Pain relief

These are the main pain relief options that will be available to you, along with details of how they can benefit you and any side effects to be aware of.

Gas and air (Entonox)

Gas and air (Entonox) is a mixture of oxygen and nitrous oxide gas. It can help to relax you and therefore reduce any pain and tension.  Many women opt for it because it's easy to use, they can control it themselves, and it has minimal side effects.

How it works

The gas and air is breathed in through a mask or mouthpiece, which you hold yourself. The gas takes about 15 to 20 seconds to take effect, so you breathe it in just as a contraction begins. It’s most effective if you take slow, deep breaths.

Side effects

Gas and air causes no harmful side effects for you or the baby, but cause you to feel light-headed. It can also cause some women to feel sick, sleepy or unable to concentrate. You can stop using it if this happens.

 

TENS machine

TENS stands for transcutaneous electrical nerve stimulation.

Some hospitals have TENS machines available, otherwise you can hire your own. A TENS machine is usually most effective during the early stages of labour, and can help eliviate any lower back pain (which many women experience at this stage).

How it works

Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.  

A TENS machine works by stimulating the body to produce more of its own natural painkillers, endorphins, at the same time reducing the amount of pain signals sent to the brain by the spinal cord.

Side effects

There are no known side effects for you or the baby.

 

Pethidine

An intramuscular injection (into the muscle of your buttock or thigh) of pethidine, or less commonly diamorphine, which helps you to relax and therefore lessen the pain.

How it works

It takes about 20 minutes to work after the injection, and the effects last between two and four hours.

Side effects

There are some possible side effects to be aware of:

  • It can make some women feel light-headed, sick and forgetful.
  • If the effects haven't worn off towards the end of labour, it can make pushing difficult 
  • It might be an idea to ask for half a dose initially to see you respond to it
  • If given too close to the actual birth, pethidine or diamorphine might affect the baby's breathing. If this does happens, another drug to reverse the effect will need to be given.
  • The drugs can interfere with the baby's first feed

 

Epidural

An epidural is a form of local anaesthetic which numbs the nerves that carry the pain impulses from the birth canal to the brain. For most women, an epidural gives complete pain relief and can be helpful for women who are having a long or particularly painful labour, or who are becoming distressed. It is not always 100% effective though and the Obstetric Anaethetics Association estimates that as many as one in eight women who ave an epidural during labour need to use other methods of pain relief.

An anaesthetist is the only person who can administer an epidural, so they are only available in a hospital environment. You won't be able to have an epidural at home.

How it works

  • A drip will run fluid through a needle into a vein in your arm.
  • While you lie on your side or sit up in a curled position, an  anaesthetist will clean your back with antiseptic, numb a small area with  some local anaesthetic and then introduce a needle into your back.
  • A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs, usually a mixture of local anaesthetic and opioid, are administered through this  tube. (An opioid is a drug that binds to special opioid receptors in the body, reducing pain.) It takes about 10 minutes to set up the epidural,  and another 10 to 15 minutes for it to work. It doesn't always work  perfectly at first and may need adjusting.
  • After it has been set up, the epidural can be topped up by your  midwife, or you may be able to top up the epidural yourself through a machine.
  • Your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby's head.

Side effects

There are some possible side effects to be aware of:

  • You may be unable to move your legs or they may feel heavy, depending on the local anaesthetic used.
  • An epidural shouldn't make you sick or drowsy.
  • Your blood pressure can drop (hypotension), however, this is rare as the fluid given through the drip in your arm helps to maintain good blood pressure.
  • Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have  to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby's head (instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing). This reduces the chance that you will need an instrumental delivery.
  • You may be fitted with a catheter to help you urinate.
  • About one in 100 women gets a headache after an epidural.
  • Your back might be a bit sore for a day or two, but epidurals don't cause long-term backache.
  • About one in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural.