There are many pharmacological and non-pharmacological methods of pain relief that you can utilise during pregnancy and birth.
Some people will access hypnobirthing classes during their pregnancy, or attend yoga or mindfulness classes which can help calm the mind and focus on breathing techniques. Others will access active birth classes or optimal fetal positioning which helps with mobility and adopting different positions during labour and birth to assist labour progress. For others, only an epidural may work.
There is no right answer and each patient will find their own way of coping during labour.
There are other forms of pain relief available such as Entonox (Gas and air) and Diamorphine or pethidine injections. If you are experiencing back pain during labour, you can have water papules or sterile water injections, which act in a similar way to acupuncture on specific points on your lower back. You are also welcome to bring your own (or rented TENS) machine in to the hospital.
We also encourage you to get in touch with our Serenity aromatherapy midwives to discuss the safe use of essential oils during labour and birth.
Water is also an amazing option for pain relief during labour and birth. We are lucky to have large birthing pools on both hospital sites and baths on the wards for use. It is worth researching your options and discussing these with your midwife/obstetrician and your birth partners. It is advisable to have some form of birth plan but remember you don’t have to stick to this rigidly if you change your mind.
Read our patient leaflet for a full overview of pain relief options available to you:
Patient Leaflet: Pain relief in childbirthPain relief video resource
Click on the expander boxes below for video resources developed by our maternity staff colleagues:
Back pain in labour
Community Midwife Rebecca discusses back pain during the labour process.
Back pain in labour
Hi everyone. We’re now going to talk about back pain and labour.
Towards the later stages of your pregnancy and in labor back pain is really common, so i’m sorry if you’re experiencing back pain, but your baby is pressing really low into the pelvis and you can imagine this is your spine, and this is your sacrum, and the baby’s head is putting a lot of pressure on this lower part of your back. Pushing it out and consequently you can get quite a lot of lower back pain during the labour process.
You can hire or purchase tens machines, which is trans-electronic nerve stimulation, you place the patches of the tens machine in this area, and that’s just above the sacrum. That’s to try to help counteract the pain receptors going up and down your spine to your brain, and that can help with backache.
Massage as well, as i’ve mentioned earlier, in this part of your back is also really helpful and really effective in easing that pain. And within North Tees hospital, they also offer water blisters, which go into the same place where the tens machine patches would go and it has a similar sort of principle in terms of counteracting that pain up to the brain.
What happens is two midwives have injections, and it is purely water, and it’s ampules of water that are injected into four areas onto the back and they’re popping up on your back like little blisters, almost like a bee sting.
Now when they are administered they do hurt a lot and it is normal for ladies to almost scream out in pain, when they get the blisters, but what we know from lots of ladies that we look after, is that they’re so effective in getting rid of that backache, and it’s like magic how quickly that backache is eased.
Pain relief
Community Midwife Rebecca discusses your options when it comes to pain relief during labour.
Pain relief
Hey everyone. In this session we’re going to talk about pain relief and we’re going to talk about natural methods of pain relief that you can adopt yourself easily at home.
We’ll also talk about pharmacological forms and relief that you may wish to choose if you go into hospital. Now when you are in labor, in the early stages are a blur, but it’s really important that you have good coping mechanisms, to help you to relax and help you cope from those early stages. Because they can take several hours, if not several days in those early stages of labour.
Try to keep your mind occupied, try to keep eating little snacks because you need the energy on board for when you get into active labor. Keep drinking because that helps as well and maybe go for a little walk, read a magazine, watch a bit of telly. Try not to get too hung up about the timing of your contractions, when they’re coming how frequently could come in, because at this stage it will just start to irritate you a little bit.
Just be mindful of the fact, that okay, i’m getting them and starting to get a little bit more stronger and a little bit more frequent.
We also said that having a bath or a shower often helps, heat or a hot water bottle which you can administer yourself at home. Place the water well above your bump, just helps you to relax and helps you cope. So distractions at this stage, is really helpful, things like a comedy on TV, or use of music also helps.
When you are in labor, if you relax through your contractions, it really helps you to cope. When you get your contraction, it starts off really mild and it gets stronger and stronger and stronger and it comes to a peak. Then it starts to really take your breath away, but then that pain starts to go off and it fades away and it’s a little bit like wave. It comes and it goes and the frequency of these contractions as the labour progresses becomes more frequent.
So the good thing about contractions, is that you know that they go. When you get them, they’re not pleasant but they always go. So by using breathing techniques and breathing through your contractions, it really helps with coping with your contractions. And when I say breathing techniques, it’s just long, slow, relaxed breathing.
The more tense you are in labor, and it’s our reaction when we’re in pain to tense up like I am, that builds up adrenaline and it makes the pain feel worse. So if you stay calm, relaxed, think relaxed shoulders, relaxed face, relaxed body, by listening to your music or your distraction therapy, and focusing on your breathing. If you
breathe it out, that contraction will eventually ease off.
All of these things you can do at home and you can get through the early stages of labour really quite effectively by using these techniques. In terms of alternative therapies, if you wish to look into this further you may wish to – you may wish to look into aromatherapy as a means of relaxation – and this isn’t something that the midwives can administer, but you yourself or your birth partner can do that.
For example lavender – might help you to relax or bergamot you could use for energy. Also massage sometimes – some ladies love massages in labour – other ladies don’t like massage in labour and can’t stand being touched.
You’ll find what’s right for you, but your birth partners can gently massage you and that can sometimes help particularly in your lower back area where your sacrum is, because your baby’s pushing against that part of your spine, so by rubbing this area that can help a lot with pain as well.
There are also other techniques that people will adopt, for example, the use of hypnobirthing and this might be something that you wish to do, which again is just a form of like a deep state of relaxation, to help you calm breathe through your contractions.
If you feel that this is not helping and you need something stronger, which often ladies do, then we would offer you paracetamol and certainly this is something what you could take at home and often in hospital the midwives will offer you codine or dihydracodine, which does work quite effectively with the paracetamol combined together and just helps to take the edge off.
Then you would also be offered entoknox or gas and air in labour. And although this is not connected into the walls, it’s very clever because the entoknox actually comes out of the walls in the hospital, or if you wanted to be in the bath for example, we have mobile gas and air, so you can have that wherever you want.
And in enable you to walk around here and there, but what the gas and air does, is it doesn’t take away the pain completely, it just helps you cope with your breathing. It helps take the edge off the pain and as those contractions are starting to build up and get stronger and stronger, that’s when you would start taking your entoknox, so it’s long slow deep breaths.
Long and slow. And as that contraction gets to the peak and you can start to feel it tailing off, that’s when you come off your gas.
It can make you feel a little bit giddy, or a little bit drunk, and sometimes ladies say they feel it makes them a bit sickly, or their mouths try it first. But do bear with it, because I do think it becomes your best friend during labour and you never really want to let it go.
In terms of the dry lips, maybe bring some lip balm with you. Or keep drinking plenty of water, to help and the sickness feeling tends to wear off. The other useful thing with gas and air, is it can be used alongside other forms of pain relief. Gas and air doesn’t actually affect your baby, its respiratory, so you breathe it in and you breathe it out. While the other forms of pain relief that you may need if the pain has become particularly strong, for example, maybe an opiate based medication, such as pethidine or diamorphine, these are really strong drugs and provides a very effective form of relief in labour.
It’s an injection, so with a needle and the midwives will draw up the medication, two midwives will check the medication and it’s usually given either into your leg or into the back of your bum.
Now diamorphine can make you sleepy, or any opiate injection can make sleepy, and it can also make you feel sick. So because of the sickness, we tend to give you an anti-sickness drug at the same time to help prevent that. It usually takes about 20 minutes to kick in, but after that 20 minutes, the sleepiness or that very relaxed state really helps you cope.
And an opiate injection is very good if you’re about six to seven centimeters dilated and it just helps you cope through that later stages of labour, before you’re ready to start pushing your baby.
It can make your baby a little bit sleepy as well, because it passes into your bloodstream. So because of that, if we can avoid it and try not to give you an injection too close to when you push your baby. One, because we need you have the energy to be aware to push your baby out. But also we don’t want your baby to be to sleepy when your baby’s born.
Please be assured though, that if you need the pain relief, nobody will deprive you of anything if it’s requested and needed, we will give you it.
One of the final methods of preparing that we do offer you is the most effective form of pain relief and that’s an epidural. Again this is one of the biggest fears that I find when I talk to my ladies ante-natally and a lot of people say ‘I don’t want an epidural’ – my advice would be not to have anything set in stone in terms of your birth plan. Just go with the flow, be guided by the staff and how you’re feeling, and I always say to my ladies don’t be a martyr.
If you feel like you need the pain relief and you’re not coping, an epidural is a really useful form of pain relief in labour. Particularly if your baby’s not quite being in the right position, and you’ve been in labour for a long time, and you’re really exhausted, it’s amazing.
An epidural is the only form of pain relief that takes away all of the pain and with all of the other forms you generally have a little bit of pain with it and are aware of your contractions. With the epidural, if it’s working effectively, it blocks the pain receptors that are going up your back, to your brain. And the epidural preforms a complete block of pain. The negatives of the epidural are it potentially can drop your blood pressure, so because of that we counteract that by putting a needle in the back of your hand with fluids open, that helps us to control your blood pressure if we need to.
You would also need to be continuously monitored in labour because of this reason. So that would mean that you would need to be attached to the CTG monitors where we put the balance around your tummy to monitor baby’s heartbeat. So we know that baby’s doing okay.
We need an anesthetist to be able to administer an epidural – there’s always an on call 24-hours a day anaesthetist for the labour ward. If however there is an emergency caesarean section going on at the same time, the anesthetist will be with that lady and you would then have to wai for your epidural until they were free.
There are some very low risks associated with an epidural to do with back pain and longer term back pain and headaches.
But if we were to give you an epidural, the anaesthetist would talk you through those potential side effects with you before you decided to have an epidural.
On occasion, the epidural doesn’t work, and isnt entirely 100% percent effective and it sometimes fails, with pockets of pain. And if that was the case, the midwives will be continuously monitoring you and how effective the epidural is. They would call back the anesthetist to come and recite the epidural to make it work for you. An epidural won’t affect your baby in anyway. But what we do know is that sometimes it’s hard for you to push your baby out because you’re not necessarily feeling the contractions.
And what happens with the epidural, it’s a needle that goes into your back when the anaesthetist administers it, but then they’ve got very thin tubing and they pull the needle out and that tube is then tipped all the way up the back and there’s a little port here where we administer the drugs.
It’s a continuous dose of drug’s to keep that nice level of pain relief, but you have a little button and you can keep pressing the button if you’re feeling any additional pain when you’ve got your contractions. The good news is is that you can’t overdose on the epidural, because there’s a pump that has a lock out to it so you can administer too much.
In terms of pushing out your baby, rather than pushing the button the midwives quite often at that stage will encourage you to not push the button, because if you can’t feel the contractions a little bit so you are guided in when to push your baby.
And towards the later stages of your pregnancy and in labour, back pain is really common so I’m sorry if your experience back pain.
But your bad baby is pressing really low into the pelvis, and you can imagine this is your spine and this is your sacrum and the baby’s head is putting a lot of pressure on this lower part of your back, pushing it out and consequently you can get quite a lot of in lower back ache during the labour process.
You can hire or purchase tens machines, which is trans-electronic nerve stimulation, you place the patches of the tens machine in this area, and that’s just above the sacrum. That’s to try to help counteract the pain receptors going up and down your spine to your brain, and that can help with backache.
Massage as well, as i’ve mentioned earlier, in this part of your back is also really helpful and really effective in easing that pain. And within North Tees hospital, they also offer water blisters, which go into the same place where the tens machine patches would go and it has a similar sort of principle in terms of counteracting that pain up to the brain.
What happens is two midwives have injections, and it is purely water, and it’s ampules of water that are injected into four areas onto the back and they’re popping up on your back like little blisters, almost like a bee sting.
Now when they are administered they do hurt a lot and it is normal for ladies to almost scream out in pain, when they get the blisters, but what we know from lots of ladies that we look after, is that they’re so effective in getting rid of that backache, and it’s like magic how quickly that backache is eased.
Positions during labour video resource
Click on the expander boxes below for video resources on the labour positions you can adopt during labour and birth to assist your labour progress:
Labour positions: Upright
Community Midwife Rebecca and Gayle demonstrate the upright position during labour.
Labour Positions: Upright
Hi everyone, we’re now here in this session on the labour ward and we’ve got the lovely Gayle Smith who’s one of our midwives.
She is going to help us demonstrate positions in labour. So when you are in an upright position rather, than being laid on the bed. It really helps with the descent of your baby and it helps if you can open up your pelvis. So if you’ve got some things like a birthing bottle at home, or an exercise ball, which is just as good.
It’s really helpful to, as Gayle is demonstrating, when you sit in this position, by opening up your pelvis, it also helps to get your baby to turn around. So they can flex their head and help press on your cervix more effectively to bring on better contractions.
If you don’t have an exercise ball at home, or you don’t find this position comfortable there’s lots of other positions that you can try. So we’ve got in a hospital, things like birthing stools and you can see it is exactly the same position as a toilet seat. Which is really helpful by helping you to open up your pelvis, but providing support and also helping if you’ve got back ache, because it’s a really good supportive position. And these sorts of positions are really good because then your birth partner can come around behind you and rub your back and massage your back if you want to.
Labour positions: Upright 2
Community Midwife Rebecca and Gayle demonstrate an alternative upright position during labour.
Labour Positions: Upright 2
So here Gayle is demonstrating another really useful position, and she’s managing to remain upright, yet she’s able to rest, and if she wanted to she could have a pillow under her head.
She’s able to relax through the labour, and through the contractions, while it’s maintaining that beautiful position, where she’s opening up her pelvis and helping baby to descend quicker.
Labour positions: Left lateral
Community Midwife Rebecca and Gayle demonstrate the left lateral position during labour.
Labour Positions: Left lateral
Here Gayle’s demonstrating another position, which ladies will often adopt in labour.
Particularly towards the later stages of the labour and this we call the left lateral. It’s really important that mums lay on the left-hand side, but this is a beautiful position for helping to get your baby to descend down through the pelvis.
Now here we’ve got a delivery bed that’s adapted into this position. and these move so they can adapt to each mum and each mum’s size, But also this could just as easily be demonstrated if the birth partner was also holding up the leg, providing that extra element of support.
Labour positions: All fours
Community Midwife Rebecca and Gayle demonstrate the all fours position during labour.
Labour positions: All fours
Now Gayle’s in an alternative position and we call this all fours. Which you can easily do at home, leaned over a puffy or onto your sofa, if you’ve got your knees on the floor at home.
But in hospital if you’re feeling that you’re not able to walk around and stay upright, as well because you’re feeling like the leg is progressing and you need a rest. The all fours position is really helpful, because again, you’re able to maintain that upright position but able to rest as well.
External resources
NHS Pain relief in labour
The national NHS website shares further information on the pain relief options available to you – breaking down how things like gas an air to epidurals can aid you during the labour process.
Hypnobirthing Teesside Website
Should you be interested in exploring hypnobirthing, what it is and how it could support you during labour – Hypnobirthing Teesside could provide you with the knowledge and tools to navigate your birthing experience.
National Childbirth Trust: Pain relief in labour
Further information on the pain relief options available to you during labour.
