Medical pain relief that might be available

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Starting & progressing through labour

Medical pain relief that might be available

Non-medical pain relief

Some women find that having a bath or shower may reduce pain in early labour. Some also find that breathing exercises and massage also reduce pain in early labour. TENS machines, whist they do not have lots of evidence of their effectiveness, have no evidence of harm and any choice of pain relief will be supported.

Medical pain relief available in all settings

Paracetamol and Dihydrocodeine are available as tablets. The effect of these tablets lasts for hours. Paracetamol can take around 30 minutes to work and dihydrocodeine can take around 90 minutes.

Gas and Air (Entonox) is available in all settings. This is a very effective form of pain relief and the effects wear off quickly if you stop using it. Gas and air can be used in a birthing pool but it can make you feel light-headed and nauseous.

Injected medications (opioid medications e.g. diamorphine, pethidine), they take around 20-30 minutes to work. They may not always take the pain away completely but may make the pain more manageable for you. They last for 2-4 hours. They may also help you feel more relaxed. However, these medications have side effects such as drowsiness, feeling sick and being sick, short term breathing problems and drowsiness for your baby. The drowsiness in your baby can last several days so it can be more difficult to breast feed and, if you feel drowsy it may impact you if you wish to give birth in water. However, giving birth in water is still an option as long as it has been around 4 hours since you received the medication and there are no concerns about safety. This is because it is advised that you don’t enter a birthing pool or bath whilst you feel drowsy or within 2 hours of receiving an opioid medication.

Patient-controlled, doctor-administered pain relief

There are two kinds of patient-controlled pain relief where you decide and oversee when you receive doses of the medication.

Through your back: An epidural is an injection that goes into your back. This numbs you from the bottom of your chest to your toes. It is more effective than opioids at relieving pain. The epidural may need to be adjusted or replaced, and you will need to have a cannula in your hand or arm. An epidural does not increase the likelihood of having a caesarean birth. The epidural doesn’t usually cause long term back pain either. It does however make the second stage of labour longer and increase the chance of an instrumental birth. You may also experience a severe headache after you give birth. You will require more monitoring which will be slightly different depending on which hospital you have chosen. But you can assume any position apart from lying flat on your back and, if you feel like you have sufficient leg strength and sensation, you can mobilise as you please, with assistance if you need it. An epidural in a twin or triplet pregnancy improves the likelihood and timing of an instrumental vaginal birth, and, if needed, a quicker birth by an urgent caesarean birth.

Through a vein (Remifentanil): having this medication means you are less likely to need an epidural or instrumental birth compared to if you receive the injected medication called pethidine. You are also more likely to have a spontaneous vaginal birth, but you may need extra oxygen than if you had pethidine. You will have to have a midwife present the entire time and continuous monitoring if you have any other risk factors. This increases your baby’s risk of respiratory distress. However, this is an effective way of relieving pain.

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