Pain relief in labour: your options, simply explained

Some women plan to use as little pain relief as possible. Others know they want an epidural the moment it is offered. Many are somewhere in between and simply want to know what is out there. All of these are valid choices. Using pain relief is not a lack of strength or faith, and not using it is not something to prove. Here is a simple guide to the common options. Availability varies between hospitals and countries, so ask your midwife what is offered where you plan to give birth.

Natural ways to cope

These can be used on their own or alongside other pain relief.

• Breathing: slow breathing, with a longer out-breath, helps you relax and stay on top of contractions.
• Moving and positions: walking, swaying, rocking on a birth ball, kneeling or leaning forward can ease pain and help labour progress.
• Warm water: a warm shower, bath or birthing pool, if available, can be very soothing.
• Massage and touch: firm pressure on the lower back, or simply holding hands, can help a lot.
• A calm setting: dim lights, familiar music, worship songs, prayer and a supportive birth companion.
• A TENS machine: a small device with pads on your back that sends gentle electrical pulses. Many women find it most useful in early labour. You usually need to hire or buy one in advance.

Gas and air

Gas and air (known as Entonox in the UK) is a mixture you breathe in through a mouthpiece or mask during contractions. You control it yourself, and it wears off quickly when you stop.

• What it does: takes the edge off the pain rather than removing it.
• Things to know: it can make you feel light-headed, sleepy or sick. If you dislike it, you can simply stop.

Opioid injections

An injection of a strong painkiller, usually into the muscle of your thigh or bottom, is offered in many hospitals.

• What it does: helps you relax and can dull the pain for a few hours.
• Things to know: it can make you feel drowsy, sick or a bit detached. If it is given close to birth, it can make the baby sleepy and affect their breathing and first feed for a while, so timing is important. Your midwife will advise.

Epidural

An epidural is a local anaesthetic given through a fine tube into your lower back by an anaesthetist. It is usually only available on a hospital labour ward.

• What it does: for most women it gives very good pain relief by numbing the lower body.
• Things to know: your legs may feel heavy and you will usually need to stay in or near the bed. Your baby's heartbeat will usually be monitored continuously, and you may need a drip and a catheter to empty your bladder. The pushing stage can take longer, and you may be more likely to need help with forceps or ventouse. Some women have a headache afterwards. The anaesthetist will explain the benefits and risks before you decide.

If you need a caesarean birth

Most planned and many unplanned caesareans are done with a spinal or epidural anaesthetic, so you are awake but do not feel pain, and your birth partner can often be with you. Sometimes a general anaesthetic is needed. Your team will explain what they recommend and why.

Questions to ask your midwife

1. Which types of pain relief are available here, and at what times?
2. Is there an anaesthetist available for epidurals day and night?
3. Are there any costs involved in my hospital?
4. Is a birthing pool available?
5. Does my medical history affect any of my choices?

It is wise to write your preferences in your birth plan, and to add that you may change your mind. You are allowed to.

Strength in weakness

Labour can bring you to the end of your own strength, whatever pain relief you use. Paul learned something precious in his own weakness:

“And he said unto me, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me.” (2 Corinthians 12:9)

You do not have to be strong enough on your own. When you feel you cannot go on, His grace is still enough, whether you are breathing through a contraction in a pool or receiving an epidural on the labour ward. Both are places where His power can rest on you.

A prayer about pain relief

Lord, I do not know how my labour will feel. Give me wisdom to choose the help I need, freedom from guilt about my choices and courage when it is hard. Let Your grace be enough for me in every moment. Amen.