What to expect during induction

Pain relief during induction

A source of information about pain relief choices in labour is the labour pains website. We have also summarised the information here. 


TENS machines

Transcutaneous electrical nerve stimulation (TENS) machine is a method of pain relief involving the use of a mild electrical current. 

It has no harmful effects on your baby. 

A gentle electrical current is passed through four flat pads stuck to your back, creating a tingling feeling. You can control the strength of the current yourself. It is sometimes helpful at the beginning of labour, particularly for backache. It is common to need some other pain relief later in labour.

TENS devices are not provided by the NHS, but you can bring you own with you for your labour.


Water (pool/bath/shower)

 Studies have shown that water birth was found to be less painful, and you will be less likely to need an epidural to reduce the pain. 

It does not add any risks to you or your baby, and your midwife will regularly check the temperature of the water to check it is safe and not rising above 37.5°C. 

There are certain situations where it is not possible to have a water birth and access to pools may be limited, talk to your team about your options.


Sterile water injections

Sterile water injections can be used as a pain relief option for back pain. Water injections can provide relief of back pain from 10 minutes after the injection for up to 3 hours. It can cause an initial stinging sensation.


Breathing/massage

Breathing exercises and massage may reduce pain during the latent/early first stage of labour.


Gas and air (Entonox)

Gas and air (Entonox) is the most common type of pain relief used during labour. You breathe it in via a facemask when you need it. You are in control the amount of Entonox you use, but to get the best effect it is important to get the timing right. 

You should start breathing the gas and air as soon as you feel a contraction coming on. You should then stop using it as the contraction ends, breathing normal air between your contractions. It works quickly and wears off in a few minutes making you feel more relaxed, but it does not take away the pain completely. Entonox is safe to use, it has no harmful effects on your baby and can be used at any stage in labour.  Common side effects include a dry mouth, feeling sick (nausea) and vomiting, and feeling dizzy, light-headed or sleepy. The side effects are mild and go away as you stop using Entonox.


Tablets

There are tablets you may be offered to relieve pain:

  • Paracetamol is commonly used for mild to moderate pain. It can be given by mouth (orally) or by a drip in a vein in your arm (intravenously). It may provide some relief in the early stages of labour. Paracetamol takes about an hour to work and provides relief for 4-6 hours. 

  • Dihydrocodeine is commonly used in labour for moderate pain. It is recommended over codeine because it is safer. It is given by mouth (orally). Dihydrocodeine takes about an hour to work and provides relief for 4-6 hours.


Injections 

During labour you can have injections of medications known as opioids. Some examples are pethidine and diamorphine. They are strong pain-relieving medications. 

They can be given by an injection into a muscle in your thigh (intramuscular). It starts to work about half an hour after the injection and can last for a few hours. Opioids can make you and your baby feel sleepy or it may mean you and your baby breathe less deeply and more slowly. So, there is a chance that your baby may need some extra support when they are born. They also can make you feel sick, but you can be given anti-sickness medicine for this. 


Patient controlled intravenous analgesia (PCA) 

A PCA is a method of pain relief where you can give yourself opioid drugs using a pump attached to a drip. 

The medicines used for PCA act quickly but only for a short period.  This makes them a good choice to help with the pain of contractions.

 It may not be as effective as epidural; therefore, you may wish to combine PCA with gas & air. 

Side effects may include slowed breathing, reduced oxygen levels, itchiness, feeling sick or sleepy, but these medicines have very little effect on your baby. It is important that we monitor for these so that they can be treated if needed 


Epidural

An epidural is a type of injection into your back to stop you feeling pain in the lower half of your body, typically where your contractions are. 

Epidurals can be the most effective method of pain relief for labour. The anaesthetist will insert a needle into the lower part of your back and use it to place a very thin tube (epidural catheter) near the nerves in your spine.  A small tube (catheter) is left in your back so you can be given painkillers through it during your labour. It may take 40 minutes to work to give pain relief. 

An epidural should not make you feel drowsy or sick or have any effect on your baby but there may be an increased chance your doctor will need to use a ventouse (suction cup on your baby’s head) or forceps to deliver the baby (instrumental birth).


References

  1. National Institute for Health and Care Excellence (2021) Inducing labour. www.nice.org.uk/guidance/ng207 - accessed 23/01/2026

  2. National Institute for Health and Care Excellence (2023) Intrapartum Care. https://www.nice.org.uk/guidance/ng235/resources/intrapartum-care-pdf-66143897812933 - accessed 23/01/2026

  3. Othman M, Jones L, Neilson JP. Non‐opioid drugs for pain management in labour. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD009223. DOI: 10.1002/14651858.CD009223.pub2. Accessed 17 March 2025.

  4. Middleton P, Shepherd E, Morris J, Crowther CA, Gomersall JC. Induction of labour at or beyond 37 weeks' gestation. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD004945. DOI: 10.1002/14651858.CD004945.pub5. Accessed 18 March 2025.

  5. Labour Pains - Information on pain relief choices during labour 2026 [Available from: https://www.labourpains.org/.