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Labour can understandably feel scary, and naturally you’ll wonder what contractions and pushing will feel like. Equipping yourself with some information in advance can help to ease your nerves, giving you an idea about some of the pain relief options available to you. Here we’ll talk through some of the most common pain relief options available in labour. Using evidence-based research, we’ll evaluate the advantages and disadvantages of each option with an informative, non-judgmental approach.

Natural alternatives such as hypnobirthing, massage and hydrotherapy are also wonderful ways of managing the sensation of tightenings and contractions. These can feel especially yummy in the comfort of your own home in the latent phase of labour; grounding and preparing yourself to meet your beautiful baby.

TENS machine

A TENS (transcutaneous electrical nerve stimulation) machine delivers small electrical impulses through your skin using sticky pads placed on your back. These electrical impulses work to intercept pain signals sent from your body to your brain, and also promotes the release of endorphins (always a good thing).

TENS machines are sometimes available to loan from your hospital or birthing centre, so it’s important to check their availability with your midwife in advance if you’re thinking about using one.

Pros

• Completely non-invasive, drug-free and doesn’t affect baby or the progress of labour
• Customisable and controlled by you: adjust the level according to your needs, with a ‘boost’ button to use during contractions
• Can be used with other pain relief options such as gas and air

Cons

• TENS can’t be used in the birthing pool or shower
• The pain relief provided can be limited, making it more effective in early labour 

Oral analgesia

Oral analgesia like paracetamol can be used in early labour at home, and a prescribed painkiller like dihydrocodeine may be offered when you first present to the hospital or birth centre in labour. Please don’t forget that ibuprofen isn’t safe to use in pregnancy!

Pros

• Paracetamol is widely available, inexpensive, and safe for both you and baby
• Dihydrocodeine offers effective relief for moderate to severe pain
• Oral analgesia is totally non-invasive

Cons

• Oral analgesia may offer limited efficacy for stronger contractions as labour progresses
• Overuse of dihydrocodeine can cause constipation (not fun), and some people may experience some nausea, vomiting and dizziness with use
• May take 20-30 minutes to have an effect

Note: Dihydrocodeine is an opioid that crosses the placenta to baby, but usually this is only poses a risk with prolonged or high-dose use which your prescribing doctor will discuss with you.

Gas and Air (Entonox)

Gas and air is a popular choice for labouring mums throughout the different stages of labour. A mix of nitrous oxide and oxygen, gas and air is inhaled through a mouthpiece for the duration of each contraction. Gas and air doesn’t cross the placenta, which means it is completely safe for baby. Using the mouthpiece can also help work as a distraction during contractions, forcing you to slow down and focus on your breathing.

Pros

• Self-administered and non-invasive, can be used as and when relief is needed whilst you mobilise
• Gas and air takes effect quite quickly, after a few deep breaths you should feel the benefit!
• Wears off soon after you stop breathing through the mouthpiece, meaning you only feel the effects when you need it

Cons

• Can make you feel lightheaded, dizzy or nauseous
• Gas and air isn’t always effective for everyone, and may provide insufficient relief as labour progresses

Opioids

Opioids such as pethidine or diamorphine can be administered by an injection into your arm or thigh. They may also be given alongside an anti-sickness medication to prevent you from vomiting or feeling nauseous.

Opioids can offer relief from the intensity of contractions for 2-4 hours; taking the edge off contractions when they come, then drifting you off to sleep so you can rest between each wave. Opioids are less suitable in the later stages of labour, so It’s important to discuss them with your midwife.

Pros

• Take effect quickly, usually providing relief within 20 minutes
• Ideal for early labour, allowing you to get some rest
• Less invasive than an epidural

Cons

• Can make you feel nauseous, dizzy or drowsy and may temporarily prevent you from feeling fully present
• Opioids will dull, but not eradicate the pain of contractions
• Cross the placenta to baby; this may make them slower to feed, or rarely, have some breathing difficulties if opioids are given too close to delivery

Epidural

An epidural involves inserting a very thin tube into your lower back, and administering local anaesthetic into this space. This is the strongest form of pain relief available in labour, and when working effectively, epidurals usually eliminate the pain of contractions completely. As labour progresses and baby navigates through the pelvis, you’ll still experience feelings of pressure with an epidural. Your feet, legs and tummy may feel completely numb, which will limit your movement and usually restrict you to different sitting/lying positions on the bed. Midwives will also recommend a urinary catheter after having an epidural, as you won’t feel the sensation of a full bladder!

Epidurals are usually only available on a labour ward in a hospital, as they will be administered by an anaesthetist. After an epidural, your midwife will monitor your blood pressure and your baby closely. It takes about 20 minutes for the anaesthetic doctor to administer the epidural, and a further 20 minutes for you to feel a change in the intensity of your contractions. Feeling itchy is an annoying, but normal and common side effect of epidurals.

If you’d like an epidural, it’s important to let your midwife know during your labour. She will ensure an epidural is timed suitably for your stage of labour, and inform the anaesthetic team as there might be a little wait involved. After you’ve had your baby, your legs might feel numb for a couple of hours.

Pros

• Most effective pain relief: epidurals aim to completely remove pain of contractions giving your time to rest and feel comfortable
• Some epidurals are patient controlled, allowing you to administer more or less anaesthetic as you need
• Pain relief is long-lasting until your baby is born and the epidural is removed

Cons

• Invasive procedure that carries risk of possible side effects, catheter also recommended
• Epidurals can slow down different stages of your labour, particularly when it comes to pushing
• Reduces mobility so an epidural limits you to staying in bed during labour
• Not always immediately available and limited to certain locations like a hospital labour ward