Pain relief in labour and childbirth is as personal as the experience itself. When you consider how varied a woman’s pain tolerance and pelvis shape, the length of labour, and the position of the baby can be, it’s really no wonder that there is no panacea. We cover a variety of options in this article, some of which may not be offered where you are. It’s important to be informed about what’s available to you so make sure you discuss it with your healthcare provider or during your antenatal classes. If you have a medical condition that affects the pain relief you can take, or just raise questions with your obstetric healthcare team, you may even be able to meet with an anesthesiologist at your hospital before writing your birth plan.

When do I need to decide on the pain relief I want?

You can discuss your options during your midwife or obstetrician appointments and we recommend that you put your preferences down in your birth plan as you approach term. However, you don’t have to decide anything until you are in labour and you are also free to change your mind while it’s happening.

Your pregnancy, your choice!

We feel strongly against judging any woman (especially yourself) on the basis of pain-relief choices, there’s no medal for best-in-class hypnobirthing skills and no shame in deciding you need an epidural in the birthing room when it wasn’t your plan. That said, knowledge is empowering and this article will take you through the pros and cons of medical pain relief.

Does paracetamol work in labour?

Not the whole way through, but the powers of this humble pill shouldn’t be underestimated! A normal dose (1000mg) taken every six hours of the early or early active stage can be very helpful. Just make sure to take the maximum dose at every 4-6 hour interval for best results, swallowing one every so often is not recommended.

What does gas and air feel like?

A bit dreamy! Gas and air takes the edge off contractions and is available on labour wards and in birth centres, as well as for home births. You breathe nitrous oxide through a mouthpiece and it takes a few minutes to take effect. The trick is to start breathing deeply as soon as the contraction begins so the gas works when the pain peaks. A less pleasant aspect of this option is that it can make you feel nauseous, though many women find this goes away after a while.

How do codydramol/dihydrocodeine tablets affect my baby?

These tablets have a mix of paracetamol and codeine, which is part of the opioid family. They relieve early labour pain where paracetamol is not enough. “High strength” forms will need to be prescribed by a doctor if you want to use it at home. “Low strength” tablets are over-the-counter medications like Solpadeine Max and do not need to be prescribed. However, BUMPS, the UK teratology information service website, recommends that you don’t use any codeine while pregnant unless it is prescribed.

While these tablets provide stronger relief than paracetamol, they can cause constipation and drowsiness. Codeine crosses the placenta, so your baby is exposed. According to BUMPS, pain relief with codeine used around the time of delivery can affect the baby for a while after birth. The baby may be ‘jittery’, have feeding issues, and need some help with breathing. These problems usually settle within the first few days.

Are opioid injections a safe form of labour pain relief?

Yes, in general, opioid injections are safe for use in labour. They’re all painkillers and work in a similar way. Different hospitals offer different kinds and some can be prescribed for home birth use by a midwife. They are only given from the time you’re in active labour. Morphine and Remifentanil are commonly administered in the US. An injection of pethidine or diamorphine might be offered during labour in the UK. Your healthcare team can advise on the options they make available. The choice of opiate may also be influenced by your medical history. Asthmatics, for example, would not be given morphine because it is likely to cause the release of histamines that might bring on an attack (an asthma attack during labour is rare, but we don’t want to encourage one!).

Any opioid injection won’t take the pain away completely but it will take the edge off your contraction and help you to rest. They are usually administered into a big muscle like your thigh or buttock and take 15-20 minutes to work. The effects last 2-4 hours. Remifentanil is injected into your arm and wears off after a few minutes but you can get more by pressing a button when you feel a contraction begin. This is why Remifentanil is sometimes called Patient Controlled Analgesia (PCA).

One reason women worry opioids aren’t safe is because they cross the placenta and impact the baby. While this won’t cause long term problems, babies are often born sleepy. Opiate injections are not usually given close to delivery as they can cause temporary breathing and heart rate problems in your baby after birth. Remifentanil can be used up to delivery with monitoring of your oxygen levels, as it can make you breathless.

While opioids are safe, their effects can be unpredictable. Some women are more sensitive to opiates than others and it’s important to speak up if you’re feeling negatively affected, there’s no need to suffer in silence and your team will know how to comfort you quickly. Many women report that they make them feel sleepy and not in control. They can cause constipation and urinary retention. They can also make you feel sick, so an anti-sickness medicine is usually given at the same time. Some women report dry mouth and hallucinations after pethidine injections. Whatever it is, the most important thing is to let your team know.

Should I have an epidural?

An epidural is anaesthetic that’s injected into the spinal fluid. It takes away pain completely. Still, it’s worth considering all the pros and cons before deciding it’s for you.

How does having an epidural work?

Women are often surprised the drug doesn’t go in through a needle. You usually sit on the edge of the hospital bed, leaning forward with your back curved as much as possible. A local anaesthethic is injected whe the epidural will be placed. You’ll feel a push as the needle is used to access the area of the spine where the medication goes. A thin, soft tube called a catheter is threaded through the needle and the needle is then removed, it was just used as a way to get the tube in the right place. The tube is then taped to your back and fitted with a port through which the medication is given and can be topped up if needed. It takes 20-30 minutes for you to feel its full effects, and you usually feel numb from the breasts down at that point.

Pros

Epidurals stop pain but don’t take away all feeling, you may still feel some pushing and pulling, especially if you have a caesarean section. This can be a pro or a con, depending on your point of view.
Epidurals can generally be administered at any time once you're in established labour, including during contractions.
After the sting of having it injected into your lower back, an epidural won’t hurt you at all and it takes away all your pain
You can have epidural injections tailored to your needs with additional pain medication, but research has shown that pregnant women are less likely to need these with an epidural.

Cons

You can’t have one at home, it can only be administered by anaesthetists, who are medical doctors
You can’t have one for a water birth
You won’t be steady enough to get out of bed or walk around. Your legs may also feel heavy.
You may need a catheter to help you urinate.
You might labour and push longer than you would have without an epidural.
Sometimes your blood pressure can drop and affect the fetus's heart rate, but this can usually be managed with several treatment options.
Epidurals may not work as well if you have had prior spinal surgery, though you would be warned about this in advance.
An epidural takes longer to work than a spinal block (see below)

Am I more likely to need assisted delivery if I have an epidural?

During the pushing stage of a delivery, were you not using an epidural, you would feel an overwhelming urge to push your baby out. With an epidural, a midwife needs to guide you through each contraction. According to the Royal College of Gynaecology and Obstetricians, having an epidural for pain relief may increase the chance of you needing an assisted birth but this is less likely with modern epidural anaesthetics. The need for an assisted birth may be reduced by not starting to push too soon after your cervix is fully open. You may wish to discuss this with your midwife in advance.

What is “a spinal”?

A spinal block, sometimes referred to as spinal anaesthesia or as “a spinal” is similar to an epidural in that it is administered into your back using a catheter. Most patients report a similar level of discomfort when a spinal block or epidural is given. A spinal works faster than an epidural and provides total pain relief, as well as loss of all feeling. It is recommended for assisted delivery and caesarean section rather than vaginal births. However, if you’ve already been given an epidural in labour, you’ll likely have this topped up for an intervention rather than be given a spinal. A spinal is typically the first choice for a woman who is not in labour but is planning a caesarean.

How can I cope with pain using medication?

There is a variety of pharmacological ways to cope with labour pains.