Which type of labour pain relief is right for me?

Every new mum’s experience in giving birth is unique. That’s why – however you choose to bring your baby into the world – it’s important to know of the options available to encourage the healthy progression of labour.

When it comes to pain relief in labour, choosing the right type for you and your baby depends on factors such as whether you want a natural birth, the position of your baby and how dilated you are. Here we will introduce the seven main options and their benefits.

Position and movement

Your position – Your position can significantly impact the ease of giving birth. Lying on your back can make contractions slower and more painful. Movement such as rocking, swaying and leaning forwards maximise your body’s ability to give birth, as they help your baby to move down the birth canal. Try alternating upright positions with resting positions to find what works best for you – although avoid switching too rapidly.

Baby’s position – Your baby’s position in the womb plays a key role in labour. The easiest way for a baby to navigate through the pelvis is head down, face towards your spine. This is called the occiput anterior (OA) position. However, if the baby is back-to-back with you (occiput posterior OP) or facing legs and bottom down (breech), this can cause more pain and may require caesarean or instrumental birth.

You can read more about getting your baby into the best position for birth here

Water birth

This is an increasingly popular option for mums to be, partially because warm water soothes pressure of contractions and, in a large birthing pool, supports you and enables you to glide into any position more comfortably. Many childbirth professionals recommend it to manage and shorten the process, although it is best to only enter the water once contractions are well established and frequent – at least five centimentres dilated.

Entonox (gas and air) can also be used during water birth to relieve pain further, and can be supplied in cylinders for a home water birth. Find out more about preparing for a water birth here.

Natural therapies

If you would like to go down the holistic route during labour, there are various complementary therapies that can lessen pain. These include acupuncture, aromatherapy, reflexology, yoga, self-hypnosis/hypnobirthing and massage techniques. Although there is mixed evidence as to the effects of natural therapies, many women say that they help to alleviate anxiety and promote relaxation.

Some midwives are qualified in areas like acupuncture, but you will often have to speak with a private specialist. For advice and support on natural therapies in childbirth, visit the British Register of Complementary Practitioners.

TENS (Transcutaneous Electrical Nerve Stimulation) machine

In labour, a TENS machine is a form of pain relief that transmits mild electrical impulses to pads on your back (electrodes). These impulses block pain signals through the spinal cord and brain, whilst also helping to relax muscles and stimulate the production of endorphins – the body’s natural painkillers.

It’s important to note that TENS machines offer the most effective pain relief in the early stages of labour when women may experience lower back pain.

Entonox (gas and air)

Entonox is a colourless, odourless gas made from half nitrous oxide and half oxygen. It is given through an antibacterial filter within a mouthpiece or mask, which many women find easy to use and control themselves wherever they choose to give birth. Although gas and air doesn’t remove pain, it can reduce it to make your birth more manageable. It only takes 15-20 second to work and can be breathed in as contractions begin.

If additional pain relief is required, you can safely use gas and air alongside a painkilling injection such as pethidine.

Painkilling injections

Pethidine, diamorphine and meptid are pain relieving drugs given by injection into the thigh. The most common is pethidine – a much more effective form of pain relief than gas and air that lasts between two and four hours. While it’s not recommended for the second stage of labour, these injections can be taken in the lead-up to lessen the pain of contractions.

Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine. Speak to your midwife to learn the advantages and side effects of the injections they offer, as all work slightly differently.

Epidural

Epidural anesthesia – This is a local anaesthetic injected into the space between two vertebra in your back via a very thin tube. It usually removes all pain and most feeling from the waist down, by numbing the nerves that carry pain impulses from the uterus. At the same time, the anaesthetist will insert a catheter into your bladder. When the mini-spinal injection starts to wear off, your anaesthetist will pass the epidural solution through the tube to give ongoing pain relief.

Combined spinal-epidural (CSE) anesthesia – Although a lot less common in childbirth, this injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. This is because the drugs are injected directly into the fluid surrounding the nerves in the spinal column.

While an epidural provides the most advanced level of pain relief, it does carry risks and can prolong the second stage of labour. Your contractions and the baby’s heart rate will need to be closely monitored and forceps may be required to help deliver the baby. You can learn more about the epidural process and its side effects here.

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