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Coping during labour

An overview of the coping mechanisms and pain relief available to you during labour.

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 childbirth

Pain 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

Pain relief

Hi, my name is Lily McInnes, I’m one of the midwives over at North Tees Hospital and I’m going to be talking to you today about the pain relief options for labour.

The first method of pain relief that we would offer is gas and air. This is usually piped from the wall and is a mixture of nitrous oxide and oxygen. We give you a mouthpiece and we will tell you to start breathing in deep breaths from the beginning of your contraction. So, we’ll encourage you to breathe slowly so that it’s in your system for the height of your contraction. As your contraction fades, we will tell you to take some deep breaths of normal air just to ease the dizziness that comes alongside with the gas and air.

One of the benefits of gas and air is that it doesn’t cross your placenta which means there is no effects for baby.

The second form of pain relief that we will offer is an opioid injection into either your thigh or your buttock. This is either called diamorphine or pethadine. We often give this alongside an anti-sickness as it can make you quite nauseous.

This can take usually about 20 minutes to work and last between 2 to 4 hours. Opioid injections do cross the placenta and can make baby quite sleepy. This is why we aim to give it earlier in labour to give you the most pain relief that you need.

The opioid injection diamorphine or pethadine can also be used alongside gas and air.

The final option for pain relief is the epidural. This is a procedure often done by an anaesthetic professional. You can ask for an epidural at any point in your labour and the midwife will facilitate this.

This is a sterile procedure that usually takes anywhere from 30 minutes. We will get you sat on the side of the bed to ensure the area is sterile and cover your back in a sticky drape.

A local anaesthetic is then given into your back. It’s often described as a bee sting. This allows the anaesthetist to pass a small needle into the back to find the epidural space to provide you adequate pain relief in your labour.

You can ask for this to stop at any moment or a break in between contractions. Women’s main worry with epidurals is that the needle is in your back for a long period of time, but don’t worry as this is very quickly removed once the epidural space is found.

Due to your labour becoming more high risk, your baby will be monitored continuously, fluids will be started, and observations will become more frequent. You can change your mind regarding pain relief at any point in your labour. Just ask your midwifery team for any advice.

Alternative methods to pain relief

Alternative methods to pain relief

Hello, my name’s Lucy Barclay and I’m a community midwife at North Tees.

Today I’m briefly going to talk about some alternative methods of pain relief that’s available to you and your baby in labour.

It’s important to talk to your healthcare provider before choosing these options to make sure it’s safe for you and the baby.

The first option that I’m going to talk about is a TENS machine. Now, this TENS machine works by providing electrical nerve stimulation to your spine. You place two pads on your lower back and then when you experience a contraction you press the monitor which is attached to these pads and it provides a stimulative electrical impulse which distracts from the contraction pains. People can use this all the way up until the baby is born.

Another alternative option for pain relief is essential oils which you can place in a diffuser and some women like to use clary sage for this as it can help boost hormones and promote oxytocin which can relax you in labour.

Massage is another alternative to assist with pain relief and you can get your birthing partner involved in this. You can do this at home or in the hospital, lower back massages can really assist in descent of the baby as well as encouraging you to be mobile in labour and it can boost that oxytocin hormone and get you nice and relaxed.

A newer technique of pain relief is a birthing comb and this is a type of acupuncture pain relief and it works by holding the birthing comb in the palm of your hand and pressing it down when you experience a pain. This type of acupuncture can distract you and help you breathe through contractions.

And finally, a fourth option of pain relief is the water blisters, and these work by injecting some sterile water into your lower back. This can be especially useful if you’re experiencing a lot of back pain. If your baby’s more towards your spine in labour, the sterile water actually puts pressure on your nerves, which distracts you from experiencing any pain and can help you be more mobile in labour if you’re struggling with your back.

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:

Birth positions

Birth positions

Hi, I’m Charlotte. I’m one of the specialist midwives at North Tees and Hartlepool NHS Foundation Trust. And this is Steph. She’s one of our students from Teesside University. Under my direct supervision, Steph is going to go through some birth positions today.

It’s important to keep upright and active during labour. This helps the baby to move into correct position and move down into the pelvis. The baby’s head will then push down on the cervix, encouraging it to dilate, which means to open.

It’s important to remember that the coccyx, the bone at the bottom of the spine, is a naturally curved bone. Lying flat on the bed, will create more work and baby will have to move uphill to exit the pelvis. Now, me and Charlotte are going to demonstrate which positions you might want to adopt during your labour. Many people choose to labour on their hands and knees. So, Charlotte, if you’d like to get into position.

The hands and knees position can be helpful if you have pain in your back rather than in your stomach.

Leaning over the bed can also be helpful to ease pain and get baby into a right position. If you get tired during your labour, you can lay on your side. In this position, you can fully relax, open your pelvis, and reduce the pressure on your back from the baby. Using a peanut ball may help you feel more comfortable and help your labour to progress. You can even use a peanut ball when you’ve had an epidural sighted.

When you stand in labour, gravity will help the baby to move down. When standing, many people instinctively rock their hips from side to side or use a circular motion. Using aids such as birthing balls can help you sit upright and help baby’s head descend into the pelvis.

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.

Coping during labour video resource

Click on the expander boxes below for video resources with information and advice about coping during labour.

Coping in labour

Coping in labour

Hi, I’m Sara, I’m a midwife at North Tees and this is Scarlett, student midwife, who’s working under direct supervision with me. Scarlett’s going to talk to you about coping with early labour at home.

It’s really important during the early stages of labour, which is also known as the latent phase, that you remain nice and calm and relaxed at home surrounded by your own home comforts.

There’s various ways to help you keep relaxed at home such as having a hot bath or a warm shower, going for walks and keeping mobile, also using your birthing ball and if you’ve got a TENS machine at home, you can also use that.

It’s really important that you stay well hydrated and you eat little and often.
Sleep as much as you can and rest while you can. Do things that make you happy by reading books, listening to music, or watching your favourite TV show, and if you need to take pain relief, then you’re allowed to take paracetamol, which is one gram every four hours, but not exceeding the daily dose of four grams in a 24-hour period.

The most important thing for you to do is to not panic. It’s really important that you stay nice and calm and relaxed to help your labour progress further.

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.

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