Helping the hurt

We look at ways to work with pain in labour including different options for pain relief.

When it comes to giving birth, most women want to know: how much is it going to hurt and will I be able to cope with the pain? Unfortunately, you can’t answer either of these questions with certainty.

But what you can do is improve your ability to cope with pain during labour, as well as understand your options for pain relief and their impact on you, your labour and baby.

Pain has a purpose

It’s not unusual for women to feel anxious and even scared of giving birth. But fear makes the body release the hormone adrenaline, and this can make contractions less efficient and slow labour down.

Pain plays a part in the process. It signals that labour has started and, as labour continues, triggers different hormones, such as endorphins, your body’s natural painkillers.

The sensations of pain change during labour and tell you that everything is progressing as it should.

Finding out about the role of hormones during labour and how you can use them to their maximum benefit can be really helpful.

You might also find it useful to read about what happens during labour, watch videos of other women giving birth and attend antenatal classes.

Your birth partner(s) will make a huge difference to how you feel during labour.

Emotional support, such as encouragement and reassurance from somebody you trust, can boost your confidence and ability to cope with pain.

It also makes sense to consider different types of pain relief. Here we look at your options…

Position and movement

Lying on your back can make your contractions slower and more painful. Movement, such as rocking, swaying and leaning forwards, maximises your body’s ability to give birth as it helps ease your baby along the birth canal.


  • No lasting side-effects; safe for mum and baby.


  • Try not to overdo it; saving energy is also important. Lying on your side for a while or sitting up supported by lots of pillows can help your body to work really well while you conserve energy.


Water can sometimes slow down labour, particularly if you get in too early.

Water soothes pain and, in a large birthing pool, supports and enables you to move into any position easily.


  • You can combine it with other options, such as Entonox (gas and air) and massage.
  • Women who labour in water need fewer interventions and are less likely to need other drugs.
  • No lasting side-effects.


  • Water can sometimes slow down labour, particularly if you get in too early.
  • You won’t be able to use TENS (see TENS below), pethidine (or other injectable drugs) or an epidural.

Transcutaneous Electrical Nerve Stimulation (TENS) machine

A TENS (transcutaneous electrical nerve stimulation) machine transmits mild electrical impulses to pads on your back, which block pain signals.


  • You can keep moving and it won’t directly interfere with your labour.
  • You can use it for as long as you want.
  • No lasting side-effects; safe for mum and baby.
  • It doesn’t need an anaesthetist, doctor or midwife.
  • It can be used at a home birth.


  • You’ll probably need someone to help you to position the pads.
  • It may only help in the early stages of labour.
  • It may have to be removed if your baby’s heart has to be monitored electronically.
  • You can use TENS before you get into water, but not when you’re in the water.
  • It might make it more difficult for your birth partner to massage your back.
  • The clinical evidence in support of TENS is lacking though many women say that it helped them.

Complimentary therapies

There are various complementary therapies, such as acupuncture, aromatherapy, reflexology, yoga, self-hypnosis and massage.


  • Some studies show acupuncture is helpful.
  • Massage or pressure on the lower part of your back can help reduce levels of stress and ease discomfort, too.
  • You can learn self-hypnosis techniques for labour by attending a course or using CDs; you don’t have to have a hypnotherapist with you in labour.


  • There is little research proving the effectiveness of these treatments though lots of women say that they found these techniques useful.
  • Apart from massage and self-hypnosis, you will need a registered practitioner to perform the therapies.

Gas & air (Entonox)

Entonox – also known as laughing gas – is a colourless, odourless gas made up of half nitrous oxide and half oxygen. You’ll probably be given gas and air through a mouthpiece and told how to breathe it in.


  • You can control it and the effects wear off very quickly once you stop inhaling.
  • It’s fast acting (taking effect after 20-30 seconds).
  • Safe for baby and no extra monitoring required while you’re using it.
  • You can use it in a birthing pool.
  • It should be available wherever you give birth, including birth centres and at home.

It can take a few contractions to get the hang of it so that it’s effective at the peak of contractions.


  • It may make you feel sick and light-headed initially, but the nausea usually passes.
  • It can dry your mouth out if you use it for long periods.
  • Keeping hold of the mask or mouthpiece may stop you from moving around and getting into a comfortable position.
  • It can take a few contractions to get the hang of it so that it’s effective at the peak of contractions.
  • If used with pethidine, it may make you feel even drowsier.

Painkilling drugs (opioids such as pethidine, diamorphine, meptid and remifentanil)

Pethidine, diamorphine and meptid are painkilling drugs given by injection into the thigh. Some hospitals offer remifentanil, which is a very strong, short acting painkiller given via a drip that you can control yourself using a machine.

All opioids pass through to your baby and can occasionally make them slower to breathe at birth. You may notice this more if your labour progresses more quickly than expected and your baby is born within two hours of your having the drug. (Effects on babies are less likely with a remifentanil infusion than they are with the other opioids because remifentanil is active in the body for a much shorter amount of time.)


  • Opioids may help you to relax and get some rest; especially if your early labour has been long and uncomfortable.
  • Pethidine, diamorphine and meptid can be given by a midwife, so there’s no need to wait for a doctor although they may have to prescribe the drug. Remifentanil infusions are set up by an anaesthetist.
  • These drugs don’t appear to slow labour down, if you’re already in established labour.
  • They may help you to postpone or avoid having an epidural if you’re finding your contractions hard to cope with.
  • Not all opioids are available at a home birth so talk to your midwife about what you could have if you’re planning to give birth at home. In some areas, drugs like these are prescribed in advance by a GP. Remifentanil is not available at home or in a midwife-led unit/birth centre.
  • It is possible to still use a birth pool or bath during labour, but not usually within two hours of a single dose of opioid, or if you feel drowsy. Protocols vary so it’s good to check with your midwife if you are considering using a painkilling drug.


  • Once you’ve had an injection of an opioid the effects last for up to four hours, so if you don’t like the sensation you can’t do anything about it. For instance, it may make you feel out of control and sick. (This is not the case with remifentanil, as the drip can be turned off and the effects fade away more quickly.)
  • Your baby may also stay sleepy for several days, making breastfeeding harder to establish.


Epidural analgesia is a local anaesthetic injected into the space between two vertebrae in your back. It usually removes all pain and most feeling from the waist down.

The combined spinal epidural (CSE) injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. At the same time, the anaesthetist will insert a catheter. When the mini-spinal injection starts to wear off, your anaesthetist will pass the epidural solution through the tube to give ongoing pain relief.


  • It gives total pain relief in 90% of cases; partial pain relief in the remainder.
  • Top-ups can usually be given by an experienced midwife once the epidural is in place so you don’t need to wait for an anaesthetist.
  • You may still be aware of your contractions, and have a clear mind, but you’ll feel no pain.

You may not feel contractions or – later on – the baby moving down so there is an increased chance of needing forceps or suction (ventouse) to help the baby out.


  • Epidurals are only available in obstetrician-led maternity units.
  • Labour may slow down as you’ll be less able to move around.
  • It takes about 20 minutes to insert and set up and another 20 minutes to work once injected.
  • You may not feel contractions or – later on – the baby moving down so there is an increased chance of needing forceps or suction (ventouse) to help the baby out.
  • Having an epidural will mean increased monitoring for mum and baby.
  • A catheter might need to be inserted to empty the bladder (as you won’t feel when you need to wee) and a drip to help if your blood pressure drops.
  • Some low-dose (mobile) epidurals now contain less anaesthetic, but include a small amount of fentanyl, an opioid drug. The fentanyl makes the epidural really effective without taking away all of your mobility, but the fentanyl might cross the placenta and make baby sleepy. It’s hard to say how much of a problem this is, but there have been studies showing different feeding behaviours in babies born after low-dose epidurals were used.

You can do it

Birth is unpredictable, but it can help to think about your different options for pain relief. Most importantly, have confidence that you can do it.

More information

Prepare for labour and learn about birth:

Find out about our doula service and ‘Relax, stretch and breathe’ course:

Read about pain relief: