Coping with pain in labour

Pain relief during labour: home birth vs birth centre vs labour ward

Explore which types of pain relief you can have during labour whether you’re at home, in a birth centre or in a labour ward.

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There are many options for pain relief during labour, and where you plan to give birth will affect what you have access to. For example, you won’t be able to have an epidural in a birth centre, and if you’re at home you won’t have access to any medical pain relief. Make sure you can use the methods of pain relief that are best for you by planning where to have your baby.

What pain relief is available where?

Labour ward Alongside birth centre Freestanding birth centre At home
Self-help methods Yes Yes Yes Yes
Tens Yes – hire or buy your own or borrow from unit Yes – hire or buy your own or borrow from unit Yes – hire or buy your own or borrow from unit Yes – hire or buy your own
Entonox Yes Yes Yes Yes
Water immersion Yes – check pool availability Yes – check pool availability Yes – check pool availability Yes – organise your own pool in advance
Pethidine or opioids Yes In some birth centres In some birth centres Depends on area
Epidural Yes No, but nearby No, would need to transfer No, would need to transfer

Natural pain relief

If you would prefer to avoid using pain-relieving drugs during labour, consider giving birth in an alongside or freestanding birth centre, or giving birth at home. There are fewer forms of medical pain relief available in these settings but this does not necessarily mean that you’ll find birth more painful. The NCT found that observational studies have shown that women who give birth in a hospital perceive birth to be more painful than women who give birth at home. Natural self-help methods such as massage and hypnobirthing can be used both in hospitals and at home, just make sure to prepare anything you might need such as massage oils or particular music. Water is another natural form of pain relief which is often used in a birth pool.

It’s worth considering that birth pools are not always available in every unit, as midwife Pauline Cooke explains in this video:

The Birthplace study of almost 65,000 women found that if women plan to give birth in an alongside or freestanding birth centre or at home, they are less likely to have an epidural and more likely to use water as a form of pain relief than if they plan to give birth in a labour ward. This evidence is based on where women plan to give birth (and not where they actually give birth) – even if a woman plans a home birth, she could end up having an epidural as she might be transferred to a labour ward during labour, but the chances are lower than if she had planned to have her baby in a labour ward to start with.

Plan carefully where to have your baby to make sure you can use the methods of pain relief that are best for you. Use our unique Birth Choice tool to search your local options.

What do I need to consider about natural pain relief?

  • If you plan an out-of-hospital birth, you might be transferred to hospital either in labour or after your baby is born. Find out more about why you might be transferred to hospital during labour.
  • Drugs that provide pain relief are usually available only in a clinical setting, so if you change your mind during labour and think you would like the option of medical pain relief, you will have to be transferred. If you’ve been told you’re at increased risk of complications, you might be advised against an out-of-hospital birth.

Using pain-relieving drugs

Even if everything is going well, you may feel strongly that you don’t want to experience pain during labour. Some pain-relief drugs such as pethidine, other opiods and epidurals are available only in clinical settings, so find out more about what they do to help you decide whether having them available is important to you. Epidurals are available only in labour wards so, if you know you would like one, consider planning to give birth in a labour ward and read our information on having an epidural.

What do I need to consider about pain-relieving drugs?

  • Pain-relieving drugs are less likely to be available in out-of-hospital settings
  • Planning to give birth in a labour ward increases the chances of having medical interventions such as an unplanned caesarean or an assisted birth. Find out more about how intervention and transfer rates differ by birth setting.

Don’t forget that you can use the Which? Birth Choice tool to find the birth setting that suits you best.

Keeping your options open

If you’re not sure how strongly you feel about the forms of pain relief you would like to use during labour, you could consider planning birth in an alongside birth centre. Women who plan to give birth in alongside birth centres are less likely to have an epidural, but can be transferred easily to a labour ward if they find they need one. This is because alongside birth centres are on the same site as a labour ward.

Explore our advice on pain relief further so you understand your options to help you decide what’s best for you.

More from Which?


These are the sources of information used in this article:

Birthplace in England Collaborative Group, Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, BMJ 2011;343:d7400 (2011)

Leap N, Dodwell M, Newburn M, Working with pain in labour: an overview of evidence, NCT New Digest, No 49 (2010)

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