Pain relief

There are different ways to help ease pain during labour, and you can ask for pain relief at any time. You can choose one method or a few, and you can change from one to another during labour. Your midwife should explain about the advantages and disadvantages of each so that you can decide what is right for you, and should support you in your choice.

Things you can try

Breathing and relaxation techniques and massage may help, and have no side effects.

You should be offered the option of being in water during labour, as this helps with pain. Your temperature will be checked every hour to make sure you are not getting too hot.

You will not be offered acupuncture, acupressure or hypnosis to relieve pain, but you can use them if you want to.

Starting to use a TENS machine once you are in established labour will not help with pain.

Drugs for pain relief

Entonox (also known as 'gas and air') is a gas that you breathe in through a mouthpiece or mask. It gives some relief, although it may make you feel sick and light‑headed.

Diamorphine, pethidine and similar drugs (called opioids) can be given as injections for pain relief. They may make you feel or be sick (although you will be offered other medication to help with this) and drowsy. You will not be able to get into water for 2 hours after an injection, or longer if you feel sleepy. After the birth your baby's breathing may be affected and they may be drowsy (which could affect breastfeeding).

Epidurals

An epidural is a local anaesthetic. The epidural is injected into the area around the spine and topped up as needed.

You can have an epidural only if you are in an obstetric unit, so if you are at home or in a midwife-led unit you will need to be transferred. You should be able to have an epidural at any point if you want one, including during the early stage of labour.

Your midwife should talk with you about the advantages and disadvantages of an epidural, including:

  • it is better at relieving pain than opioids

  • you and your baby will need careful monitoring, which is likely to mean that you can't move around as much

  • it is not linked to a longer first stage of labour or an increased chance of having a caesarean section

  • it is linked to a longer second stage of labour and an increased chance of a forceps birth or a ventouse birth

  • it is not linked to long‑term backache.

If you choose to have an epidural, you and your baby will need to be monitored more closely. Your blood pressure will be checked more often and you will be put on a drip. Your baby's heartbeat will also need to be monitored using a machine (electronic monitoring) for the first 30 minutes after you have the epidural, and after each top‑up.

If you are still in pain 30 minutes after the epidural or a top‑up, the anaesthetist should be asked to come and assess you again.

The dose of anaesthetic you are given should be low enough that you can still move around a little and get into whatever position you find most comfortable. But as you have top‑ups over the course of your labour, you will probably be able to move less.

You may be able to have a type of epidural that you can top up yourself.

Your midwife will tell you when your cervix is fully dilated, and will advise you not to push for at least 1 hour, unless you have a strong urge to do so or your baby's head is visible. You will then be encouraged to push during contractions. (See also information about the second stage of labour.)

Once started, your epidural should continue until after your baby is born, your placenta is delivered and any stitching you need has been done.

Questions about pain relief

  • What types of pain relief are there?

  • What can I try if I don't want to have drugs?

  • How might being in water help?

  • When can I use the birthing pool?

  • How might gas and air or opioids affect me and my baby?

  • What does having an epidural involve?

  • How might an epidural affect me and my baby?

  • How much will I be able to move around if I have an epidural?

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