Pain relief in labour

Labour and birth

Pain relief means stopping or reducing the pain you feel during labour with medicines or medical treatments. Pain relief can include:

Each method has advantages and disadvantages. We have included these to help you decide which method is best for you.

If you have any questions or concerns, please speak to your midwife. 

Gas and air (entonox)

This is a mixture of nitrous oxide and oxygen, also known as gas and air. It is simple, quick to act and wears off in minutes.

You breathe the gas through a mouthpiece. To get the full benefit you should start breathing it as soon as the contraction starts, and stop as soon as it ends.

Advantages
  • It can be used at any time during labour.
  • You are in control of how much you have.
  • It can be breathed out of your system very quickly.
Disadvantages and risks
  • Breathing the gas between contractions can make you feel light-headed and tingly.
  • It might make you feel a little sick.
  • It will not take the pain away completely.

Diamorphine injection

This is an opioid (morphine based painkiller) injection. It helps with pain by acting on your body's central nervous system.

It will only be used if it is appropriate to your situation during labour.

It might be offered to you for your labour if you would like to stay at the Home from Home birth centre but would like some stronger pain relief. You might also have it if you cannot have an epidural. 

Your midwife can give you the injection while you are in hospital. It cannot be used at home.

It can be given at any time during your labour but is best to be given before you start pushing.

Advantages
  • It can help with anxiety.           
  • You can have the injection at the Home from Home birth centre.
  • It can be used with entonox (gas and air).
  • It can be used at any time during your labour.
Disadvantages and risks
  • It does not offer much pain relief during labour.
  • It is not an option if you are having your baby at home.
  • It can make you feel sleepy, or sick. You will be given anti-sickness medicine to help.
  • It can affect the baby, as it crosses the placenta. After the birth, your baby might be sleepy, or have problems controlling their breathing.
  • It can have an impact on breastfeeding.

Epidural

This is a local anaesthetic in your back that should stop you from feeling pain. It's the most complex form of pain relief and must be done by an anaesthetist.

If you have certain bleeding disorders and complications during pregnancy it might not be suitable for you.

You have a drip, giving you fluid into a vein in your arm. We'll ask you to curl up on your side or sit bending forwards. We'll clean your back and give you a small injection of local anaesthetic into your skin. This will help with any discomfort when the epidural is put in.

A small tube is put into your back, near the nerves carrying pain from the womb. This needs to be done carefully, as puncturing the bag of fluid surrounding the nerves might give you a headache afterwards. It's important to keep still while the anaesthetist is putting in the epidural. After the tube is in place you will be able to move.

Once the tube has been put in, pain medicines can be ‘topped up’ as often as you need them, by a pump that you can control.

Your midwife will check your blood pressure regularly, as the pain medicine might cause your blood pressure to fall slightly. The anaesthetist and your midwife will also check that the epidural is working properly by using a cold spray on your abdomen and legs to test your sensation. They will ask you about your pain to check how the epidural is helping.

It usually takes about 20 minutes for the epidural to work. Sometimes it does not work well at first, and some changes might be needed.

Your baby might be continuously monitored using a fetal heart rate monitor, also known as a cardiotocograph (CTG) once the epidural is put in. This can be stopped after 30 minutes if it is safe to do so.

Advantages
  • It should not make you feel sleepy, or feel sick.
  • It can usually take away all of your pain.
  • It has a minimal effect on your baby.
  • It is usually possible to have pain relief without numbness or 'heavy legs'. This is called a 'mobile epidural'. Some people can walk to a chair or the bathroom, but many choose to stay in bed. After a few hours, the legs can become quite heavy and you might have to stay in bed.
Disadvantages and risks
  • The epidural might not work at first, and another dose of epidural drugs might be given.
  • Occasionally, the epidural does not work, and you need another epidural.
  • You might get a severe headache after an epidural, although this can be treated. This happens in about 1 in 100 people.
  • You might have tenderness where the epidural was given. There is good evidence to show that epidurals do not cause long term back problems.
  • Occasionally, an epidural can make your blood pressure drop, which is why you have a drip in your vein.
  • About 1 in 2,000 people get a tingling feeling, or numbness, in part of one leg after having a baby. These problems are more likely to happen from childbirth itself rather than from an epidural. This will usually fade 1 to 2 weeks after your baby's birth.
  • It might make the second stage of your labour longer, and lower your urge to push your baby out. There is evidence to show that the number of people needing an assisted birth with suction or forceps is higher after an epidural.
  • It might make it difficult for you to have a pee. You are more likely to need a small tube (catheter) put into your bladder to help you pee.
  • The epidural might make you feel shivery, but this is rare.
  • The epidural can make you itch, but medicine can be given to help this.
  • Other serious complications can happen, but are very rare.

Epidural for assisted birth or caesarean section

If you need an assisted birth procedure (such as a forceps, or a caesarean section), your epidural can usually be made more effective to allow this to take place without any pain.

A stronger local anaesthetic and other pain medicines are injected into your epidural tube. This is safer for you and your baby than having a general anaesthetic.

If you have not had an epidural, a spinal anaesthetic can be used.

Spinal anaesthetic

Epidurals are slow to act, particularly in late labour. If the pain medicines are put directly into the bag of fluid around the nerves in your back, they work much faster. This is called a spinal anaesthetic.

A much smaller needle is used than with an epidural, so the risk of headache is small. Spinal anaesthesia is used for forceps births and caesarean sections.

Some people cannot have an epidural or spinal anaesthetic because they have certain health conditions. If this is the case, the anaesthetist will speak to you about other types of pain relief.

Patient controlled analgesia (PCA) pump

Opioids (morphine type painkiller) can be given through a small tube put in one of your veins. The opioids are put into a pump and you are given a button to press so that you can give yourself pain relief when you need to.

The equipment is set up so that you cannot overdose (have too much pain medicine).

Resource number: 0075/VER4
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