Your choices for pain relief in labour

In order to help you plan your choices, please download the Mum and Baby App (add app ICON) Please complete your personal care plan and you can then discuss your birth plan and questions with your Midwife throughout your pregnancy journey. Alternatively you can complete the Birth plan in your maternity notes.
You may have attended Antenatal Classes, which may have helped you with your choices about pain relief; if not your midwife and/or obstetrician will be happy to answer your questions about pain relief throughout your pregnancy.  Around 34 weeks, the birth planning discussion forms part of your antenatal appointment; this is an opportunity to review your choice about place of birth, pain relief and feeding options for you and your baby.

Depending on what your choice is for the place of birth for your baby, the birth planning discussion can be tailored to your individual needs and preferences about pain relief. Please see our information leaflet to see what options are available at Hillingdon on place of birth. Having an idea about your preferences is good and you can make changes as your birth progresses depending on you and your baby’sneeds.

Positive birth and choices about types of pain relief

Positive birth is about you having choice and information to enable you to make decisions during the course of your birth, and having confidence in your body to birth a baby. You can help yourself by using relaxation, hypno-birthing, having analgesia at home e.g. paracetamol, using massage and movement, water and having a supporting birth partner with you, which can help towards having a satisfying birth experience. Anxiety and fear can increase your levels of pain; having an understanding of what is happening to your body can help you in your coping strategies.

All women are different; some find trying different positions during labour and birth as well as moving can make a real difference. Being upright, particularly walking around, sometimes helps labour to progress. Some women like to kneel, or rock backwards and forwards, some women like to be massaged, whereas others do not like to be touched. This is where your partner can help by massaging your back, playing music you like or talking and encouraging you.

Feeling in control of what is happening to you is important. Please discuss your plans with your midwife and they can explain anything to you that you do not understand. Keeping calm and in tune with your body can help you manage the pain. For early labour, keeping hydrated, using simple analgesia at home and making use of a bath (if you have one) can help.

Types of pain relief

Self-help »

Have confidence in your ability to labour and have a positive attitude. Using relaxation, breathing, moving about and having a partner to support and massage you will all help you to have a satisfying birth experience.

Fear makes pain worse, and many people feel frightened of what they don’t understand or can’t control. So learning about labour from antenatal classes, or from your midwife, and from websites like this one are important first steps towards helping yourself cope during labour.

You can also:

  • 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. Please 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
  • If you are in hospital encourage us to dim the lighting for you. The following are known to help:

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.

TENS »

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.

Water birth »

Choosing to give birth in water can increase relaxation and reduce the need for medical intervention; a water birth is an option for women. Women who have complex pregnancies may need an individual discussion, often with the Consultant Midwife, to help them in their birth planning choices. At Hillingdon, the birthing pool is located on the ground floor. Women can choose water for either labour and or birth. 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 injection »

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 injection »

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.

Epidural »

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 although you can opt for an epidural immediately if you want. 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): this numbs the skin so that putting in the epidural needle does not hurt. It is important to keep really still while the anaesthetist is putting in the epidural and if you are having a contraction or need to move a little, please let the anaesthetist know and they will carry on with the epidural again after the contraction has passed.

The epidural needle has to be put in just far enough for the anaesthetic to reach the nerves that pass the messages about the pain of labour. Your anaesthetist has to be careful to avoid puncturing the spinal fluid that lies a little deeper than this, otherwise this may give you a headache afterwards. 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.

Once the epidural catheter is in place, you will be given the analgesia through the catheter. It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give good pain relief. While the epidural is starting to work, your midwife will take your blood pressure regularly. Most epidurals will give highly effective pain relief but sometimes the epidural doesn’t work well enough at first and your anaesthetist needs to adjust it, or even take the epidural catheter out and put it in again. Both the anaesthetist and your midwife will sometimes check that the epidural painkillers are working on the right nerves by using a cold spray on your tummy and legs and asking you how cold it feels (the same nerves cause us to feel pain and cold sensations).

Labouring with an epidural

At Hillingdon Hospital, we deliver the epidural local anaesthetic mixture that relieves your pain via a pump attached to your epidural catheter. You receive this medication via the epidural pump automatically at hourly intervals. However, you can also press the extra dose button on a cord attached to the epidural pump if you have additional or 'breakthrough' pain. The pump lets you know that you are getting an extra dose by sounding a beep. After an extra dose the pump then has a lockout time limit so you do not receive too much medication. There is a green light on the remote dose cord that blinks whenever the lockout time is over and another dose can be given. If you request a dose too soon, the pump will not deliver a dose and you will not hear any beeping sound. When this happens, just wait a few minutes and try again.

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. Some women find that if their labour goes on for a long time they get some heaviness in their legs even with a ‘mobile epidural’.

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.

The medical evidence is that once you are fully dilated, it tends to take longer to push your baby out after an epidural compared to without an epidural. However, the babies are not adversely affected by the extra time taken. The delay is partly because you may no longer have an automatic urge to push as the baby comes down the birth canal; however, 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 easily 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.

More information

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.

Information about pain relief and anaesthesia by doctors for you