From natural methods of pain relief to epidurals and more, we bring you the lowdown on all your options for pain relief during labour – including alternatives if you can't get gas and air – to help you make the best choice for you and your baby.
If you're getting ready to meet your baby, and perhaps drawing up a birth plan , you're bound to start thinking about what pain relief you might want to use during labour.
And if you're giving birth in early 2023, you may be worried hearing about the news that some UK hospitals are suspending use of gas and air .
There's a wide array of options to help with pain relief in labour, so we've pulled it all together in this comprehensive guide to your pain relief options for giving birth; with plenty of alternatives if gas and air isn't available.
What are my pain relief options in labour?
According to the NHS , your pain relief options are:
- Self-help (breathing, moving, water, massage, relaxation)
- Alternative methods (hypnobirthing, aromatherapy, homeopathy)
- TENS machine
- Entonox, also known as gas and air
- Pethidine or diamorphine
Not sure what they all do or are? Read on to find out more about different pain relief options for labour...
Self-help and alternative methods
There are several natural things you can try during labour that don't involve medicines or painkillers.
These can be used instead of, or as well as, other forms of pain relief, so you can always give them a try and still move on to something stronger.
Natural methods of pain relief for labour include:
Slow, deep, rhythmic breathing may help you cope with the pain of contractions. Try breathing in for a count of four, and out for a count of six. This is also a great way to de-stress at any time throughout your pregnancy and beyond.
Hynpobirthing classes teach you a new way of thinking about labour and birth, which may help you feel more in control. Studies have found that women who use hypnobirthing techniques may need less medical pain relief during labour.
There's plenty of evidence that being in warm water can help to relieve aches and pains. In early labour at home, try taking a warm bath (not too hot though, as overheating isn't good for your baby; if your skin turns bright pink, the water's too hot).
Many women also like to use a birth pool once labour has progressed. If you're having a home birth, you'll need to hire one. If you're giving birth at a hospital or birth centre, ask them if they have a birth pool available.
Most hospitals and birth centres will have a birth pool or two, but there can sometimes be lots of women wanting to use it, so your midwife may not be able to guarantee it'll be available.
You may be advised against a water birth if you have certain risk factors, such as pre-eclampsia or a breech baby. Also, if you want medical pain relief other than gas and air, you won't be able to have a water birth, so do bear this in mind.
Using gravity can help keep labour progressing, so using movements you'll learn in pregnancy yoga or antenatal classes can help you cope with pain without slowing things down.
Try the following positions:
- kneeling, leaning on a bed or birth ball if it helps
- getting down on all fours
- walking around
- using a birthing chair
- standing up and leaning on your partner
This can be especially helpful if you're experiencing contractions in your lower back. Try kneeling and leaning forwards over a bed or birthing ball, while your partner strokes or massages your lower back.
Massage can also help to relax you, and promote the hormone oxytocin, which helps labour go more quickly. So even a neck, shoulder, hand or foot massage might help you feel more relaxed and cope better with the pain.
Understanding what's happening
Going to antenatal classes can help take the fear out of labour. If you understand what a contraction is and what's happening to your body, it can help you not to panic and cope with the pain better.
Aromatherapy, homeopathy, acupuncture and reflexology
There isn't much evidence that any of these can help with labour pains. If you'd like to try them, always check with a qualified practitioner first.
Take care if buying natural remedies online; they're poorly regulated and may not always do what they say. When in doubt, check with your midwife before taking anything.
Paracetamol and other over-the-counter painkillers
There isn't much evidence that paracetamol can help in early labour, but it's generally fine to try it if you like. It's a good idea to get the OK from your midwife first, though.
Don't take ibuprofen after 30 weeks of pregnancy without talking to your doctor first; ibuprofen in late pregnancy can lead to health problems for your baby. And never take aspirin during pregnancy, as it's not safe for your baby.
What is a TENS Machine?
TENS stands for transcutaneous electrical nerve stimulation.
That may sound scary, but a TENS machine is basically just a smallish device, a bit like a battery pack with wires and patches hanging off it. You stick the patches onto your back, and they emit tiny electrical pulses.
These are thought to help by distracting you from the pain, and by producing natural endorphins that block pain signals in the body.
TENS machines are completely safe and have no side effects. However, you can't wear them in the bath and NICE doesn't recommend them for established labour, only for helping with pain in the early stages.
There's no need to buy one. Most chemists will hire them out and your hospital may have them, too.
If you do want to buy one, Tenscare is a recommended make. See more details here at Amazon.
Entonox (gas and air)
Many women manage well in labour using Entonox, or gas and air, as it's more commonly called. This is a gas that you inhale, made of 50% oxygen and 50% nitrous oxide.
You can use entonox wherever you give birth; at home, at a birth centre (midwife-led unit), or in hospital.
Your midwife will show you how to use it, then you'll be able to use it as often as you need in labour.
It's normally given to you via a mouthpiece which you hold. You'll be advised to breathe in at the start of each contraction. The first few breaths can make you feel dizzy and light-headed and make your face feel numb, but these will wear off quickly.
The great thing about gas and air is that it works within seconds of inhaling it and there are no harmful side-effects. As soon as you stop using it, it's completely out of your system.
It also gives you something to focus on as labour progresses, helping take your mind off the pain and onto your breathing, which relaxes you.
It's not a pain relief, as such, but gas and air does remove you from the pain, making labour much more manageable. Some even compare it to being drunk!
Pethidine and diamorphine
Pethidine is an opiate (like morphine) that is injected into your leg or bum. Diamorphine is also used in a similar way, although is less common.
These medications are usually available in hospitals and birth centres, but you'll need to talk to your midwife about it if you're planning a home birth.
It takes about 20 minutes to work and can offer up to four hours of pain relief.
However, it can make some women feel woozy, sick and a bit 'out of it' during labour.
Some research does also suggest that when mothers have pethidine in labour it can make babies slow to breastfeed after delivery for around 24 hours. In this case, your baby may need a dose of a different medicine to counteract the effect.
An epidural offers full pain relief in labour, acting as an anaesthetic rather than a painkiller. It makes you completely numb from the waist down.
You can only have an epidural if you give birth in hospital; it's not available for home births or at birth centres (midwife-led units).
If you want an epidural, your midwife will need to get the anaesthetist to set this up. This can take some time to do, so it's a good idea to let your midwife know in advance if you know you want an epidural. If you decide you want one during labour, it can often still be arranged, though.
Some women don't want an epidural because it's a painful injection. Although it's uncomfortable, it doesn't take long to set up. You'll sit upright and very still while the injection goes into your lower back. You'll also be put on an intravenous drip.
The epidural can be topped up as required, so if it's not blocking the pain, alert your midwife who can ramp it up.
Although many women swear by epidurals to take away the pain of contractions completely, there are downsides, such as:
- You will need to be monitored constantly, so a CTG (cardiotocography) monitor will be set up to monitor the wellbeing of your unborn baby, and your blood pressure, pulse and temperature will need to be taken regularly.
- You will not be able to move around so will be confined to a bed.
- Your labour could end up lasting longer.
- As you may not be able to feel the contractions, you will need to rely on your midwife telling you to push, therefore you may not push effectively. This increases the risk of an instrumental (forceps or ventouse) or caesarean section birth.
- You will more than likely need a catheter in to empty your bladder, as you may have no sensation to have a wee. A full bladder can sometimes prevent a babies head from coming down.
- Epidurals don't always work, you may not get any pain relief from it, or you may have relief in patches. It's thought that about one in 10 women who have an epidural need additional pain relief, too.
- You may get a very bad headache from the epidural.
What's a mobile epidural?
A mobile epidural uses a lower dose of anaesthetic, so you may retain some feeling in your legs and be able to move around a little. They're not available in all hospitals, so if you're interested, ask your midwife what's available near you.
Common questions about pain relief
How do I know which pain relief to choose?
It's always a good idea to discuss the different methods with your midwife. Some women know they want an epidural (the strongest form of pain relief) and others are definite that they don't.
Mostly, it comes down to personal preference and how labour progresses. You may find your contractions bearable. Labour may go quicker than expected (or slower). Or, you may really gel with your midwife and be happy to be led by their suggestions.
Whichever pain relief is your preference, it's a good idea to know exactly what they are – and how they all work – before you make your choice.
Will I even need pain relief?
That depends on your pain threshold, as well as how your labour progresses.
If you're induced , your obstetrician will most likely recommend having an epidural. This is because the contractions are often stronger and more painful during an induction. It's still your choice, of course.
If your labour progresses quickly or you get to hospital already quite far along, you may be too late for any pain relief other than gas and air.
Remember that even if you've written on your birth plan that you don't want pain relief in labour, you can always change your mind!
What pain relief do most women use?
According to a 2019 survey by the CareQuality Commission , in England:
- About 80% of women used gas and air
- About 35% of women used natural methods such as hypnosis, breathing and massage
- About 30% of women had an epidural
- About 25% of women used pethidine or a similar painkiller
- Almost 20% of women used a birthing pool
- About 15% of women used a TENS machine
Overall, about 40% of women used a different type of pain relief to what they had planned. For women giving birth for the first time, almost half of them changed their mind about pain relief on the day.
So whatever type of pain relief you're aiming for, do be prepared to be flexible.
If I use a birthing centre, can I still have pain relief?
Birthing centres can be independent midwife-led centres or simply a separate floor of a hospital (upstairs or downstairs from the labour ward).
There are lots of advantages to birthing centres, such as:
- rooms tend to be bigger than on the labour ward
- they tend to be more modern with TVs, en suite bathrooms, individual birthing pools etc
- your partner will be allowed to stay in the room with you after having the baby
However, as attractive as these things can be when you do your tour, make sure you ask what pain relief is on offer.
Most birthing centres only offer gas and air (though some also offer pethidine), so if you want an epidural you'll need to opt for the labour ward. Birthing centres are also only advised for low-risk pregnancies.
You can always book in to a birthing centre and change your mind. You can also start your labour on a birthing centre and move to a labour ward (if it's close by) if you do decide you want stronger pain relief.
If you're in an independent birthing centre, this may be an ambulance ride away, so bear this in mind when you're weighing up your options. The same goes for home birth.
If pain relief is important to you, your best bet is to have your baby on a labour ward.
What mums say about epidurals
We asked you for your experiences of epidural for pain relief in labour. Here's what you told us:
'I found the epidural to be brilliant and putting it in was really pain free compared to my contractions that I had been experiencing for three days. You experience some slight twitching and discomfort but the relief from contractions was brilliant and I could finally get some rest.'
'Once it was in it was amazing, suddenly the pain was gone and the rest of my labour was very chatty and I had a button so I could control the dosage. The downsides: when it came to pushing I had no natural urge because of the epidural and not having had babies before it made it very hard to know what I should be doing. I also had a very sore back where it had been for about three months.'
'I had an epidural and I loved it. I planned an all-natural birth, but as I was induced I was bed-bound and not allowed to move around so found it harder to manage the pain. It didn't take away the pressure, but it did help the pain. I still knew when I needed to push – the MW didn't need to assist me, and I was up and walking around within half hour of having my DD. I've had no lasting effects from it. If I were to have more children, I would definitely consider an epidural again.'
'My epidural experience wasn't pleasant. I didn't feel the needle go in thankfully but it didn't work so I had to have it inserted again. I didn't like pushing without feeling and felt out of control. The reason I asked for one was because I was induced twice and my baby was back to back – agony. I also wasn't prepared for the after effects such as a catheter and even after this was removed I was still struggling to move properly or control my bladder. Since my birth I have had increased back ache; some people say it's the epidural's fault and some people disagree, I'm unsure to be honest. I think next time I would hope to not need it and experience birth more naturally.'
'I had my epidural late on into my labour. Worked amazing at the time, could barely feel anything. However after I got home, I started having excruciating headaches and felt awful. The needle had gone too far into my spine and spinal fluid was leaking. I couldn't hold my baby and wasn't able to breastfeed. I had to go back into hospital and have blood taken from my arms and injected down my spine to stop the leaking (blood patch). So I don't think I would ever have a epidural again.'
Discuss your pain relief options with other mums-to-be and those who've already been there in our forum below, or check out our articles for more ways to prepare for giving birth.