Pain relief in labour: Epidurals, Pethidine and TENs Machines

When it comes to giving birth, the experience is different for everyone. There’s no right way or wrong way, no bad choices or good choices. There’s simply labour, and birth. More importantly, the labour and birth that’s right for you.

Whether you’re considering a home birth, a labour without pain relief, or a C-Section, knowing what your pain relief options are in labour is never a bad idea. Being in the know will help you to follow your instincts, and make the best decisions for you and your baby.

So, let’s take a look at some of the forms of pain relief during labour and get ready for the arrival of your new baby!

An epidural is a type of anesthetic that’s administered by an injection into your back. Whilst you’re having the epidural, a drip will be placed into your arm so that you can be given fluids¹. (pretty clever, right?).

Once given, an epidural stops pain signals travelling to the brain from the spine² making it a very effective way of easing the pain you may experience in labour.

If you’re thinking that an epidural isn't for you, you’re not alone. Many women don’t feel comfortable with it either. But we’d like to put your mind at ease. Whether you end up being advised to have an epidural, or you choose to have one during your labour, there are definite upsides³:

• In the vast majority of cases, epidurals are swift and pain-free.
• Epidurals are a very effective form of pain relief. 
• In the main, your baby won’t be affected by your epidural.

According to NICE guidelines, if you want to have an epidural, at any point in your labour, then you should be able to have one if you’re in an obstetric unit⁴. 

As with all forms of pain relief in labour, there are some side effects to having an epidural, for example it can slow things down, resulting in a longer labour.⁶ Other side effects include⁷:

• Headaches. 
• A drop in your blood pressure.
• Depending on the local anaesthetic used, an epidural may make your legs feel heavy.

Don’t worry though, any side effects that you find yourself experiencing can be managed by your doctor and midwife. 

As with most things parenting, there’s no one size fits all. There are different types of epidural, each with different benefits and considerations. Let’s take a look. 

Epidurals as a form of pain relief have come a long way. A good example of this is the mobile epidural, which allows you to have the pain relief and the ability to move around, without experiencing the numbness or the feeling of ‘heavy legs’⁸.

Assisted delivery is where forceps or a ventouse is used to help your baby arrive.

The Combined Spinal Epidural sounds like a bit of a mouthful, but it’s actually pretty ingenious!

Given during the first stage of your labour, a painkiller is injected into your spine whilst an epidural is set up. As the injection wears off, anesthetic will be delivered through your epidural⁹.

If you’re having an assisted birth, you’re likely to be given a spinal¹⁰, which is a local anaesthetic injected into the small of your back. The relief will be immediate, but it will only last for two hours, and it can’t be topped up, so it may well be combined with an epidural.

Pethidine is a painkiller that’s sometimes used during the first stage of labour. It’s an opioid drug, a synthetic version of morphine which can be given either by injection, or through a tube.

We get it; you’re probably thinking this isn’t what you had in mind when considering pain relief during labour. But read on.

For many women, pethidine provides very welcome relief, particularly if labour is long. It can really aid relaxation, providing you with the chance to recharge and reboot as you move closer towards meeting your baby for the very first time!

There are numerous benefits to using pethidine to make your birth experience a little more relaxed.
 

• Pethidine starts to work quickly, taking around 20 minutes to provide relief.
• It can be given by your midwife without the assistance of a doctor. 
• You’re in the driver’s seat. If pethidine is given via a tube, you can control it, and get a level of relief that works for you. 

As well as the benefits, pethidine does have some side-effects. For example, you might experience a feeling of sickness¹¹. Try not to worry though, if this happens there are other drugs that can help you to manage this. 

One of the most common questions about pethidine as a form of pain relief during labour, is how it can impact your baby. So here’s what you need to know. 

Pethidine is an opiate, and as such can cross the placenta. A small amount will pass through to your baby, and you may notice that your new addition is quite sleepy after entering the world. But there’s no reason for you to worry, this is very common when pethidine is used in labour¹². 

TENS stands for transcutaneous electrical nerve stimulation. But enough about the acronym, how can it help when you’re in labour? 

A TENS machine is a small device that’s connected by wires to electrodes. Electrodes are sticky pads, placed on the parts of your body where you’re experiencing pain - most commonly on the back. 

Here’s the fun part; via the pads, the TENS machine produces a gentle electrical current which creates a tingling feeling and encourages your body to produce endorphins, your body’s natural pain relief and feel-good chemical.

As far as the advantages of the TENS machine go, there are quite a few. There’s no risk to your baby¹⁴, you can stay mobile and active during your labour, and you can even use it if you’ve chosen a home birth. The best bit is that you’re fully in control. You can increase the level of pulse depending on how much pain you’re feeling at any time.

Remember that you’ll need to remove the TENS machine if you choose to get into the birthing pool or if your baby’s heart needs monitoring.

Giving birth is quite the adventure. It can feel a little bit like running a marathon, conserving energy when you need to, and really putting your foot on the gas when you see the finishing line! It’s a journey. 

Meptid is a form of pain relief during labour that provides a helping hand when coping with strong contractions. Whilst it’s got very similar benefits to pethidine, it doesn’t seem to affect a baby’s breathing as much¹⁵. You might still experience some dizziness and nausea though. You can take meptid at any time during the first stage of labour and it will start working pretty quickly - within 15 minutes, in fact!

Gas and air is like the Marmite of labour pain relief options - some women love it, others not so much! 

Gas and air is also known as Entonox. You inhale it through a mouthpiece or a mask and it’s completely taste free. For many women, it really takes the edge off their contractions, but for others it causes feelings of nausea and results in a dry mouth. 

There’s a trick to using gas and air. You should begin to inhale as soon as you feel a contraction begin, that way you’ll be able to ride the wave in the most comfortable way possible - a little bit like surfing!

There are a number of benefits to using gas and air¹⁶:

• You’re in control. You can use it at any point during your birthing journey.
• Gas and air can be used if you’ve chosen to have a home and/or water birth.
• It can be combined with other forms of pain relief during labour.
• Gas and air won’t harm your baby and it won’t stay in your system for long.

Of course! Whilst some women know the type of pain relief they want during their labour, others prefer to give birth without it. If you opt to experience your labour without pain relief, you can do so either at hospital or at home. 

Going through labour without pain relief is, for many women, a wonderfully empowering experience, with a number of positives: 

You’re likely to push more instinctively as you follow your body’s natural rhythms.

• Recovery time can be quicker. 
• If you’re classed as having a low risk pregnancy and you’re in good health, the risk of interventions are reduced¹⁷. 
• You’ll be mobile, meaning that you can change position and find the most comfortable way to birth.      

… and cons 

• If you’re classed as having a high-risk pregnancy, a pain relief free labour may not be an option. 
• There’s no guarantee that not using pain relief will avoid the need for pain relief or other interventions. 

When thinking about your pain relief in labour, remember that not all options are available at all hospitals or other birthing centres. Be sure to check with your birth place of choice before deciding on the right pain relief path for you. 

If you’ve got any questions or worries, or you’d simply like a bit more information about bringing your little one into the world, remember to talk to your midwife. You can also call our team of pregnancy and baby care experts. And remember! You can also contact our careline and talk to our team of pregnancy and baby care experts.