology has an impact on pain intensity.
A small review of previous reflexology studies by researchers at Iran’s Ishafan University noted several studies which found that laboring women who’d used reflexology were more comfortable, and that their pain was less intense than those who hadn’t.
They concluded: “Properly using of this technique, reflexology can reduce the labor pain…
“Generally, the results of this study - which include reducing the length of the labor, labor pain intensity, postpartum hemorrhage and improving Apgar score - can play an important role in promoting mothers’ health and their satisfaction.”
What MFM mums say
A few of our mums have tried reflexology in order to speed things up – and reported good labours after the fact.
"I had 2 sessions of reflexology when i went overdue, they were 2 days in a row. I have no idea if it had anything to do with my labour but I spent 4 hours at home and when I eventually couldnt cope anymore I arrived at the hospital and was fully dilated!
"Reflexology is supposed to get your bits ready for labour so I'm hoping my £60 was worth it!! I had the reflexology on the Tues and Weds and had my baby boy on the Saturday," wrote Lisa D.
"I used reflexology when trying to conceive and throughout my pregnancy and found it really relaxing," added Emsy4.
"I had a session about 5 days before my due date and got her to work really hard on my feet to bring on labour but it didn't have any effect and I went 2 weeks overdue in the end!
"I had a really good labour though, despite being induced - just less than 4 hours! x
However, it certainly didn’t work for many due and overdue mums – not that they minded the treatment!
“I had it a couple of times at 40+1 and 41 weeks,” shared HJLmumdrum. “It didn't bring on labour for me... it was super relaxing though and did help with my swollen feet!”
Are there other drug-free pain relief options?
To be honest, it really depends. There are a few complementary therapies you can try to help you in the run up to and during labour, including:
How each of these will impact you will really depend on your personality, how your birth's going, your pain threshold, etc...
For example, some people find acupuncture to be a miracle pain-reliever, while others experience it as a load of alternative medicine nonsense.
So, while we don't want to say these will all definitely work, most if not all will help relax you, prepare you to deal with the pain, and at the very least are worth exploring.