Pain relief in labour: your options explained

You don’t need to decide everything in advance, but it helps to know what’s on offer. Here’s how each option works and what the NHS says about it.

Self-help

Relaxing, breathing, changing position, massage, a warm bath and paracetamol early on can all help. The NHS notes these need no medical treatment, and a partner can help with massage. Not everyone wants to be touched, and that’s fine.

TENS

Small electrical pulses delivered through pads on your back. The NHS says there are no known side effects for you or your baby and you can move around while using it. It adds that TENS has not been shown to be effective in the active phase of labour and is probably most useful in early labour. Not every hospital has machines, so you may need to hire one.

Gas and air (Entonox)

A mix of oxygen and nitrous oxide that you breathe in through a mouthpiece, which you control yourself. The NHS says it takes about 15 to 20 seconds to work, so you breathe it in just as a contraction begins. It reduces pain but doesn’t take it away, and it can make you feel lightheaded, sick or sleepy. You can stop whenever you want.

Pethidine or diamorphine

An injection into your thigh or buttock. The NHS says it takes about 20 minutes to work and lasts 2 to 4 hours. It can leave you feeling woozy, sick and forgetful. If it is given too close to the birth it can affect your baby’s breathing, so it isn’t recommended near the second stage, and it can affect the first feed.

Epidural

A local anaesthetic through a thin tube in your back, usually giving complete pain relief. It is only available in a hospital obstetric unit. It can make the second stage longer; see epidural in labour for what the NHS and anaesthetists say.

Remifentanil

Given through a drip in your arm, which you control with a button. The NHS says it works quickly and wears off after a few minutes. It can cause sleepiness, sickness and breathlessness, so your oxygen levels are monitored.

Water

A bath or birth pool can help you relax and make contractions feel less painful. The NHS says the water is kept at a comfortable temperature, no higher than 37.5C. See water birth.

Hypnobirthing and complementary therapies

Tommy’s says research suggests hypnobirthing can help reduce fear and pain, though not all studies agree it reduces the need for drugs. It takes practice, and you can use it alongside other pain relief. The NHS says most other complementary techniques (such as acupuncture and aromatherapy) are not proven to give effective pain relief, and most hospitals don’t offer them for labour pain.

It’s fine to change your mind

You can start with one option and move to another, or have more than one. Wanting pain relief is not a failure. Talk to your midwife before labour so you know what your unit offers.

Questions people ask

When is it too late for an epidural?

It depends on how labour is going and what your unit can do. Ask for it early if you think you’ll want one, as the NHS says it takes about 10 minutes to set up and another 10 to 15 for it to work.

Does gas and air affect my baby?

The NHS lists lightheadedness, sickness and sleepiness as effects for you, and says you control it yourself. Using it for more than 24 hours can reduce your vitamin B12 levels.

Can I have pain relief at a home birth?

The NHS says epidurals aren’t available at home, but gas and air, a birth pool, TENS and relaxation techniques are options. See is homebirth the right choice for you?.

Do I need a birth plan for this?

A plan can help you think it through. See writing a birth plan.