From gas and air to epidurals – everything you need to know about your pain relief options during labour and what’s available in different birth settings.
Will I be able to cope with the pain of labour?
It’s natural to feel worried about the pain of labour, particularly if you haven’t given birth before or if you’ve previously experienced a painful labour without the right support to help you cope.
You can be reassured that, when the baby is in the right position and labour is progressing well naturally, many women are able to manage the pain if they’re encouraged by a supportive midwife or birth partner.
Women whose labour is not progressing well, perhaps because their baby is in a difficult position or they require intervention to speed up labour, are more likely to need stronger pain relief like an epidural. First-time mums are also more likely to need more pain relief than women who have had a baby before.
Only a small minority of women use no pain relief at all – most try at least one of the many methods available, according to a 2018 survey by the Care Quality Commission (CQC).
“Some people say you forget the pain of labour, but I don’t think that’s true. You may not be able to visualise the intensity of it again after the birth, but I think it’s a bit disrespectful to women to say that you forget about it.” Laura
Which types of pain relief are there?
There are many ways to cope with pain during labour. Knowing about the various pain relief options that are available can help you write your birth plan and feel more confident ahead of the birth.
Gas and air (entonox)
Entonox is a mixture of gas and oxygen which is inhaled using a mouthpiece. This is the most widely used form of pain relief and can be used at any stage of labour, in any birth setting and alongside other forms of pain relief. Read more about using gas and air in labour.
Comfort aids and self-help methods
Natural or non-medical methods, like being immersed in water, relaxation techniques, massage, aromatherapy and acupuncture, can help you cope with the pain of labour with few or no side effects. Find out more in our guides to natural pain relief and using water in labour.
Our guide to epidurals gives you the lowdown on this powerful form of pain relief where a local anaesthetic is injected into part of your spine to temporarily numb the nerves carrying pain messages.
There are a number of different opioids which can help ease labour pains, most of which are injected. Go to our full guide to pain-relieving drugs for more information on what’s available and the pros and cons of each.
What pain relief is most commonly used in labour?
- Gas and air is the most popular form of pain relief and is used by three-quarters of mums.
- Self-help methods, like massage or relaxation techniques, are used by a third of women.
- Three in ten women have an epidural.
In England, four in ten women end up using a different kind of pain relief than they had planned to before going into labour, according to the CQC.
The most common reasons to use a different pain relief were:
- medical reasons (29%)
- the woman changed her mind (26%)
- there wasn’t enough time to use the planned pain relief (20%)
- the chosen pain relief didn’t work (20%).
What pain relief is available in different birth settings?
Where you plan to give birth will affect which types of pain relief 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 probably won’t have access to any medical pain relief but you can be guaranteed to have access to a birth pool.
If you already know what types of pain relief you would like to use, go to our Birth Choice tool to find the location most suited to what you want.
It is worth remembering, however, that unexpected things can happen during birth, so it’s important to remain flexible. It’s also a good idea to have some understanding of all different forms of pain relief, so you can make informed decisions – whatever situation you find yourself in.
How can I plan the birth so I’ll have access to the pain relief I want?
When you’re talking to your midwife about where to have your baby and writing a birth plan, it’s a good idea to bear in mind what types of pain relief are available in different birth settings and factor that into your decision.
How you think about pain relief options will depend both on which pain relief you think you want to use in labour, as well as how willing you are to consider transferring to a hospital if you’re at home or in a birth centre and find the pain is too much to manage and you need an epidural.
Where should I plan to give birth if I want to avoid using pain-relieving drugs?
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 women who give birth in a hospital perceive birth to be more painful than women who give birth at home.
The Birthplace study of almost 65,000 women discovered that if you’re at low risk of complications and plan to give birth in an alongside or freestanding birth centre or at home, you’re less likely to have an epidural and more likely to use water as a form of pain relief than if you plan to give birth in a labour ward.
This is based on where you plan to give birth rather than where your baby actually is born. Even if you plan a home birth, you may end up having an epidural as you might be transferred to a labour ward during labour, but the chances are lower than if you plan to have your baby in a labour ward to start with.
Where should I plan to give birth if I think I want to have stronger drugs or an epidural?
If you feel strongly that you’ll want to have an epidural or stronger pain-relief drugs, such as certain opioids, consider planning to give birth in a labour ward. All pain relief options are available at the labour ward and you won’t have to be transferred to another birth setting when you’re in labour if you want to use stronger drugs.
However, it can be good to know that if you’re at low risk of complications, you’re more likely to have interventions, like an assisted delivery or unplanned c-section, if you plan to give birth in the labour ward.
Where should I plan to give birth if I want to keep my pain relief 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.
These are the sources of information used in this article:
Care Quality Commission, Maternity Services Survey 2018 (2018)
Redshaw M, Henderson J, Safely Delivered: a national survey of women’s experience of maternity care 2014, NPEU, University of Oxford (2015)
Leap N, Dodwell M, Newburn M, Working with pain in labour: an overview of evidence, NCT New Digest, No 49 (2010)