Almost 70,000 less women are given pain relief during childbirth compared to a decade ago
Gas and air (Entonox)
This is a mixture of oxygen and nitrous oxide gas. Gas and air won’t remove all the pain, but it can help reduce it and make it more bearable.
Many women like it because it’s easy to use and they control it themselves.
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself.
The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.
There are no harmful side effects for you or the baby, but it can make you feel light-headed
Some women find that it makes them feel sick, sleepy or unable to concentrate – if this happens, you can stop using it.
If gas and air doesn’t give you enough pain relief, you can ask for a painkilling injection as well.
Pethidine injections in labour
This is an injection of the drug pethidine into your thigh or buttock to relieve pain.
It can also help you to relax. Sometimes, less commonly, a drug called diamorphine is used.
It takes about 20 minutes to work after the injection. The effects last between two and four hours, so wouldn’t be recommended if you’re getting close to the pushing (second) stage of labour.
There are some side effects to be aware of:
- it can make some women feel woozy, sick and forgetful
- if pethidine or diamorphine are given too close to the time of delivery, they may affect the baby’s breathing – if this happens, another drug to reverse the effect will be given
- the drugs can interfere with the baby’s first feed
An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy.
For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour.
An anaesthetist is the only person who can give an epidural, so it won’t be available at home.
If you think you might want one, check whether anaesthetists are always available at your hospital.
How much you can move your legs after en epidural depends on the local anaesthetic used. Some units offer ‘mobile’ epidurals, which means you can walk around.
However, this also requires the baby’s heart rate to be monitored remotely (by telemetry) and many units don’t have the equipment to do this.
Ask your midwife if mobile epidural is available in your local unit.
An epidural can provide very good pain relief, but it’s not always 100 per cent effective in labour.
The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief.
How does an epidural work?
To have an epidural:
- a drip will run fluid through a needle into a vein in your arm
- while you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back
- a very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting
- the epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine
- your contractions and the baby’s heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby’s head
Side effects of epidurals in labour
There are some side effects to be aware of:
- An epidural may make your legs feel heavy, depending on the local anaesthetic used.
- Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.
- Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push.
- You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
- About one in 100 women gets a headache after an epidural. If this happens, it can be treated.
- Your back might be a bit sore for a day or two, but epidurals don’t cause long-term backache.
- About one in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You’ll be advised by the doctor or midwife when you can get out of bed.