Pain relief during childbirth

Every birth and labour is different and each woman experiences labour pain differently. As part of your birth plan, you need to think about what pain relief you want during labour and the birth.

Pain during labour is caused by contractions of the muscles of your uterus and by pressure on your cervix. This pain can begin as an achy feeling and build up to strong cramping in your abdomen, groin and back. Some women experience pain in their sides or thighs as well.

What are my options?

There are many options for pain relief during labour and birth. These include non-medical techniques as well as different types of medication. It's important to know your options and discuss your choices with your lead maternity carer. Remember that your choices may change when your labour starts. It’s great to have a plan, but it’s also OK to change it if you need to. Many factors will influence how you feel during labour – the size and position of your baby, how well the labour progresses, how tired you feel and your level of pain tolerance.

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Non-medical techniques

Many non-medical pain relief techniques are used during childbirth. These have been found to reduce pain, or at least modify how you perceive it, and help you cope better with labour. Some of the most common ones are listed in the table below.

Pain-relief option Description
Breathing techniques Breathing techniques may help you to ‘ride the wave’ of each contraction by distraction. Slow deep breathing maximises the amount of oxygen available to you and your baby and can calm both of you as well.   
Massage/mirimiri  Massage or pressing firmly on your lower back or shoulders can help to ease the pain. Do not massage your abdomen. You can use your favourite massage oil. 
Heat packs or cold packs These can help your body release its natural painkillers called endorphins.
Walking or changing positions Some women find walking or changing positions between kneeling, sitting, standing and crouching helpful. You can also lean on the walls, use a Swiss ball or sit on lazy boy chairs. 
Relaxation techniques  Relaxation techniques such as music, yoga or meditation can help reduce pain intensity.
Warm bath or showers This is an option during the first stage of labour. A warm bath can relax you and help you cope with the contractions. Having a shower can help with any back pain you might be experiencing. Having a bath or shower to ease pain during labour is not the same as having a water birth.
Aromatherapy Essential oils are used with massage or heated over a burner. There is no evidence that aromatherapy provides pain relief, but some women find it pleasant. If you’re thinking of using aromatherapy, check that your hospital or birth centre allows it.
Acupuncture  It is not clear how acupuncture works. There are no known side effects for mother or baby. Only a trained person should perform acupuncture. Not all hospitals have an acupuncture therapist on staff, so you may need to discuss arranging your own practitioner.
Transcutaneous electrical nerve stimulation (TENS) In this technique nerves in your lower back are stimulated using a small hand-held device called a TENS machine which you control. TENS has no known side effects for mother or baby and many women find it helpful either alone or in combination with other methods of pain relief. A TENS machine is not suitable for everyone. People with a pacemaker should not use one. They can’t be used in the shower or in water. Not all hospitals or birth centres have them.

Medical pain-relief options

The main medical pain-relieving options for labour include nitrous oxide (laughing gas), injections for pain (such as pethidine or morphine) and epidural anaesthesia.

Medication Description
Nitrous oxide
(also called laughing gas or Entonox)
  • Nitrous oxide is given as a gas that you breathe in through a mouth piece when you're having a contraction.
  • The gas takes a few seconds to work, so it's important to breathe from the mouth piece as soon as a contraction starts.
  • Nitrous oxide doesn’t stop the pain entirely but lessens the intensity of each contraction.
  • It's not effective in all women – in about one-third of women, it doesn't offer any pain relief. 
  • Possible side effects with nitrous oxide include nausea (feeling sick), vomiting (being sick), confusion and disorientation.
Injections for pain (pethidine or morphine)
  • Morphine or pethidine are given by injection. They do not block the pain completely but helps to ease it.
  • These medications cross the placenta and can make you and your baby drowsy, so are not usually given if you're close to delivery (within 2 hours of birth).
  • These medications can make you feel sick, so anti-nausea medications are usually given at the same time.
  • The drowsy effects of pethidine can affect your baby's sucking reflex and ability to breast feed after birth.
Epidural anaesthesia
  • Epidural injections makes you feel numb and blocks pain from your waist down – in your belly, hip, and legs.
  • It's the most effective pain relief option for child birth, as it allows you to stay awake and alert during your baby’s birth.
  • It is given as an injection through the back, into the lining of your spinal cord.
  • Your baby’s heart rate will be monitored continuously.
  • In some women, after the first dose, pain relief may not be complete and you may still experience some pain. This may require the procedure to be repeated.
  • After the epidural has been inserted, your blood pressure may drop, causing you to feel faint and nauseated. This may also cause stress to your baby. This is treated by giving you intravenous fluid.
  • An epidural often causes some muscle weakness in your legs, so women who have had an epidural anaesthetic may be confined to bed.
  • The lack of sensation in your lower body means that you will not be able to tell when you need to urinate (pee). In most cases, this means that a urinary catheter will be inserted.
  • Possible side effects include a headache, itchiness and pain or tenderness where the epidural was injected.

References

Epidurals for managing your pain during child birth New Zealand Society of Anaesthetists Inc, 2016
Inducing labour, pain relief, and help during birth Ministry of Health, New Zealand, 2016
Childbirth – pain relief options Better Health, Australia, 2014

Credits: Health Navigator Editorial Team. Last reviewed: 07 Aug 2017