Pain Relief During Labour: Epidural and Other Options

Labour pain is different for every woman. Some mothers cope well with breathing, movement and support, while others prefer medical pain relief such as an epidural, gas and air, or pain-relief injections. There is no “right” or “wrong” choice. The best option depends on your pain level, birth plan, medical condition, labour progress, hospital availability and personal preference.

It is helpful to understand your options before labour starts, because decisions can feel harder when contractions are intense. You can also stay flexible. Many women start with non-medical methods and later choose medical pain relief if they need more support.

ACOG states that pain relief medication during labour does not make birth “less natural” and does not increase the likelihood of caesarean birth. ACOG also notes that labour pain medicines have no long-term effects on the baby or the child’s later development. [1]

Quick Comparison: Labour Pain Relief Options

1. Epidural Pain Relief

An epidural is one of the most effective forms of pain relief during labour. It involves placing a small tube, called a catheter, into the epidural space in the lower back. Pain-relieving medicine is then given through the tube to reduce pain from contractions.

An epidural does not make you unconscious. You are usually awake and aware, but the lower part of your body feels much less pain. Some women still feel pressure during contractions or when the baby is moving down, but the painful sensation is greatly reduced.

SingHealth explains that epidural analgesia provides pain relief with little or no sedation to the mother. [2]

Possible benefits of an epidural

• Provides strong pain relief
• Can help a tired mother rest during a long labour
• Allows the mother to remain awake and involved
• Can be topped up if more pain relief is needed
• Can be useful if assisted delivery or emergency caesarean becomes necessary

Possible disadvantages or side effects

• May cause a drop in blood pressure, so monitoring is needed
• May cause numbness or heavy legs
• May make it harder to move around freely
• May require a urinary catheter if you cannot pass urine
• May lengthen the pushing stage for some women
• May cause shivering, itchiness or temporary soreness at the insertion site
• Rarely, may cause a severe headache after birth

Most side effects are temporary, but your anaesthetist will explain the benefits and risks before the procedure where possible.

When might an epidural not be suitable?

An epidural may not be suitable for every woman. Your doctor or anaesthetist will consider factors such as blood clotting problems, infection near the injection site, very low platelet count, certain spine conditions, some neurological conditions, or urgency if birth is happening very quickly.

If you are interested in an epidural, discuss it during antenatal visits, especially if you have medical conditions, previous back surgery, scoliosis, blood disorders or are taking blood-thinning medication.

2. Gas and Air / Entonox

Gas and air, also known as Entonox, is a mixture of nitrous oxide and oxygen. It is usually breathed in through a mask or mouthpiece during contractions.

SingHealth describes Entonox as a gas made of 50% nitrous oxide and 50% oxygen. [3] NHS says gas and air will not remove all the pain, but it can help reduce it and make it easier to bear. [4]

Possible benefits

• Easy to use
• Works quickly and wears off quickly
• You control when to breathe it in
• Does not usually restrict movement as much as an epidural
• Can be used during different stages of labour, depending on hospital practice

Possible side effects

• Dizziness
• Nausea
• Light-headedness
• Dry mouth
• Feeling detached or sleepy

Gas and air may not be enough for strong labour pain, but some women find it helpful when combined with breathing, movement, water or massage.

ACOG advises that nitrous oxide should not be used together with systemic opioids or sedative medicines because of concern about maternal breathing effects. [5]

3. Opioid Pain-Relief Injections

Some hospitals may offer opioid pain-relief injections during labour. Examples may include pethidine, diamorphine or similar medicines, depending on hospital practice.

These medicines do not numb the lower body like an epidural. Instead, they act on the nervous system and may help reduce pain perception, promote relaxation and allow some rest.

Tommy’s notes that opioids such as pethidine or diamorphine may help women cope better with contractions, sleep through contractions and relax. [6]

Possible benefits

• May help you relax
• May reduce how intense contractions feel
• Can be useful in earlier labour for some women
• Does not require an epidural procedure

Possible disadvantages or side effects

• May cause nausea or vomiting
• May make you sleepy or drowsy
• May make you feel less clear-headed
• May not provide enough pain relief for advanced labour
• If given close to birth, may make the baby sleepy or affect breathing

Because timing matters, your doctor or midwife will consider how close you are to delivery before giving opioid pain relief.

4. TENS Machine

TENS stands for transcutaneous electrical nerve stimulation. It uses small sticky pads placed on the back to send gentle electrical pulses through the skin.

TENS is commonly used in early labour, especially for backache or mild-to-moderate contraction pain. It may help by distracting from pain signals and encouraging the body’s natural pain-relief responses.

NHS includes TENS among pain relief methods during labour and notes that it is often most effective in early labour. [4]

Possible benefits

• Drug-free option
• You can control the intensity
• May help early labour discomfort
• No known effect on the baby when used appropriately

Things to consider

• May not be enough for strong active labour pain
• Cannot usually be used in water
• May need to be rented, bought or arranged before labour
• Check with your maternity team if suitable for you

5. Water, Shower or Birth Pool

Warm water may help some women relax and cope with contractions. This may be through a warm shower, bath or birth pool, depending on hospital facilities and your medical situation.

NHS lists birth pools as one method of pain relief during labour. [4]

Possible benefits

• May help relaxation
• May reduce muscle tension
• May make movement easier
• Can create a calmer labour environment

Things to consider

• Not always available in every hospital or room
• May not be suitable for all pregnancies
• May not be recommended if continuous monitoring or urgent intervention is needed
• Water temperature must be safe and comfortable

Ask your hospital early whether water-based pain relief is available and under what circumstances it can be used.

6. Breathing, Relaxation and Movement

Breathing techniques do not remove labour pain, but they can help the mother stay calmer, reduce panic, and work with contractions instead of fighting them.

Useful coping methods may include:

• Slow breathing during contractions
• Changing positions
• Walking or swaying
• Leaning forward over a chair or birth ball
• Using calming music or low lighting
• Visualisation or hypnobirthing techniques
• Having a supportive birth partner

These methods may be especially useful in early labour and can also be combined with medical pain relief.

7. Massage, Counter-Pressure and Heat

Massage or pressure on the lower back may help some women, especially if labour pain is felt strongly in the back. A warm pack may also help muscle tension.

Birth partners can support by:

• Massaging the lower back
• Applying steady counter-pressure during contractions
• Offering water between contractions
• Helping the mother change positions
• Reminding her to breathe slowly

Always ask the mother what feels helpful. During labour, some women like touch, while others prefer not to be touched.

8. Local Anaesthetic and Pudendal Block

Local anaesthetic may be used to numb a small area before stitches if there is a tear or episiotomy. A pudendal block is an injection that can numb pain around the vagina, vulva and perineum near delivery.

ACOG explains that a pudendal block can be used around the time of delivery to relieve pain in the vagina, vulva and perineum, including if there is a tear or episiotomy. [7]

Choosing the Right Pain Relief: Questions to Ask Before Birth

Before labour, ask your gynae or hospital team:

• Is epidural available 24 hours in this hospital?
• At what stage of labour can I request an epidural?
• What are the common side effects of epidural in this hospital?
• Is gas and air available?
• What opioid injections are offered?
• Can I use a TENS machine?
• Are showers, baths or birth pools available?
• What happens if I want to change my pain relief plan during labour?
• Are there any medical reasons why I should avoid certain options?

Can You Change Your Mind During Labour?

Yes. Many women change their pain relief plan during labour. You may start with breathing and movement, then ask for gas and air, then later request an epidural. Or you may plan for an epidural but progress quickly and use other options instead.

A flexible birth plan is often more useful than a fixed one. The goal is a safe birth and a mother who feels supported.

Does Epidural Increase the Chance of C-Section?

Many mothers worry that choosing an epidural will automatically lead to a caesarean section. ACOG states that pain relief medications do not increase the likelihood of caesarean birth. [1]

However, every labour is different. Caesarean delivery may be needed for other reasons, such as fetal distress, labour not progressing, placenta problems, breech position or other medical concerns.

Can Pain Relief Affect the Baby?

Different pain relief options affect the baby differently. Epidural medicine mostly acts around the nerves in the mother’s lower body and generally causes little or no sedation. Opioid injections may make the baby sleepy if given close to birth. Gas and air works quickly and wears off quickly.

Your maternity team will consider timing, dose, labour progress and your baby’s wellbeing before recommending or giving pain relief.

Singapore Context: Discuss Options With Your Hospital Early

In Singapore, pain relief options can vary between public and private hospitals, and even between labour situations. Some options may depend on staff availability, medical condition, room type, labour progress and hospital protocols.

It is useful to ask during antenatal visits or hospital admission:

• Whether epidural is available round-the-clock
• Whether Entonox is available
• Whether TENS machines are allowed
• Whether water-based pain relief is available
• What happens if labour progresses too quickly for epidural
• What pain relief options are available for induced labour

When Pain Relief Needs Urgent Medical Review

During labour, inform your maternity team immediately if you experience:

• Severe headache
• Chest pain or severe shortness of breath
• Sudden weakness, numbness or confusion
• Severe dizziness or fainting
• Heavy bleeding
• Fever or feeling very unwell
• Severe pain that feels different from contractions
• Reduced baby movements before admission

Some symptoms may be unrelated to labour pain and need prompt assessment.

FAQ: Pain Relief During Labour

What is the most effective pain relief during labour?

An epidural is generally considered one of the most effective forms of labour pain relief. It can greatly reduce contraction pain while allowing the mother to remain awake and involved.

Does an epidural make birth less natural?

No. ACOG states that using pain medication does not make labour less natural. Pain relief can help mothers cope better with labour and delivery.

Can I still feel contractions with an epidural?

Many women feel pressure or tightening with an epidural, but the painful sensation is usually greatly reduced. The exact feeling varies from person to person.

Does epidural increase the chance of caesarean birth?

ACOG states that labour pain medications do not increase the likelihood of caesarean birth. Caesarean delivery may still be needed for other medical reasons.

What is gas and air during labour?

Gas and air, or Entonox, is a mixture of nitrous oxide and oxygen. It is breathed through a mask or mouthpiece during contractions and can help make pain easier to bear, although it does not remove pain completely.

Can I use non-medical pain relief and still ask for epidural later?

Yes. Many women start with breathing, movement, massage, water or TENS and later request medical pain relief if needed. Labour plans can be flexible.

Are opioid injections safe during labour?

Opioid injections may be used in some labour settings, but timing matters. They may cause drowsiness, nausea or affect the baby if given close to birth. Your maternity team will consider whether they are suitable.

Should I decide on pain relief before labour?

It is helpful to understand your options before labour, but you can still change your mind. Discuss your preferences and medical considerations with your gynae or hospital team.

Key Takeaway

Labour pain relief is personal. Epidural offers strong pain relief, while gas and air, opioid injections, TENS, water, movement, breathing, massage and support can also help mothers cope. Some women use one method; others use a combination.

The best plan is a flexible one. Learn your options, ask your hospital what is available, discuss medical concerns with your gynae, and allow yourself to adjust your pain relief choices during labour. Needing pain relief does not mean you have failed. A supported, safe birth is what matters most.

References

• [1] American College of Obstetricians and Gynecologists, Medications for Pain Relief During Labor and Delivery.
• [2] HealthXchange Singapore, Labour Pain Relief: How Does an Epidural Work?
• [3] SingHealth, Pain Relief Options Including Epidural for Women in Labour.
• [4] NHS, Pain Relief in Labour.
• [5] American College of Obstetricians and Gynecologists, Use of Nitrous Oxide in Labor and Possible Interaction With Systemic Opioids or Sedatives/Hypnotics.
• [6] Tommy’s, Pain Relief in Labour and Birth.
• [7] American College of Obstetricians and Gynecologists, Making Sense of Childbirth Pain Relief Options.
• [8] Mayo Clinic, Labor and Delivery: Pain Medications.