Pain relief options
The following options are suitable when in established labour, for ideas to support you in early labour, visit our labour and birth section.
Tens machine: Transcutaneous electrical nerve stimulation (TENS) machines are small, portable devices that use a gentle electrical current to interrupt the pain signals received by the brain. They also encourage the natural production of endorphins – the body’s own natural pain reliever. They can be held in your hand or attached with a belt clip. There are two or four pads that stick to your skin (on your back) and allow the gentle current to stimulate pain receptors. The TENS machine should come with a booklet demonstrating where the pads should be placed, please be assured there is no right or wrong way to place the pads. The pads will produce a tingling sensation which you are in control of increasing or decreasing. There is also a ‘boost’ button to give a more intense surge during contractions. There are no known risks to either yourself or to the baby, although some people do not like the feel of the tingling sensation. It cannot be used alongside water, and will need to be removed before using a bath, shower or birthing pool. Ask your community midwife about hiring one to use for home or hospital birth.
Entonox (Gas & Air): Entonox is a mixture of 50% oxygen and 50% nitrous oxide gas and it does not taste or smell of anything. You breathe it in through a mask or mouthpiece during contractions, and it starts to work almost immediately - your midwife will teach you how to use it to get the best effect. You are in control of when to breathe it in and many people find it helps to reduce pain. It does not take pain away completely and many people choose to use gas & air alongside another form of pain relief (for example, by using a TENS machine or by being in the birthing pool). Some people may find it makes them feel dizzy or nauseous, although this often disappears quickly. Some people find they do not like the euphoric sensation it causes. The effects stop as soon as you stop breathing the gas, and the effects do not pass to your baby. Entonox is available for home birth or hospital birth.
Water: Using water in labour is a form of pain relief and may be used at home or in hospital. Regular warm showers or baths are very helpful in early labour, and may also be continued throughout established labour. All of our induction and birthing rooms are en-suite and have either a shower or bath for you to use. There is also a very large bathroom with a large bath and low lighting for you to use in labour – please ask your midwife if you wish to use it. Once you are in established labour, you may wish to use our birthing pool. The pool room is on the Birthing Unit and has a large, fixed pool with low lighting, a birthing stool and birth ball. The pool is most suitable for labours considered ‘low risk’ however please do discuss with your midwife if you wish to make a plan for a pool birth where there are risk factors (LINK TO BIRTH OPTIONS). Please note, our birthing unit has one pool room only and pre-booking is not available. Your midwife will support you to use other forms of water therapy (bath, shower, warm or cool compresses) until the pool becomes available. Ask your community midwife if you are interested in hiring a pool for use at home, they will make the appropriate referral.
Diamorphine or pethidine: These are in a family of painkillers known as ‘opiods’ or an ‘opiate’. Opiates are frequently used in labour as they are known for reducing pain and causing a sleepy, relaxed feeling. Your midwife will inform you which one is available to you and why. Opiates are given as an injection into a large muscle, usually the thigh or buttock. They usually take around 20 minutes to be effective and the effects last for around 2-3 hours. Some people enjoy the relaxed feeling it brings, and it helps them to get some sleep for part of their labour. Some people do not like the sleepiness and report it made them feel ‘detached’ from themselves. A more common side effect is feeling nauseous and midwives will offer an anti-sickness medication at the same time as giving an opiate. Opiates cross the placenta (pass to baby) and the baby may be born with similar effects of drowsiness. This may make baby sleepy or uninterested in feeding. In very rare cases, some babies need support to start breathing on their own if the effect of an opiate is severe. You can read more detail about opiates here. Opiates are not given during home births and are only available for hospital births. You do not need extra monitoring in labour following an opiate injection unless the midwife has any concerns about you or baby. You may use the birthing pool once the effects have worn off, usually 3-4 hours following the injection. Your midwife will advise and support you with timing the opiate injection if you wish to receive one.
Epidural: This is an injection given by an anaesthetist into a precise part of your lower back to stop you feeling pain in your abdomen. The medication given is usually a combination of local anaesthetic and opioid medication (usually Fentanyl) which aims to prevent you feeling the pain of contractions but also be aware of the pushing sensation during the second stage of labour. Your midwife will encourage you to change positions frequently.
It can be difficult to get the balance of pain control and sensation right. Some people find they are unable to stand or empty their bladder with an epidural. For this reason, you may be offered a catheter during labour which is removed before your baby is born. Some people require regular ‘top-ups’ of the epidural medication or a continuous infusion which may be given by a trained midwife. A long labour may contribute to being unable to move around or not being able to feel how to push. This may increase the length of the second stage of labour (the pushing stage) and increase the need for an assisted birth (a ventouse or forceps to help your baby to birth).
The epidural can be topped up with stronger medication if you are offered a caesarean birth during labour. There are some risks with an epidural, some are common and some are very rare and epidurals do not usually affect your baby. You can read about risks in detail here. Epidurals are only given in hospitals and other forms of pain relief are not used at the same time. Some forms of complementary pain relief (for example, hypnotherapy) may be used alongside epidurals – ask your midwife for guidance.
Complementary pain relief:
Hypnotherapy: This is a common form of complementary therapy and may be used in many ways. Some people choose to learn hypnobirthing techniques either online or in a class. Other people use hypnotherapy by listening and to music or meditations. Ask your birth partner to make a playlist of songs that have special meaning for you. Our midwives are very familiar with and supportive of hypnobirthing techniques, although please remember they are not hypnobirthing teachers. They will use the words you prefer them to use wherever possible, please remind gently and politely if they are forgotten.
Acupressure: You are welcome to bring with you any tools or techniques you have learnt to use in your pregnancy, such as an acupressure comb. Our midwives are not trained in their use but will support you and your birth partner to use any safe methods.