Coping strategies for labour and birth

Labour can be painful – it can help to learn about all the ways you can relieve the pain.

It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you.

Ask your midwife or doctor to explain what's available so you can decide what's best for you.

Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more or less pain relief than you'd planned, or your doctor or midwife may suggest alternative pain relief to help the delivery.

Self-help in labour

You're likely to feel more relaxed in labour and better placed to cope with the pain if you:

Learn about labour - this can make you feel more in control and less frightened about what's going to happen; talk to your midwife or doctor, ask them questions, and go to antenatal classes
Learn how to relax, stay calm, and breathe deeply
Keep moving – your position can make a difference, so try kneeling, walking around, or rocking backwards and forwards
Bring a partner, friend or relative to support you during labour, but don't worry if you don't have one – your midwife will give you all the support you need
Ask your partner to massage you – although you may find you don't want to be touched
Have a bath.

Using water in labour (water birth)

There is lots of evidence to suggest that being in water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature, but not above 37.5C, and your temperature will be monitored.

There are some circumstances where using the birthing pool would not be recommended. Discuss this with your midwife or doctor if you would like more information.

The National Childbirth Trust has information on using water during labour and birth .

TENS machines

This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire your own machine.

TENS has not been shown to be effective during the active phase of labour, when contractions get longer, stronger and more frequent. It's probably most effective during the early stages, when many women experience lower back pain.

TENS may also be useful while you're at home in the early stages of labour or if you plan to give birth at home. If you're interested in TENS, learn how to use it in the later months of your pregnancy. Ask your midwife to show you how it works.

How TENS machines work

Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS.

TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord.

Side effects of TENS machines

There are no known side effects for either you or the baby.

Alternative methods of labour pain relief

Some women may choose alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques aren't proven to provide effective pain relief.

If you'd like to use any of these methods, it's important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals don't offer them for pain relief during labour.

If you want to try any of these techniques, make sure the practitioner is properly trained and experienced. Learn more about complementary and alternative medicines and how they're regulated.

Gas and air (Entonox) for labour

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.

Side effects

There are no harmful side effects for you or the baby
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.

Injections in labour

Injections can be given into your buttock or thigh to relieve pain. Commonly used drugs are Pethidine, Meptid and Diamorphine; uses of these drugs vary across our hospitals, please discuss further with your midwife or doctor.

The injections take about 20 minutes to work, and effects last between 2 and 4 hours. These drugs are not usually recommended if you're getting close to the pushing (second) stage of labour.

Side effects

There are some side effects to be aware of:

It can make some women feel woozy, sick and forgetful
If these drugs 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

Epidural

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, and they are not available in midwifery led birth centres.

An epidural can provide very good pain relief, but it's not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that 1 in 8 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. This means that forceps or a ventouse may be needed to help deliver the baby's head (instrumental delivery ). When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you'll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.

You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.

About 1 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 1 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.

Read more about the pros and cons of epidurals .