Whether you visualise having a drug-free water birth or are ready to sign up for every drug you can get your hands on, knowing all about what pain-relief options are available will help you make the right choice in labour
- Availability: Stock up at home.
- How it works: This over-the-counter choice blocks the production of pain-causing chemicals. It will take the edge off, but won’t affect your ability to move around or feel contractions.
- Staying power: You’ll often be advised to take it at home while waiting for things to really get started. ‘It will help you get some sleep before you go to hospital,’ says Adele Hamilton, senior lecturer in midwifery at City University, London.
- Control factor: Totally in your hands.
- Duration: You can take it anytime but most women just use it in the first stage.
- Side effects: None known.
- Watch out for: Taking too many. Always stick to the recommended dose of one to two tablets every four hours.
- Availability: You can buy your own or hire one for up to four weeks.
- How it works: TENS stands for ‘transcutaneous electrical nerve stimulation’ (we can see why they shortened it). Four sticky pads attach to your back and wires send out electrical pulses that block pain messages from your nerves to your brain. The pulses also encourage the release of endorphins, our body’s natural pain relievers.
- Staying power: It has mixed results. Some women find it very effective, while others don’t experience any results – you really just have to try it and see how you go.
- Control factor: You’re in charge and can regulate the degree of stimulation.
- Duration: Can be used throughout labour, but most women need something stronger after the early stage.
- Side effects: None known.
- Watch out for: Getting it near the water. TENS machines are battery operated, so you’ll have to take it off if you want to be in a bath or birth pool.
- Availability: Birth pools aren’t available in all hospitals, but some allow you to take one in, so it’s worth asking. You can buy or hire one for home and many midwife-led units have them.
- How it works: Water will help you relax and soothe contraction pains. It also makes it really easy for you to try out and hold different birth positions.
- Staying power: The benefits are instant – water cushions your body, making contractions feel less painful. Many women also find the comfort of a warm bath is enough to get through the first stage of labour.
- Control factor: You can get out at any time, but have someone on hand in case you feel light-headed.
- Duration: Although you can deliver in the pool, your midwife may ask you to get out for examinations. Some women also start to get restless and feel the need to get out and walk around.
- Side effects: None known.
- Watch out for: Water could slow down labour if you get in too soon – your midwife will tell you the right time.
Gas and air
- Availability: Entonox – or gas and air – is available in all hospitals and birth centres, and can also be administered at home by a midwife.
- How it works: Made up of oxygen and nitrous oxide, it’s relaxing effect blunts pain, rather than blocking it out altogether.
- Staying power: It takes around 30-40 seconds to kick in and continues to be effective as long as you breathe it in.
- Control factor: You have full control and it’s easy to start and stop.
- Duration: It can be used in all stages, but your midwife might ask you to come off it in the final stage to focus fully on pushing.
- Side effects: Sickness, light-headedness and a dry mouth are possible.
- Watch out for: Your timing – it takes around 30 seconds of breathing the gas to offer relief, so start inhaling Entonox as soon as you feel a contraction coming on for maximum effectiveness.
- Availability: This injection is administered by a midwife at home or in hospital.
- How it works: It takes around 20 minutes to work and the aim is to help you relax – pethidine distracts from the pain, rather than prevents it.
- Staying power: It can stay in your system for between two to four hours.
- Control factor: The injection lasts a couple of hours, then you can choose whether to have a top-up.
- Duration: It can be given in early and mid-labour, but timing is key. If you have pethidine before labour is established, it may slow things down. But, if the injection hasn’t worn off by the time you’re 10cm dilated, it can make it difficult to push.
- Side effects: Nausea, dizziness and it may interfere with breastfeeding.
- Watch out for: Having a dose at the end of labour. If it’s given very late, it can cross the placenta and your baby may be drowsy when born. This won’t affect him long term, but may make him reluctant to feed at first.
- Availability: An anaesthetist has to administer an epidural, so you need to be in hospital. They are often very busy, so think about requesting it early.
- How it works: ‘A local anaesthetic is injected into your spine through the small of your back,’ says obstetric anaesthetist Dr Mike Kinsella. ‘It’s the most effective form of pain relief, and will leave you numb from your stomach to your toes.’
- Staying power: After the epidural’s been set up, a midwife will top it up or you might be able to do this yourself.
- Control factor: The midwife will have to tell you when to push, as you won’t feel your contractions.
- Duration: ‘We have to be certain you’re in labour, so your contractions need to be regular and your cervix dilating before the epidural is given,’ says Mike.
- Side effects: It can prolong labour, so there’s a chance you’ll need forceps or a ventouse. Your blood pressure may drop and around one in 100 women get a bad headache afterwards.
- Watch out for: ‘Feeling disconnected from your body,’ says doula Lucy Symons. ‘Try to time it so the epidural wears off a little before you need to push, allowing you to feel the urge naturally.’