There are a variety of options for pain relief in labour. Which one a woman chooses depends on variables such as her background wishes, expectations, labour and childbirth history, her fears, how quickly her labour progresses and developments in the labour. There is no single recommendation. Indeed, a woman’s choice can vary for one labour to the next.
The main options are:
Non-medicated pain relief
- Relaxation therapy. Fear and a lack of knowledge of labour and childbirth can intensify pain sensation. There are antenatal courses a woman can attend to help overcome this. Relaxation therapy can help a woman to be more in-tune with her body during labour. She can learn how to use breathing and focus techniques in labour and how she can relax more. Relaxation therapy can result in a quicker and more efficient labour and enable her to avoid medications or an epidural anaesthetic for pain relief.
- Hypnotherapy. I have had patients who have learnt the technique of self-hypnosis antenatally and by embracing this in labour have often had quicker and more efficient labours and have been able to avoid medications or epidural anaesthetics for pain relief.
- Active birth. Moving around in labour, changing positions, squatting on a gym ball, etc. can help with coping with the pain of contractions. As well by staying upright gravity helps baby’s head to move down through your pelvis.
- Hot and cold packs and/or showers or baths. These can be soothing, help a woman cope with the pain and relax more in labour.
- Water births. Labouring and giving birth in a bath often helps a woman cope with pain, relax more and can result in a more efficient labour. Labouring and delivering in the bath increases the likelihood of a normal delivery and with no or minimal perineal trauma.
- Massage and touch. When done by your husband/partner in labour this can reduce muscle tension and help with relaxation. Practice antenatally to develop an appropriate technique.
- Acupuncture, acupressure, aromatherapy. These can be effective in overcoming the pain of labour.
- TENS machine. Wires from a small battery-operated box are attached to your body by sticky pads. Small electrical impulses are transmitted to the body during contractions to help you cope with pain. A TENS machine can help especially in early labour.
- Water injections in the back. These are administered by a trained midwife into the lower back subcutaneously. These can provide a few hours of pain relief in the lower back region.
Medicated pain relief
- Nitrous oxide gas. A labouring woman can breathe a mixture of nitrous oxide ( ‘laughing gas’) and oxygen during contractions. As well as giving a degree of pain relief the technique of breathing the gas mixture can help a woman focus during contractions. It is safe though you should hold the mask and not your partner, so you do not get too much nitrous oxide. Excess nitrous oxide can temporarily reduce your level of consciousness. Nitrous oxide inhalation is no danger to baby. The mixture can be changed according to your response and needs. Nitrous oxide is more suitable when pain relief is needed in advanced or rapidly progressing labour.
- Morphine or pethidine. Opioid injections can be highly effective, especially for quicker and more efficient labours.
Opioid injections reduce the severity but do not take away the pain.
Opioid injections can help you relax and consequentially give you a more efficient labour.
An opioid injection can take up to 30 minutes to be effective and has a limited life of benefit of 4 to 6 hours. The dose and frequency vary according to your build and need.
An opioid injection should not be given within 2 hours of delivery as it can cause respiratory depression of you baby. If this happens you baby will be given an injection of a drug called naloxone to counteract the effect.
- Epidural anaesthetic. An anaesthetist doctor will insert a fine plastic tube (catheter) into the epidural space of your lower back. Local anaesthetic is then introduced down this catheter. More anaesthetic medication can be given via the epidural catheter during labour. The local anaesthetic blocks the nerves in the lumbar back region as they exit the spinal cord and so numbs the pain of labour.
An epidural usually results in a pain free labour and childbirth experience.
Most women who request an epidural do so when they are not coping with pain of labour. They may have tried or not tried alternative pain relief approaches. Because an epidural gives a woman a pain free labour some women request an epidural at the onset of pain. Some women request an epidural and then induction of labour as they do not want any pain whatsoever.
As there is no pain after an epidural a woman is more relaxed. This can help make labour more efficient. If Syntocinon augmentation is needed to make the contractions stronger and more efficient this can be done without causing the woman any pain.
Second stage needs to be managed carefully after an epidural block so as not to increase the likelihood of an operative vaginal delivery because of inefficient pushing. If second stage is managed appropriately I believe the likelihood of an operative vaginal delivery is not more, and maybe even less, than would be the case without an epidural. If delivery is managed correctly then I have found the incidence and severity of perineal trauma with delivery is less than it is for women who do not have epidural blocks.
Some epidurals do not give full pain relief. This is usually due to fibrous band in the epidural that stop the flow of the anaesthetic drug.
If the epidural needle accidentally punctures the dura the fluid around the spinal cord will leak. This is called a ‘dural tap’. It will need management by the anaesthetist to prevent or minimise a consequential headache.
The epidural can result in a woman’s blood pressure dropping, which will cause her to be lightheaded and can temporarily reduce blood flow to baby. There should be adequate intravenous fluids given before the epidural is started to minimise this risk. As well her blood pressure will need to be carefully monitored.
As there is loss of bladder function with an epidural block a woman will not be able to pass urine while the epidural is working. She will need a catheter in her bladder until after the epidural has been removed and its impact on bladder function has ceased.
A woman will be less mobile after the epidural block is working and so will need to be confined to her bed until after the epidural effect has worn off. There can be reasonable movement of legs with some epidural blocks.
A small number of women will not be able to have epidural blocks because of deformity of the spine (congenital or due to past spinal trauma) or morbid obesity (if there is too much adipose tissue over the spine).
- Spinal anaesthetic. This is done by an anaesthetist doctor. Anaesthetic medication is injected into the fluid around the spinal cord using a fine special needle. There is no catheter.
A spinal block has a very quick onset of anaesthesia and is predictably very efficient in giving total pain relief. It will only be effective for a short time (up to about 2 hours). Consequently, it is suitable for effective pain relief if it is needed and delivery is imminent or for some operative vaginal deliveries. Sometimes it is done when an epidural catheter is inserted so give quick onset of pain relief.
The risks of a spinal anaesthetic are the same as an epidural except for dural tap headaches. With an epidural a larger needle is used, and it is not meant to pierce the dura. With a spinal anaesthetic a finer needle is used that pierces the dura. The hole in the dura with a spinal anaesthetic is much smaller and so the incidence of headaches is much less.
Have ideas about your preference and prepare if appropriate e.g. relaxation therapy or hypnotherapy courses if you wish to choose these options.
Be flexible and incredibly open minded as labour and childbirth happenings are totally unpredictable.
If you or your husband/partner are rigid in thinking you may well be disappointed. For example, I remember a couple who had decided in her pregnancy ‘no epidural’. Once she experienced painful labour contractions, she changed her mind. There was confrontation with her husband with him saying to her: “But we agreed – you will not have an epidural!”
I have had patients who planned to have to have epidurals and when they arrived at hospital they were fully dilated and soon after arriving had normal deliveries without any analgesics needed.
I have had patients who did not want epidurals but once they realised how painful their contractions were quickly changed their mind.
Some women decide on epidurals when it is apparent they are having more challenging longer duration labours.
Do not let others (e.g. family and friends) or social media make the decision for you. It is your body, your labour, and your childbirth experience. Do not left fear of possible (though very unlikely) side effects stop you having appropriate pain relief.
The midwives are there to guide you, support you, encourage and respect your opinion. I and the midwives always have your and your baby’s wellbeing as top priority.
Always ask if you have any fears, anxieties or questions about pain relief in labour. Feel free to discuss your thoughts and preferences about pain relief in labour at your antenatal visits