Reading Time: 9 min read 
Published: 10/01/2024 
Last Updated: 10/01/2024 
Labour is a painful experience for many women. If you’re a first time mum — or have had a difficult experience in previous pregnancies — you may be worried about how to manage labour pain. But fortunately there are plenty of pain relief options available for women undergoing all kinds of births.
In this guide to pain relief in labour, you’ll learn all about your options and the pros and cons of each.
Table of Contents
- Is labour pain bearable?
- Which is more painful: C-section or vaginal birth?
- Pain relief options in labour
- What’s the best pain relief in labour?
- Natural and non-pharmacological pain relief options in labour
- What can you use for pain relief in early labour?
- 5 pain relief in labour statistics
- Other types of pain relief for pregnant women
Is labour pain bearable?
Different women have different experiences in terms of how painful their labour experience is. Some find the discomfort comparable to intense period pains, while others will use multiple types of pharmacological pain relief to manage their pain. It depends on the circumstances of the birth and your pain threshold.
However, it can help to remember that labour pain isn’t constant. While each contraction can be very painful (and will get more intense) you will get breaks in between. The pushing phase can also be difficult, but remembering that this is the last stage can help.
Interviews with new mothers suggest reminding yourself that labour pain won’t last forever can help with pain management [1]:
“The pain was increasing and nothing could decrease it, I could not do anything, so I tolerated it because I knew it would be over soon”.
Which is more painful: C-section or vaginal birth?
In general, you’ll feel more pain throughout a vaginal birth than during a Caesarean section. That’s because the contractions you feel during a vaginal birth build in intensity, leading to the pushing phase (which can also be painful). But there are several pain relief options that can help you manage discomfort at each stage of labour.
With a C-section, you’ll usually be given a spinal block or epidural to numb the lower half of your body, so you don’t feel much discomfort during the birth itself. However, you may feel more pain as the anaesthetic wears off.
Recovery from a C-section can be long and uncomfortable. Some women find the pain after a C-section can hamper their daily activities as much as six weeks after childbirth [2].
Pain relief options in labour
For most pregnant women, the following types of pain relief are available during labour.
1. Gentle movement and activity
Staying active during labour can help you find more comfortable positions to stand, sit, and lie in, helping to relieve pain [3]. Using a birth ball is a good way to alleviate pressure on the perineum and vagina in the early stages of labour.
Pros and cons:
| Pros | Cons |
|---|---|
| Relieves pressure on painful areas | May not be possible if you’re receiving an IV drip |
| Allows you to find your most comfortable position | Not usually possible if you have an epidural |
| Can provide a distraction from the pain |
2. Stress reduction techniques
Low stress levels are important in labour, as this ensures the continuous release of oxytocin: the hormone that makes your labour progress. Many stress reduction techniques (such as hypnobirthing, meditation, and gentle exercise) can also help relieve pain in the early stages of labour.
Pros and cons:
| Pros | Cons |
|---|---|
| Relieves pressure on painful areas | Good for pain management rather than pain reduction |
| Can provide a distraction from the pain | Requires some practice beforehand to be most effective |
| Helpful for managing pain when labouring at home | May be more difficult in later stages of labour |
| Can be used anywhere (home, car, birth centre, hospital) |
3. Paracetamol
Paracetamol is an over-the-counter painkiller which is commonly used to manage pain in the early stages of labour. You can take it in tablet form at home, and you may be offered a paracetamol IV drip in the hospital.
However, paracetamol may slow your labour progression, as it can hinder production of prostaglandins which help to dilate the cervix [4].
Pros and cons:
| Pros | Cons |
|---|---|
| Medical pain relief that’s readily available | May slow progression of labour |
| Helpful for managing pain when labouring at home | Takes around one hour to work (in tablet form — a paracetamol IV drip can work within 5-10 minutes) |
| Safer than other types of pharmacological pain relief [4] |
4. TENS machine
A TENS machine uses low-voltage electrical pulses to distract you from contraction pain. Some studies have shown that using a TENS machine can reduce severe pain, though not all research corroborates this [5].
Pros and cons:
| Pros | Cons |
|---|---|
| Can be particularly helpful if you have back pain in labour | Not all studies confirm TENS machines are effective in labour |
| Can provide a distraction from the pain | You’ll need guidance on how to use a TENS machine effectively |
| Can be used anywhere (home, car, birth centre, hospital) |
5. Water birth
Studies have shown that labouring in water can make you feel more buoyant and reduce your perception of pain in labour [6]. Being in the water can also help you move more, release endorphins, and boost oxytocin levels by relieving stress. All these factors can reduce the need for other types of pain relief and potentially shorten labour times.
A water birth is usually only offered if your pregnancy is considered low-risk. If you’re unsure if any health or fertility conditions might put you at greater risk during labour, consider visiting a private gynaecology clinic before trying to conceive.
Pros and cons:
| Pros | Cons |
|---|---|
| Can be used with some other types of pain relief (such as gas and air) | May not be accessible to all women |
| Relieves stress and boosts oxytocin release | Only available in low-risk pregnancies |
| Reduces pain perception | Can’t be used after an epidural |
| May shorten labour times |
6. Gas and air (Entonox)
Gas and air is a type of patient-controlled pain relief that is often offered to pregnant women in the UK. It’s a mixture of oxygen and nitrous oxide gas that should be inhaled at the start of each contraction. Gas and air doesn’t usually eliminate the pain you feel, but it can make it more manageable. You can use gas and air while having a water birth if you want additional pain relief.
The relief from gas and air only lasts a few minutes. Some women report feeling drunk or lightheaded during this time.
Pros and cons:
| Pros | Cons |
|---|---|
| Available in most birth settings (including home birth) | Can make you feel nauseous, dizzy, or lightheaded |
| You control how much gas and air you use | Very short-term pain relief |
| Relatively low-risk way to make pain feel more manageable |
7. Pethidine
Pethidine is a drug derived from opium (also known as an opiate) that’s sometimes offered to women in labour. It’s given via a single injection in your thigh, and it should relieve labour pain and make you feel more relaxed. This can promote oxytocin release.
Pethidine starts to take effect after around 20 minutes, and can last up to four hours. Because of the sedative effect, it’s not usually offered if you’re close to the pushing phase.
Pros and cons:
| Pros | Cons |
|---|---|
| Promotes relaxation and oxytocin release | Only available in a hospital setting |
| Pain relief lasts up to four hours | Can have short-term adverse effects on your baby |
| Fast-acting pain relief | Can’t be used when you’re close to or in the second stage of labour |
| You can move around normally |
8. Diamorphine
Diamorphine is another opiate sometimes offered for pain relief in labour. Like pethidine, it’s given as an injection, and can relieve pain and make you feel more relaxed. It’s used less often than pethidine, as some studies suggest it can increase labour times [7].
All opiates can make your baby drowsy. That means they may need extra support after birth, so it’s important to note this when considering opioid pain relief in labour.
Pros and cons:
| Pros | Cons |
|---|---|
| Promotes relaxation and oxytocin release | Only available in a hospital setting |
| Pain relief lasts for up to four hours | Can have short-term adverse effects on your baby |
| Fast-acting pain relief | Can’t be used when you’re close to or in the second stage of labour |
| You can move around normally | May prolong labour time |
9. Remifentanil
Another opiate for labour pain relief, remifentanil is offered on some labour wards in the UK. Unlike pethidine and diamorphine, which are administered as a single injection, remifentanil is given as an IV drip that you control by pressing a button.
Remifentanil doesn’t last as long as other labour opioid medications, and can make you feel breathless. It can also make your baby drowsy during and after birth.
Pros and cons:
| Pros | Cons |
|---|---|
| Promotes relaxation and oxytocin release | Short-term pain relief |
| Works and wears off very quickly | Only available in a hospital setting |
| You control how much of the drug is administered | Can have short-term adverse effects on your baby |
| You can move around normally | Can’t be used when you’re close or in the second stage of labour |
| Can be used alongside gas and air | Can’t normally be used after other opiate painkillers |
10. Epidural
One of the best-known types of labour medication, an epidural provides the most complete, long-lasting pain relief. A needle inserts a catheter into the spine, which can then be used to give you medication that numbs the lower half of your body. This can be topped up as needed.
Epidurals in labour are common in the UK, especially if you have a particularly long or painful labour. They shouldn’t be confused with epidural steroid injections, which are used as a back and spine treatment for painful conditions like herniated discs or sciatica.
Pros and cons:
| Pros | Cons |
|---|---|
| Complete and long-lasting pain relief | Restricts your movement |
| Can be topped up as needed | Makes it more difficult to know when to push |
| Little to no effect on your baby | Can only be given when your cervix is at least 3cm dilated |
| Allows you to rest and sleep during a long or difficult labour | May slow the progression of labour and prolong delivery time |
| Greater risk of instrumental delivery (with forceps or suction) |
What’s the best pain relief in labour?
The best pain relief is that which helps you stay relaxed and able to cope throughout the labour process. Reducing stress is key to a smooth vaginal birth, so it’s important to choose pain relief options that will help you stay calm.
An epidural is likely to give you the most complete pain relief in labour, but it does come with some drawbacks. Some women feel less in control after an epidural, as it’s often more difficult to feel contractions and know when to push. You may also be more at risk of forceps or ventouse-assisted delivery [8].
Natural and non-pharmacological pain relief options in labour
While many women choose pharmacological methods to make labour pain more manageable, some prefer to use natural techniques. This table compares natural versus pharmacological labour pain relief options:
| Natural pain relief | Pharmacological pain relief |
|---|---|
| Water (baths, showers, and birthing pools) | Paracetamol |
| Breathing techniques | Gas and air |
| Gentle movement | Opiates (pethidine, diamorphine, remifentanil) |
| TENS machine | Epidural |
| Acupuncture | |
| Massage |
What can you use for pain relief in early labour?
In early labour, natural pain relief methods are often recommended. You may be labouring at home for a while, so the pharmacological pain relief options will be limited. You can still take a normal dose of paracetamol to help you manage the pain.
If you’re having a home birth, your midwife will be able to provide certain types of pharmacological pain relief (usually paracetamol and gas and air).
5 pain relief in labour statistics
Choosing your pain relief options can be tricky, but you’ll have support from your midwife and medical team. These statistics will put some of these pain relief options into perspective:
- Women who have a birth partner with them during labour may need less pharmacological pain relief [9].
- Gas and air is the most common pain relief method in the UK, with around 79% of birthing people using it in 2019 [11].
- Around 60% of people in labour opt for an epidural in the UK [12]. This is one of the highest rates in Europe, but has dropped over the last few years.
- More than 60% of women in all age groups used anaesthetic and/or medical pain relief methods throughout labour in 2021 [10].
- In the UK, white women are more likely to opt for an epidural than women of other ethnicities [13].
Other types of pain relief for pregnant women
While labour pain is one of the most nerve-racking experiences of pregnancy, many women also feel discomfort in the earlier stages. Sciatica in pregnancy is a common ailment, as is backache and round ligament pain.
If you have persistent lower back pain or any other back and spine conditions during pregnancy, seek support from your midwife. If they’re unable to provide the relief you need, a private pain management unit can help.
Book an appointment at Harley Street Specialist Hospital to learn more about how we can help you stay mobile and manage pain before, during, and after pregnancy.
