Pain relief in labour

TENS machines stand for 'transcutaneous electrical nerve stimulation'. They have been shown to be most effective during the active phase of labour, and during the early stages with lower back pain. TENS machines are made up of electrodes that transmit small safe electric currents via a stimulator and as it allows you to be mobile it can be good in the early stages of labour and for home births. TENS machines are not known to be harmful to your baby.  A birthing pool, aromatherapy and hypno-birthing are other non-medical options with growing popularity that focus on relaxation and mentality to help encourage a positive birthing experience.

Gas and air (also known as Entonox) is made up of oxygen and nitrous oxide, and is usually the first line painkiller used in labour. This is safe, doesn’t cause any harm to the baby, and is used via a mobile hand-held mask with the mother being in control of how much they inhale. This doesn’t get rid of the pain completely but helps to make it more bearable. Gas and air can leave people feeling woozy and drowsy, and occasionally cause symptoms of nausea, vomiting or dizziness. This is usually limited to its use, and once it is stopped these symptoms usually settle very quickly. 

If the gas and air doesn’t work, then an epidural might be considered. Epidurals are given by an anaesthetist, where a local anaesthetic is injected into the back to provide complete pain relief and numbness to the lower part of your body. A small dose is given at first and if there is a good response then increasing doses can be given later.

As this is a local anaesthetic, you do not have to be put to sleep to have this procedure done. You and the baby will both need to be monitored in the pregnancy and you will no longer be able to walk around. Side effects can include numbness which can last a short time or a long time, a headache, a drop in blood pressure and difficulty feeling your contractions which may lead to the labour progressing slowly and requiring help from your medical team, commonly via instrumentation (use of instruments to help deliver your baby). 

If a C-section needs to be conducted, then a spinal block is given (unless in rare cases of an emergency C-section where occasionally patients are put to sleep quickly to operate immediately). This is injected in the back to numb the lower part of the body and can last up to 2 hours. This can cause low blood pressure, severe headaches, dizziness, localised itching and sometimes difficulty initiating lactation.

Pethidine injections are another option that can be given as well. These can help reduce anxiety, can be used in combination with gas and air and can be given at any time during labour. The downsides are that it is not always an effective method of pain relief, it can cause drowsiness and slowed breathing to both mother and baby and can have negative effects on breastfeeding. Because of this it is used less often than other forms of pain relief in labour.