Pain relief during labour

Giving birth is usually painful, but the pain is not necessarily unbearable or even continuous. The pain occurs as contractions peak, but then fades until the next one. Your contractions get stronger and closer together as labour progresses, and the pain usually feels more intense.

How you feel about the pain and cope with it will depend on your pain threshold, your personality, how supported you feel, your anxiety levels, whether you're under stress and so on.

If you decide beforehand that you want pain relief or want it as an option, you need to find out about what side-effects there are, if any, and how effective a particular method is.

Talk about your choices with a midwife or doctor, and discuss it with other women at your antenatal class. It will certainly be on the agenda - it's something everyone wants to know something about.

Drugs for pain relief

• Nitrous oxide (gas and air or entonox) - comes from a cylinder attached to a tube and mouthpiece/mask. You can use it to take the edge off the pain. You can't overdose on it, there is no build-up, you are in control of it, and only insignificant amounts reach your baby. Some women don't like it: it has a distinctive smell and taste, which some find unpleasant.
• Pethidine and diamorphine - usually administered by syringe into your bottom. Both take up to 20 minutes to take effect, but then last for between two and four hours. If given too close to delivery, they can affect the baby's breathing at birth and leave him sedated for a day or two, making feeding more difficult.
• Epidural - an anaesthetic drug is injected into the epidural space at the side of the spinal cord. It numbs the body from the lower back downwards. A thin tube is left in place to allow top-ups as needed. Research indicates that you're more likely to have an assisted delivery with an epidural.You may be offered a ‘mobile’ or low-dose epidural, which allows you to retain some feeling. This helps you feel the urge to push in second stage.

In all cases, if you've planned a drug-free labour but then change your mind, don't be afraid to say so. Bear in mind, though, that as you get closer to delivery not all methods will remain available to you. Discuss this with your midwife as your labour progresses.

Non-drug pain relief

Pain relief doesn't necessarily mean taking drugs. Fear - of not knowing what's happening or what to expect - can make pain feel worse than it actually is. Learning to relax can make a big difference, as can feeling in control. Don't be afraid to ask your midwife questions.

Your position can make a difference too. Move about, kneel up or walk around - whatever feels most comfortable. It also helps to think about the pain positively: each moment of pain is bringing your baby's arrival closer.

Pain-relief methods that don't involve drugs include:

• Massage, usually done by your birth companion.
• Relaxation, learned at antenatal classes.
• Breathing exercises, learned at classes.
• TENS (transcutaneous electrical nerve stimulation) - electrodes are placed on your back, which deliver a slight electrical charge to the nerve endings (you may have to hire a machine in advance).
• Hypnosis, either learned in advance or given by a therapist.
• Acupuncture, given by a therapist.
• Water, in a birth pool or a deep bath.

None of these has any side-effects on your baby and there are no after-effects for you, either. The drawback is their effect is limited, and some of them (such as TENS) don’t have a good evidence base showing they work. However, having your personal choice respected, being in control and a possible placebo effect can be effective in individual cases.

What's available where?

If you choose to have your baby at home, all the non-drug forms of pain relief will be an option. The midwife should also be able to give you nitrous oxide and/or pethidine should you want it.

In hospital, all forms are available, but check whether epidurals are available at all times, as an anaesthetist is needed to give one.

Anaesthesia

You'll need a complete form of pain relief for a caesarean. Most are done with an epidural, which means you're conscious throughout and can hold your baby as soon as he's born. An alternative is a spinal anaesthetic, which has similar effects and also allows you to stay awake.

Occasionally, you might be given a general anaesthetic. This is usually in the case of emergency as it takes effect more quickly than an epidural. You should come round fairly soon after the delivery.