What are my pain relief options?
Your options explained
No one can predict how labour will feel. Some cope well, whilst others need quite a lot of help to overcome the pain. Getting to know what options are available to you beforehand can make deciding in the midst of a contraction a lot simpler!
You’ll need to find out what options are available to you, as not all the pain relief choices below are widely offered. It’s best to talk it through with your midwife to see what’s best for your individual circumstances, especially as some pain relief options have side-effects or need to be used in conjunction with something else.
Gas and air
Also known as Entonox, this is inhaled through a mouthpiece or mask. It is colourless, tasteless and takes the edge off contractions. You can use gas and air in home and water births too. It’s totally under your control, can be used at any stage of birth and is easily combined with other pain relief options. Gas and air doesn’t stay in your system for long and will not harm your baby.
Remember to start breathing the gas and air the very second you feel a contraction beginning. If you wait until the contraction really hurts, it will be working in between contractions, which will be of no benefit. Gas and air can give you a dry mouth or make you feel sick so keep a cup of water handy.
A TENS machine may clip onto your clothing or might be hand-held and produces pulses that prevent pain signals from reaching your brain. It has four pads which you place on your back. These are connected to a small monitor by wires. Especially helpful in the early stages of labour, it helps your body to release its own, natural "feel good" chemicals, called endorphins. You can move around whilst using a TENS machine, there’s no effect on your baby plus you can even use it in home births.
You control the pulses according to the level of pain you’re experiencing. It takes about an hour for your body to really start responding to the TENS machine; so start using it at the very beginning of your labour to get the most benefit. As very few hospitals provide TENS machines, it’s worth hiring one from a chemist (around £20 – £30/month) and using it at home beforehand if needed.
Most women find a TENS machine works best in the first half of labour. You will have to take it off if your baby’s heart needs monitoring, you want a massage or if you enter a birthing pool. Bear in mind removing a TENS machine will mean it stops having an effect but you can combine it with other options to reduce pain.
This painkiller is a synthetic version of morphine and may offer some relief, especially with a labour that is progressing very slowly:
- It only takes around 20 minutes to start working.
- It can be given by your midwife without consulting a doctor.
- Pethidine is either injected or provided via a tube, which you can control.
Pethidine is usually given with another drug to stop the feelings of sickness that may occur. It can only be given during the first stage of labour.
Pethidine can slow down your labour. If given shortly before birth it can affect your baby’s breathing and feeding and make them less alert. If necessary your baby can have an injection to reverse the effects of the drug.
This can be given when you need extra help to cope with strong contractions and usually starts working in just 15 minutes. You can take it at any time during the first stage of labour.
Meptid has the same advantages as pethidine but does not seem to affect your baby’s breathing as much. However, it could make you feel dizzy and/or sick.
As Meptid is not available everywhere, check with your midwife beforehand whether your hospital uses it.
For the majority of women who have an epidural they are pain-free and work well. As it doesn’t cause drowsiness or give you a foggy head, you’ll be fully aware of your labour. An epidural is basically a local anaesthetic (similar to the stuff dentists use) that is injected into your lower back or delivered by a drip, which has a timed release or is controlled by your midwife and anaesthetist.
Epidurals can be fantastic at helping you through childbirth, so don’t be put off by the side effects. The fact is most women sail through with no problems; it’s most likely that you will too. If you do want to have one, check your hospital has an anaesthetist available and bear in mind that it isn’t available for home births or in some birth centres.
When can you have an epidural?
Most women have an epidural when their cervix is about five to six centimetres dilated and the contractions are strong, though this will depend on whether it is your first baby or a subsequent one. If you are dilated any further it may be too late to be given one and your midwife may suggest you use another form of pain relief.
What are the side effects?
An epidural can make labour longer, especially the pushing stage. If it hasn’t worn off during the first stage of labour, your midwife may need to tell you when to push during the second stage. It’s worth discussing with your midwife whether you should let your epidural wear off for the second stage of labour so that you can feel the contractions and push more effectively during delivery.
An epidural means you are bed-bound and you may feel shivery. It can also cause a drop in blood pressure, though you’ll have a drip to counteract that. You'll be attached to a monitor to check your contractions and your baby's heartbeat, and will also be attached to a blood pressure machine. On rare occasions epidurals can cause bad headaches, but these can be treated by your anaesthetist.
This is quite new and great at removing pain during childbirth. Unlike an epidural, you’ll still be able to feel your legs and perineal area, which will help you push your baby out, and reduce the chances of needing an assisted delivery.
Mobile epidurals are given like a traditional epidural. You can have one even before the first stage of labour. It’s basically a combination of anaesthetic and pain relief drugs. Unlike a traditional epidural, the only side effect you may feel is some itchiness.
Sounds ideal doesn’t it? The only catch is not all hospitals offer them so it’s best to check before you write your birth plan.
Combined Spinal Epidural (CSE)
If you need to stop pain fast but want to be able to move around, this should do the trick. CSEs are given during the first stage of labour. A painkiller is injected into your back at the same time as an epidural is set up. As the spinal injection wears off, an anaesthetic will be delivered through your epidural to ensure you stay pain-free. A CSE has the same side effects as a traditional epidural but delivers great relief. They aren’t available everywhere, so check with your midwife whether your hospital offers this as an option.
Spinal (local anaesthetic)
Spinals are not usually used for normal deliveries, unless you are having an assisted birth.
When you have a spinal you’ll be given an injection of local anaesthetic to the small of your back using a very fine needle. You’ll have immediate pain relief for two hours but it cannot be topped up after. This is why a spinal is usually combined with an epidural (and consequently has similar side effects).