Read our latest advice on Coronavirus (COVID-19)


Our services are open and safe to attend – we are here to help

Pain relief in labour

Resources

More in this section

 

There are different methods to help you cope with any pain or discomfort you might have during labour. These include

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

You can also use coping methods in labour, such as aromatherapy, TENS machines and relaxation therapies.

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

Entonox® (gas and air)

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.

The timing is important in the use of Entonox. 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.

Diasadvantages

  • 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 anytime 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

  • 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 that should stop you feeling pain. It is the most complex form of pain relief, and must be done by an anaesthetist.

Most people can have an epidural. If you have certain bleeding disorders and complications during pregnancy it might not be suitable for you.

You will need a drip, which gives you fluid into a vein in your arm. You might also need the drip during labour for other reasons.

You will be asked to curl up on your side or sit bending forwards. We will 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 is 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.

While the epidural is working, 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 the pain you might be feeling 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

  • 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 of 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 occur, but are very rare.

Assisted birth or caesarean section operation

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.

Patient controlled analgesia (PCA) pumps

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.

This might be opioids (morphine type painkiller) given through a small tube put in one of your veins. The opioids are put into a pump – like the one used for an epidural – 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 and have too much pain medicine.

Antenatal classes

To prepare for the arrival of your baby, you might find it helpful to go to antenatal classes.

The classes give you information about what happens during your pregnancy, how to care for your baby, and what to expect when you go into labour. You will learn about methods to help you cope with labour pain.

 

 

Ref number: 0075/VER4

Date published: March 2018 | Review date: March 2021

© 2018 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request

 


Where next?

 Contact us

If you have any questions, contact our helpline, Monday to Friday, 10am to 6pm.

Phone: 020 7188 8760

Print this page

Download Coping        methods and options for pain relief in labour (PDF 141KB)

Staying safe in our hospitals

We've made some important changes to help keep you safe. Find out more.

Was this helpful?

If you have any comments about this information, we would be happy to hear from you. Fill in our simple online form or email:

PatientInformationTeam
@gstt.nhs.uk

Our information is changing

Find out how we are making our patient information more accessible and inclusive.

PIF TICK logo - trusted health information