There’s no getting away from the fact that labour can be painful, but the levels of pain experienced can vary greatly. Here we look at both natural and medical pain relief methods and explain how they work.
We often hold our breath in response to pain, or we take shallow and rapid breaths. The result is that oxygen flow to the tissues is reduced, so muscles have to work harder, the body tires more quickly, and pain, or the perception of pain, becomes greater.
Focusing on keeping your breathing steady and rhythmic during contractions helps you to stay calm and work with the rhythm of your contractions, in turn conserving energy and maximizing the oxygen flow to you and your baby.
Later in labour, panting and blowing helps you to resist pushing down before you’re fully dilated.
Practise breathing techniques during pregnancy so that you’re comfortable using them in labour. Relax your jaw while you breathe in steadily through your nose to a count of three and then gently out through your mouth for the same count, breathing down into your abdomen.
Familiarise your partner with the techniques, too, so he can help you focus during labour if you feel panicky and distracted.
TENS (transcutaneous electrical nerve stimulation) is a battery-powered device that transmits electrical pulses to the body via wires attached to your back with sticky pads.
The idea is that the pulses block pain signals to the brain and trigger the release of the body’s natural painkillers, endorphins.
TENS is thought to be most useful for taking the edge off the milder contractions of early labour and for symptoms such as backache. It is easy to use; you turn it on when labour starts, and a booster button allows you to increase the strength of the impulses during a contraction.
There are no side effects for you or your baby, and you can move around freely, although you have to remove the device in water.
Being immersed in warm water is relaxing, soothing for muscles, and supportive as the buoyancy of the water takes pressure off your back and pelvis and makes it easier to move around and adopt different positions.
Some studies suggest that women who labour in water have less need of some pain-relieving drugs, and are also less likely to have an epidural or to need stitches.
You can ease early labour symptoms with a warm bath at home and if you wish to use a birthing pool, these can be hired for use at home and are available in many hospitals.
The water in a birthing pool is kept at around 37.5 degrees C (99.5 degrees F), warm enough to relax in, but not hot enough to distress your baby.
Talk to the hospital unit before labour to find out what facilities they offer and how many staff are trained to manage water births.
Once you’re in the pool the doctor will monitor your baby’s heartbeat with a waterproof hand-held Sonicaid, and check your temperature and blood pressure.
She may carry out an internal examination while you’re in the pool, or may do one after you have visited the toilet and before you get back in. If she has any concerns about you or your baby she will ask you to get out.
You can choose to get out of the pool to have your baby, or remain in it for the birth. If you give birth in the pool, the doctor will wait until your baby is completely delivered before bringing her to the surface. Babies have an innate ‘dive’ reflex, which stops them breathing until they are out of water.
Hypnobirthing helps women to reach a state of deep relaxation during labour using positive visualisations, relaxation techniques and simple self-hypnosis.
The aim is to eliminate the fear of pain, and women are encouraged to embrace the surge of contractions, each one bringing their baby closer. Some studies suggest that women who practise hypnobirthing use fewer medical drugs, have shorter labours and have fewer interventions, although research is ongoing into the effectiveness of the technique.
While natural therapies can help women to feel calm and more relaxed in labour there is little evidence that they are an effective form of pain relief.
This traditional Chinese medicine involves inserting thin needles into the body at certain points to restore the flow of energy or ‘chi’. The aim of the treatment is that the woman is more relaxed and as a result less likely to use medical forms of pain relief. However, make sure you go with a trusted provider that comes recommended.
This complementary therapy uses essential oils made from concentrated plant extracts, applied through massage, inhaled or added to a warm bath, to calm and relax.
Not all oils are recommended during labour, so check which ones are safe to use with a qualified practitioner.
This works on the premise that specific points on the feet, and sometimes on the hands, correspond to different parts of the body. Stimulating these points is thought to work on the corresponding organ or body system to provide relaxation, pain relief and healing.
Touch and massage can be soothing in labour, promoting relaxation and stimulating the circulation.
Applying deep pressure to the lower back can ease the discomfort of back pain, and in between contractions a light shoulder and upper back massage can be calming. Ask your partner to try out different strokes before labour.
Keeping upright and moving around during the first stage of labour is thought to make labour more efficient as you work with gravity to encourage your baby down into the birth canal.
You can walk around, and adopt upright positions using props such as birthing balls, chairs, mats, walls and pillows to help you sit, kneel, or relax forwards.
During the second, pushing stage of labour, being supported in an upright position, such as a squat or on all fours, helps to open up your pelvis, and again uses gravity to push your baby out.
A mixture of oxygen and nitrous oxide, gas and air is inhaled through a mouthpiece or mask to help reduce rather than eliminate pain.
It can be used throughout labour, but women often find they need stronger pain relief as labour progresses. Gas and air works quickly and its effects are short-lived, so it should be inhaled at the start of a contraction to work as the contraction peaks.
Once you stop breathing it in, the gas and air leaves your system, so there’s no benefit in taking it between contractions. It has no known side effects on the baby, but some women report feeling light-headed and nauseous.
These are sedative drugs which are given to relieve the pain from contractions. They are particularly useful in a long labour where you may need to rest – it’s hard to imagine but you can actually doze between contractions! The main disadvantage is that it can make you feel drowsy and sick and, if it is given too close to birth, it may make the baby drowsy and interfere with breastfeeding. These effects can be reversed with further drugs.
An epidural is a type of local anaesthetic used during labour to numb the lower abdomen. For most women this provides complete pain relief without affecting the baby.
The procedure needs to be performed in hospital by an anaesthetist. A hollow needle is inserted into the ‘epidural space’, the area between the spinal cord and the spinal column.
Once in place, a tube is inserted through which a combination of drugs is administered. Epidurals start to work within around 20 minutes, and can be topped up throughout labour.
Your blood pressure and contractions will be checked regularly, and your baby’s heart rate constantly monitored. As well as numbing the abdomen, epidurals also affect the pelvis and legs, which means most women are temporarily unable to walk, and will need a catheter to pass urine. As you won’t feel contractions, you will need to rely on your doctor or nurse to tell you when to push in the second stage.
Some units offer low-dose mobile epidurals, which provide excellent pain relief while retaining some sensation in the legs so that you can move around with support.
A spinal block is a one-off injection administered directly into the spinal fluid. This acts speedily, within 5 to 10 minutes, lasts for 1 to 2 hours and can’t be topped up. It can be given as a combined spinal-epidural (CSE) or on its own if pain relief is needed quickly.