Pain relief in labour and birth

Labour pain can be difficult to manage, but there are pain relief options available that can help. It’s good to know what they are before you go into labour.

On this page

Relief for labour pain

Breathing and relaxation during labour

Hypnobirthing

Alternative methods of pain relief

Using a birthing ball

Having a water birth

TENS (transcutaneous electrical nerve stimulation) and labour

Gas and air (Entonox) in labour

Pain relief using opioids

Epidural

Relief for labour pain

It's helpful to know which pain relief options you can have before the birth. It might help you stay calm, which can mean an easier birth. If you are stressed and tense, your contractions may feel more painful and not work as well.

You may also find it helpful to:

• talk to your midwife about pain relief  
• write down your wishes in your birth plan
• learn as much as you can about labour – you could try talking to your midwife and going to some antenatal classes
• keep moving and try different positions during labour
• have a birth partner who can support you, if possible

Read more about positive ways to prepare for labour.

You may have very clear ideas about the pain relief you want or don’t want. This is helpful but try to keep an open mind.

You may find that, for whatever reason, some methods are not enough on the day. Don't feel bad about this, do whatever is best for you at the time.

You may find that you are in the latent stage of labour for a long time before things really get going. Things that can help with early labour include:

• warm baths
• back massages 
• paracetamol
• a TENS machine
• moving around. 

Try not to worry about how you’ll manage when labour gets going. When it happens, everyone deals with it in their own way.

Some find an inner calmness, some swear and shout, and others want to have all the pain relief they can. All these reactions are fine and normal, and your healthcare professionals have seen it all before. 

Breathing and relaxation during labour

Slow, rhythmic breathing will help you get into a relaxed state that can help you cope better with labour. Being able to relax, rather than tense up, during a contraction helps your body manage labour better.

Many antenatal classes cover ways of relaxing and breathing in labour. It's good to find out about these, whatever you decide to do when you go into labour. 

You could try breathing slowly in through your nose while counting to 4, then slowly out through your mouth while counting to 8.

Breathing and relaxation doesn't affect your baby. You can use breathing techniques and also have pain relief.  

Hypnobirthing

Hypnobirthing is a way of managing pain that can be used during labour and birth. It uses a mixture of visualisation, relaxation and deep breathing techniques.

Breathing exercises have been part of antenatal classes for a long time. Hypnobirthing also includes relaxation, visualisation and mindfulness to help you focus on your body and the birth of your baby. 

Hypnobirthing can be used with all other types of pain relief and can be added to your birth plan.

Find out more about hypnobirthing.

Alternative methods of pain relief

Some people may choose alternative treatments (complementary therapies) such as acupuncture, aromatherapy and reflexology. Your midwife or doctor should support you in trying these therapies, although most of them aren’t proven to give effective pain relief. 

Using a birthing ball

A birthing ball is an inflatable, burst-resistant ball – similar to an exercise ball. Gently bouncing or rocking on it may help you relax and ease pain.

Ask your midwife whether there will be birthing balls in your maternity unit. You could also buy or borrow one before the birth. Try them out before you buy because birthing balls come in different sizes. 

• Using a birthing ball doesn't affect your baby.
• You stay in control of it and you can use other pain relief at the same time.
• It's useful for support in different labour positions.

Learn more about how to use a birthing ball in pregnancy and labour.

Having a water birth

You may find that being in water helps you cope better with pain and feel more relaxed. The water also gives support to your body so you can move more freely.

You can hire a birth pool to use at home, or there may be one at your hospital or birth centre. A birth pool is larger and deeper than a bath so there is space to move in the water. Your midwife will check your temperature every hour to make sure you’re not getting too hot.

Tell your midwife as early in your pregnancy as possible if you'd like a water birth. If you're planning a home birth, you can hire a pool. Ask your midwife about this.  

Pros of having a water birth

• Being in water doesn't affect your baby.
• You can get out at any time.
• You can also use gas and air (Entonox) while in the pool. 

Cons

• You can't use a TENS machine. 
• You won’t be able to have some pain-relieving drugs. For example, you can’t have opiates, such as pethidine, for about 2 to 3 hours before you get into the pool, and you can’t have an epidural.
• The birth pool may not be available if the hospital or birth centre is busy.
• Birth pools take time to fill, so if things happen quickly you might not have time to use it.
• In some circumstances, you may be advised not to use a birth pool. For example if your baby is in a breech position, you have a high BMI or you’re having twins or more.

Find out more about having a water birth.

TENS (transcutaneous electrical nerve stimulation) and labour

A TENS machine is a small machine that is attached to your back with sticky pads. It sends out tiny electrical impulses to block pain signals sent from your body to your brain.

Using TENS may make you less aware of the pain in early labour. It can also trigger the release of endorphins, which are your body's pain-relieving chemicals.

You can hire or buy a TENS machine, so you have it ready at the start of labour. Try it out before you go into labour (after you reach 37 weeks) so you can learn how it works. For the best results, start using it early in your labour.

Pros

• A TENS machine doesn't affect your baby.
• You control it yourself.
• You can use other pain relief at the same time.

Cons

• If you only start using a TENS machine when you’re in established labour, it will not help with pain.
• It may not work for everyone.
• You can't use it in a birthing pool, bath or shower as there is a danger of electrocution.
• You may need other pain relief methods as well.

Gas and air (Entonox) in labour

This is a mixture of oxygen and nitrous oxide gas. You breathe this in just as a contraction begins using a mask or mouthpiece, which you hold yourself. It works best if you take slow, deep breaths.

You can have it while you’re having a water birth. If you're planning to have a home birth, talk to your midwife before the baby is due about using it at home.

Pros

• It takes the edge off the pain.
• It works quickly.
• It can be used at any time during labour.
• It can be used with other forms of pain relief.
• You are in control of it.
• Gas and air doesn’t affect the baby.
• It's easy to use.
• You can stop using it at any point and the effects go away quickly.

Cons

• It doesn't get rid of all the pain.
• It might make your mouth feel dry (sipping water or sucking ice cubes will help).
• It may make you feel sick or lightheaded, nauseous or sleepy.
• You may need to use other pain relief methods as well.

Pain relief using opioids

Diamorphine, pethidine and similar drugs (calledopioids) can be given as injections for pain relief. Each one works slightly differently.

Find out in advance what injections your hospital offers. Talk to your birth partner and midwife about the side effects, which are different for each drug. 

Pros

• They may help you cope better with contractions.
• You may be able to sleep through contractions.
• They can help you to relax.

Cons - will vary depending on the drug

• They can cause nausea and vomiting (although you can be given other medication to help with this).
• They can make you drowsy.
• They may affect you baby’s breathing after the birth and they may be drowsy (which could affect breastfeeding).
• You won’t be able to use the birthing pool for at least 2 hours after you’ve had an injection.

Epidural

An epidural is a local anaesthetic that is injected into the spine and topped up as needed. You can only have an epidural if you are in an obstetric unit (labour ward). If you are at home or in a midwife-led unit you will need to be moved to a hospital first.

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 contractions and your baby's heartbeat will also need to be monitored using a machine (electronic monitoring) for at least the first 30 minutes after you have the epidural, and after each top-up. Your midwife may also recommend ongoing checking of the baby to make sure they are well. 

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

Pros

• You should be able to have an epidural at any point.
• It is better at relieving pain than opioids.
• It is not linked to a longer first stage of labour or an increased chance of having a caesarean section.
• It is not linked to long‑term backache.
• You may be able to have a type of epidural that you can top up yourself.

Cons

• You may not be able to move around as much after you’ve had a few top-ups.
• Epidurals are linked to a longer second stage of labour and an increased chance of an assisted birth.
• You can only have it in hospital, because it needs to be given by an anaesthetist.
• You will need to be monitored more closely in labour.
• There can be side effects, including low blood pressure, loss of bladder control, itchy skin, feeling sick, headaches, infection and nerve damage.

Talk to your midwife about the risks and benefits of epidurals and other pain relief, to see what’s right for you. You can also contact Tommy’s midwives for information and support. Call 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected]

Learn more about your options for giving birth and how to make a birth plan.