Pain relief options for labour can look different to every woman. This might be due to the place of birth, equipment and experience of birthing support present and because pain is considered to be a unique experience. There is no universal scale or measurement, we all experience pain differently.

Some women describe the pain of labour as ‘severe’, ‘tiresome’ and unrelenting – whilst others have described it as ‘bearable’ ‘fast’ and even, pleasurable/euphoric at times. This may seem unlikely to many, but our perceptions of pain can be impacted by so many variables.

Our expectations, education, medical history, family support and mental health – all can impact our approach to how we labour.

So, when preparing for labour, it is important to be able to have open and honest conversations with experienced healthcare professionals about what may occur, how the body changes during labour and what each mother hopes to achieve through her experience.

• For some, this may be natural and drug-free labour.
• For others, it is a ‘wait and see how I go’ approach.
• And for others still, any and all pharmacological pain relief is welcome.

What are your options for pain relief in labour?

Pharmacological intervention (using pain relief drugs in labour) can include the use of gas (nitrous oxide + oxygen) pethidine, morphine and other opioid medications either via inhalation, injection/infusion or epidural.

Entonox gas is a type of pain relief used in labour. It is a mixture of 50% Nitrous Oxide and 50% Oxygen. Gas is widely used as a first line pain relief in labour for its ease of use and minimal effect on baby.

When inhaled, it reaches peak effect after 20-30sec and therefore Mothers should be counselled how to use it effectively – timing it with the peak of the contractions.

Benefits of using gas for pain relief in labour:

• It’s non-invasive, often readily available and easy to use
• Can be used in conjunction with water immersion and mobilisation in labour
• Low risk of respiratory impact to the baby as gas is eliminated from the lungs shortly after exposure

Negatives of gas usage in labour:

• Can cause nausea/vomiting
• Dry mouth and disorientation or sedating effect
• Inability to provide complete pain relief in labour for many women

Morphine/pethidine injection is offered in many tertiary birthing facilities. It is easily given via injection and can be administered by midwives for pain relief in early labour.

Benefits of morphine/pethidine injection include:

• Provides pain relief, mainly reducing intensity/peak of contractions
• Drowsy effect often encourages periods of much-needed rest in labour

Negatives of morphine/pethidine injection include:

• Can cause respiratory depression of mother and baby
• Does cross the placenta and effects on baby peak at 2-3hours after intramuscular injection, for this reason its recommended use is during early labour.

Epidural for pain relief in labour

Opioid medication administered into the epidural space (intrathecal administration). Epidurals can be administered during most stages of labour in order to block nerve pain to the abdomen, pelvis and lower limbs. When successful, epidurals can provide complete pain relief in labour, however feelings of pain/pressure may still break through during the pushing stage is this involves different nerve endings that are not targeted by initial administration.

Depending on placement and spinal anatomy – the density of the epidural nerve block can vary, ranging from minimal mobility impairment to total immobility in labour.

Benefits of epidurals in labour:

• Can provide complete pain relief during labour
• Helps reduce stress and fear
• Provides the opportunity for the labouring mother to rest (which in turn can often aid progress of labour)
• If assisted delivery or caesarean delivery is required for unpredictable reasons, epidurals provide pain relief and can often be ‘topped up’ for surgery with relative ease
• Helps reduce high blood pressure which is important for women who suffer from hypertension

Negatives of epidurals in labour:

• Possibility of ineffectiveness due to placement, anatomy/physiology or labour duration
• Can slow the process of spontaneous labour requiring intervention (use of synthetic oxytocin infusion)
• A ‘heavy’ epidural block can mean partial or total temporary loss of sensation in lower limbs resulting in inability to walk around the room or leave the bed
• Risks of permanent or temporary nerve damage and infection during insertion
• Can cause drop in blood pressure (hypotension)
• Increased risk of intervention
• Decreased sense of control

While epidural is regarded as the most efficient and widely recognised form of pharmacological pain relief, it does not necessarily ensure a positive birth experience and can present its own risks of further medical intervention.

For many mothers, the decreased sense of control and increased risks associated with epidurals are unwarranted side effects. For these labouring mothers, non-pharmacological pain relief (natural) options may be preferred.

Some natural pain relief options may include:

• Relaxation and massage – known as ‘mind-body’ interventions. Can easily be administered by support persons or partners in labour.

• Aromatherapy and hypnobirthing – designed to induce a sense of calm and distract/soothe/alleviate labour pain

• Water immersion therapy – helps to promote muscle relaxation, comfort and reduced weight/pressure from spine, pelvis and stomach.

• TENS (transcutaneous electrical nerve stimulation) – small electrical impulses via portable machine which helps reduce nerve pain triggered in specific areas.

Benefits of non-pharmacological pain relief methods in labour include:

• Safe and non-invasive
• Minimal or no harm to mother or baby
• Inexpensive and readily available
• Helps calm/soothe/distract/alleviate pain in labour
• Easily administered by healthcare providers and support people in labour
• No loss of sensation, so able to mobilise around the birthing room
• Lower rates of intervention in labour

Negatives of non-pharmacological pain relief methods in labour include:

• Inability to provide complete pain relief in labour for most women

If you are wondering what pain relief options are right for you and your labour, there may not be a right answer. But it is important for you to know what options are available to you and their risks/benefits.

Ask your healthcare provider to outline these options to help you to make an informed decision. This will help you to mentally, physically and emotionally prepare for the changes of labour and how these will impact you.

Written by Keryn Thompson RM & IBCLC (L-301766)

References

Aksoy, H., Yücel, B., Aksoy, U., Acmaz, G., Aydin, T., & Babayigit, M. A. (2016). The relationship between expectation, experience and perception of labour pain: an observational study. SpringerPlus, 5(1). https://doi.org/10.1186/s40064-016-3366-z

Anabah, T., Olufolabi, A., Boyd, J., & George, R. (2015). Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. Southern African Journal of Anaesthesia and Analgesia, 21(1), 19–22. https://doi.org/10.1080/22201181.2015.1013322

Anim-Somuah, M., Smyth, R. M., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd000331.pub4

Bergh, I. H. E., Johansson, A., Bratt, A., Ekström, A., & Mårtensson, L. B. (2015). Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards. Women and Birth, 28(2), Article e14-e18. https://doi.org/10.1016/j.wombi.2015.01.010

Chu, A., Ma, S., & Datta, S. (2017). Analgesia in labour and delivery. Obstetrics, Gynaecology & Reproductive Medicine, 27(6), 184–190. https://doi.org/10.1016/j.ogrm.2017.04.001

Deshmukh, V. L., Ghosh, S. S., Yelikar, K. A., & Gadappa, S. N. (2017). Effects of Epidural Labour Analgesia in Mother and Foetus. The Journal of Obstetrics and Gynecology of India, 68(2), 111–116. https://doi.org/10.1007/s13224-017-1063-7

Freeman, L. M., Bloemenkamp, K. W., Franssen, M. T., Papatsonis, D. N., Hajenius, P. J., Hollmann, M. W., Woiski, M. D., Porath, M., van den Berg, H. J., van Beek, E., Borchert, O. W. H. M., Schuitemaker, N., Sikkema, J. M., Kuipers, A. H. M., Logtenberg, S. L. M., van der Salm, P. C. M., Oude Rengerink, K., Lopriore, E., van den Akker-van Marle, M. E., . . . Middeldorp, J. M. (2015). Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial. BMJ, 350(feb23 10), h846. https://doi.org/10.1136/bmj.h846

Kibuka, M., & Thornton, J. G. (2017). Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008070.pub3

Lennon, R. (2018). Pain management in labour and childbirth: Going back to basics. British Journal of Midwifery, 26(10), 637–641. https://doi.org/10.12968/bjom.2018.26.10.637

Logtenberg, S. L. M., Verhoeven, C. J., Oude Rengerink, K., Sluijs, A.-M., Freeman, L. M., Schellevis, F. G., & Mol, B. W. (2018). Pharmacological pain relief and fear of childbirth in low risk women; secondary analysis of the RAVEL study. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-018-1986-8

López-Gimeno, E., Falguera-Puig, G., Vicente-Hernández, M. M., Angelet, M., Garreta, G. V., & Seguranyes, G. (2021). Birth plan presentation to hospitals and its relation to obstetric outcomes and selected pain relief methods during childbirth. BMC Pregnancy and Childbirth, 21(1). https://doi.org/10.1186/s12884-021-03739-z

Mahomed, K., Chin, D., & Drew, A. (2015). Epidural analgesia during labour – maternal understanding and experience – informed consent. Journal of Obstetrics and Gynaecology, 35(8), 807–809. https://doi.org/10.3109/01443615.2015.1011103