Written by:

Dr Elliott Ridgeon

BA (Oxon), BMBCh

Dr Ridgeon is an anaesthetist in the Oxford School of Anaesthesia. He studied at the University of Oxford, and has a research interest in trials in Critical Care. Elliott’s daily practice is spent on busy hospital labour wards, providing anaesthesia and analgesia for pregnant mothers, alongside general duties in the operating theatres and Intensive Care Unit.

Pain Relief During Labour – The Methods Used

In this article:

  • How painful is childbirth?
  • Do I need pain relief?
  • What are the methods of pain relief?
  • Who will decide which pain relief I am offered?
  • Can I decide to have an epidural?
  • Will pain relief affect my baby?
  • How will pain relief affect my labour and recovery?
  • Main Points

Pain Relief During Labour – The Methods Used

There’s a reason why childbirth is referred to as labour but it’s a very personal experience and everyone has their own pain threshold. How much you want to feel of it is completely up to you. In this article, we explore your options.

How painful is childbirth?

There really is no easy answer for this. No two labours are the same and everyone experiences pain in a different way. Generally, the early stages of labour are less painful than the transition stage and the pushing stages. Some women have fast labours, so even if it is painful, they feel able to cope over a shorter time. Some women have longer labours, where even a smaller amount of pain may become hard to deal with over hours. What’s important is that you inform and prepare yourself for the pain of labour and so that you have a good understanding of your options for pain relief.

Do I need pain relief?

This really depends on what you consider “pain relief”. All women will find their own way of managing labour. Aromatherapy and hypnosis are considered as much as a form of pain relief as medications and epidurals. But not all women require medical forms of pain relief during labour and many women express a preference for natural labour. It is not “unnatural” to ask for pain relief, nor is it a failure to feel that you need it during labour or delivery. If you require any kind of surgical intervention (e.g. C-section, episiotomy, repair of a tear to the perineum), pain relief will be essential to the safe conduct of the procedure itself.

What are the methods of pain relief?

These are usually divided into non-medical and medical (or “chemical”) options.

Non-medical

  • Breathing techniques: Controlling and focusing the breathing pattern to aid relaxation and alleviate pain.
  • Hypnobirthing: self-hypnosis and hypnotherapy to control and overcome the pain of labour and childbirth.
  • TENS machines: stands for Transcutaneous Electrical Nerve Stimulation. A machine that delivers small electrical currents via sticky pads to areas on the skin, causing a tingling sensation, which reduces pain signals to the brain and relaxes muscles.
  • Acupressure and massage: pressure applied to muscles and other points on the body to relieve tension and improve relaxation.
  • Aromatherapy: scented oils used as fragrance, in bathing or massage to aid relaxation.
  • Water birth: labouring in a birthing pool

Medical

  • Oral painkillers (paracetamol, dihydrocodeine): tablets or liquids given at regular intervals to reduce pain. Dihydrocodeine is related to morphine.
  • Injected painkillers (diamorphine): an injection into the muscle (similar to the needle used for a vaccination) of a strong, painkilling, morphine-like substance. Pethidine is similar, and is also sometimes used. However, many hospitals now prefer diamorphine as pethidine can have more side-effects. It is not given towards the end of labour as it can result in the baby being drowsy or can affect its breathing following birth.
  • Entonox (gas and air): a fast-acting mixture of nitrous oxide (N2O) and oxygen that is breathed in through a mouthpiece.
  • Epidural: an injection in the back to put a small flexible tube in place, down which painkillers and anaesthetic (numbing) solution can be given, to work directly on nerves. Top-ups can be given at regular intervals once the tube is in place, without further needles.
  • Spinal: a single-shot injection to the back, with painkillers and anaesthetic (numbing) solution placed directly on nerves.
  • Patient Controlled Analgesia (PCA, an intermittent IV injection, usually Remifentanil): IV injections of rapid-acting painkillers related to morphine, controlled by a button pressed by the patient whenever they feel pain.

Who will decide which pain relief I am offered?

You can use all or none of these methods and in whichever order you prefer.  It is up to you to decide if you would like pain relief and what you would like. Not all forms of pain relief will work for all people, so you may have to try one or two before you find the one that is right for you. It is a good idea to have some knowledge in advance, as being in pain on the day may mean it’s harder to explore options and to communicate your choices. You can put your preferences into your birth plan but you can also change your mind at any time. Your birthing partner may be able to advocate for you, but the final decision is still yours. You will always have a dedicated midwife for the duration of your labour who will be able to go over your options with you.

It’s worth knowing that some pain relief options (epidurals, spinals and PCAs) are only given in the labour ward and will mean that you cannot birth in water.

Can I decide to have an epidural?

As long as you are in established labour, you have the option to have an epidural. It takes a little while to actually perform the epidural and then also for the pain relief to start working. When it is inserted, you need to sit still. Therefore, if you think you want an epidural it’s worth not waiting until you are moving around in lots of pain. The anaesthetists are very skilled and will work with you to insert it between contractions. The only time you may be refused an epidural is if it is likely that the baby is going to be delivered before the anaesthetist can actually get the epidural in.

Epidurals can be a very effective form of pain relief. However, epidurals can reduce the strength of contractions, lead to a longer time pushing and may increase the likelihood that you need an instrumental delivery. Read more about having an epidural here.

Will pain relief affect my baby?

It is very unlikely that pain relief as described above will affect your baby. Methods used in pregnancy, labour and childbirth are designed to be as risk-free as possible for mother and baby. Once the baby is born, all pain-relief methods are also very safe for breast-feeding.

How will pain relief affect my labour and recovery?

Your choice of pain relief will have some implications for your labour. As mentioned, some forms of pain relief mean that you will have to labour in the labour ward rather than in a midwife-led birthing unit. Some medications, in particular opioids (morphine-like drugs) can cause itching, nausea, and vomiting. Epidurals have been linked to a higher need for an instrumental delivery.

When it comes to recovery, pain relief can allow you to be up and walking around faster. This is better for your recovery and also lets you care for your baby more easily. All forms of pain-relief prescribed by professionals will be safe for breastfeeding.

Main Points

  • Many women find they need pain relief during labour and childbirth.
  • Pain relief is typically split into medical and non-medical methods.
  • Non-medical methods include breathing techniques, hypnobirthing, Tens Machines and massage.
  • Medical pain relief methods suitable for childbirth include oral pain killers, injected pain killers, Entonox, epidural, spinal and PCA.
  • Pain relief methods are designed to be as risk-free as possible for both mother and baby.
  • All forms of pain relief carry some side effects, but each method will be discussed with you before use.
  • You can choose to have pain relief at any time during labour, even if you have planned to have a drug-free birth.

 

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