Pain management during labour - your complete guide

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Let’s not beat around the bush: labour and pain go hand in hand. Thankfully, though, there are plenty of ways to help you cope! From harnessing the power of your mind to harnessing the powers of an anaesthetist, here’s what you need to know so you can start deciding

Water

The run-down
Standing in a warm shower can be comforting, and depending on where you give birth, you can labour and deliver in a large birthing pool containing warm water, too. “Most women use water in labour and find it relaxing, soothing and effective in helping them cope with pain,” says Kaye Dyson, midwife at The Royal Women’s Hospital Victoria.

The pros
“Being in a bath gives a mum a sense of weightlessness and it also encourages the release of feel-good hormones, endorphins, helping her to relax and control her breathing,” says Kaye. Plus it’s a natural form of pain relief, so there’ll be no effects on bub.

The cons
Not all facilities have birthing pools, so you’ll need to check. “Plus, while you might be allowed to labour in a birthing pool, you might not be able to deliver there too, so depending on what you want, this also needs looking into,” says Kaye. Also, if you experience any complications you’ll have to get out, which can be disappointing.

Mum’s tip
“I intended on wearing a bikini top in the birthing pool but was more comfortable without anything on. I’d recommend it as it was lovely having direct skin-to-skin contact with my baby in the soothing water,” says Tegan Mikhail, mum to Havannah, 12 months.

Gas and air

The run-down
“This is made up of a mixture of oxygen and nitrous oxide,” explains Kaye. You normally breathe it in, evenly and deeply, through a mouth piece that you hold between your teeth.

The pros
It’s easy to use, can be used any time during labour and doesn’t stop you having other forms of pain relief as your labour progresses. “It’s safe for your baby too and doesn’t stay in your system, plus you’re in control,” says Kaye.

The cons
“It might make you feel light-headed and vomit,” Kaye says. It’s also quite a mild painkiller, so you may find it doesn’t help you enough.

Mum’s tip
“I found gas and air a useful distraction, as it helped me focus on something other than the pain. However, when it came to pushing my baby out, I put the mouthpiece down so I could concentrate,” says Kirsty Moore, mum to Larni, three, and Cohen, three months.

Intravenous pain relief

The run-down
Most commonly these forms of pain relief are pethidine or morphine, both of which are strong painkillers. “They can be given through a drip or as an injection into the leg,” says Dr Makarla Stead, obstetric anaesthetist at Royal Brisbane and Women’s Hospital. “The effect varies, but often a woman says they don’t take the pain away fully, but it seems to not bother her as much.”

The pros
These pain relievers can be given by a midwife so you don’t have to rely on an anaesthetist being available and they take a short time to take effect. “They’re also repeatable if given as one-off injections and are often a good alternative for women who can’t have an epidural,” says Dr Stead.

The cons
You need to check that they’re available at your hospital, and as having them too close to the birth can affect your baby’s breathing, they’re normally only offered in the first stage of labour. “They can also make you feel dizzy, drowsy, sick or even vomit,” says Dr Stead.

Mum’s tip
“During Leila’s delivery I was given pethidine nearly four hours before she was born, but my advice would be to have it earlier as I felt a lot calmer after it. For Anissa’s birth I had it as soon as I started to feel uncomfortable, which was much better, as I was able to cope with the pain from the start,” says Courtney Smith, whose daughters are now two years and seven months respectively.

TENS machine

The run-down
TENS stands for transcutaneous electrical nerve stimulation and the machine is a small device with wires that lead to adhesive pads that sit on your lower back – normally two on each side. “Electrical pulses are passed through the wires and these interrupt the pain message to the brain so pain is reduced,” explains Kaye.

The pros
You have control as you can increase or decrease the pulses at any time. “It’s also safe for bub, has no lasting side effects and you can hire one too,” says Kaye.

The cons
It generally works best during the first stage of labour, but the device can’t be used in water, and if you want to use massage during your labour then a TENS machine might make this a bit more tricky.

Mum’s tip
“I made sure that both my partner and I knew exactly how to use the TENS machine before the big day by having a few practise runs first,” says Jenny Tuner, mum to Jessica, four months. “I would also advise having plenty of spare batteries as the last thing you want is them going flat!”

Epidural

The run-down
“An epidural allows painkilling drugs and local anesthetic to pass into your back via a fine tube,” explains Dr Stead. For labour pains, normally a low dose is given so you can still push without feeling any pain, but if it’s for a caesarean a much stronger dose is needed. In the event of a caesarean, rather than an epidural, there’s also the option of a spinal block. “This is a single painkilling injection that works faster than an epidural,” explains Dr Stead. It has a stronger effect than a labour epidural, so you feel completely numb from the waist down.

The pros
“An epidural is a very effective form of pain relief and keeps your mind completely clear and alert,” Dr Stead says. You can also have one at any time during labour and once in, it only takes about 20 minutes to take effect. “Almost nothing gets across to your baby, so it’s safe for her too,” she adds.

The cons
Not all hospitals offer epidurals, so you need to check in advance. You may also feel shivery and itchy, which is a side effect of the painkilling drug, and won’t be able to move around. “As you may not be able to feel when you need to wee, you’ll need a catheter put in to empty your bladder too,” says Dr Stead.

Mum’s tip
“I had an epidural and would say to other mums not to worry about when they put the catheter in. I was a bit unsure, but they do it after the epidural is in place so you can’t
feel it,” says Emma McCluney, mum to Quinn, four months. “I didn’t notice it after the birth either, as I was so distracted by everything else, especially by my new baby!”

Calming techniques

The run-down
Visualisation is all about drawing strength, motivation and focus through picturing something happening. “Visualisation can work by explaining to a mum how her uterus moves during birth so she can visualise something from that to help her,” says Dr Shari Read, founder of BirthSkills. “Meditation, meanwhile, concentrates on one area, like breathing, which keeps the mind focused so the body can get on with labour.” Self-hypnosis involves going into a state of physical and emotional relaxation and some or all of the above are also used in some form in Hypnobirthing and Calmbirth techniques. The desired effect for all is a calmer, more positive birth experience.

The pros
These skills are great ones for life in general and even if you do need drug-based pain relief during labour, they can still be used to stay calm. “Another plus is a mum feels energised after the birth because she’s been relaxed during it,” says Dr Read.

The cons
You have to be in the right mindset for it to work. “A mum has to understand why she’s using these approaches and how these techniques work before choosing to use them,” says Dr Read. Plus, they need practising in advance.

Mum’s tip
“I found smelling lavender oil while I was practising meditation before the birth really helpful. It created an association between the two so that when I was in labour and I smelled it again, I just went into auto pilot and I knew exactly what I needed to do,” says Katie Shepherd, mum to Emily, three months.

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