Pearl obstetrics | gynaecology

Pain relief options in labour

Pain relief in labour

Most women do not require pain relief during early labour, but seek it once the active phase of first-stage labour begins.

Nondrug techniques can be learnt as part of antenatal care, including relaxation techniques. However, as pain increases with advancing labour, the methods of relief below are all available and are recommended.

Women who receive continuous support during labour are more likely to give birth unaided and are less likely to use analgesia. This is more effective when it is started early in labour, by women who are not part of the hospital staff. Support from a trusted member of the family or a friend is ideal.


Transcutaneous electrical nerve stimulation (TENS) applies controlled mild electrical stimulation to the skin by means of electrodes. This provides distraction-like pain-relief in early labour.
• There is no compelling evidence for TENS being very effective.
• However there is a high degree of patient satisfaction with this method.
• It should NOT be used in established labour, and doesn’t work then anyway.

Complementary therapies

• No effect was seen for women receiving aromatherapy.
• Acupuncture and hypnosis may be beneficial for the management of pain during labour; however, the number of women studied has been small.
• Few other complementary therapies have been subjected to proper scientific study.

Nitrous oxide and oxygen (Entonox®)

This mixture is inhaled during painful contractions.
• The main advantages are that it is under the patient’s control, it takes effect within seconds and wears off quickly with no side-effects.
• Half of women obtain satisfactory relief.
• It is generally considered safe, as long as it’s not overused.


This is widely used. It is effective within 15 minutes and lasts for 2-3 hours.
• There has been wide debate over the efficacy of pethidine.
• It is very effective in early labour, provides relaxation
• It can affect the baby so is best not used in more advanced labour.

Epidural analgesia

Epidural analgesia is achieved by an injection in the back close to the nerves that transmit pain. It’s the most effective method of pain relief in labour.
• It is the most effective way of relieving pain in labour – providing relief in 95% of cases.
• Makes examinations much easier.
• It can also be used if forceps, vacuum extraction or Caesarean section are required. This can be very helpful if an emergency occurs.
• Chronic back pain afterwards is not more common in women having epidurals. The pregnancy is the main cause of back pain after birth.
• Dizziness or shivering may occur.
• It increases the length of pushing. But we can counteract this effect.
• There is an increased rate of vacuum & forceps.
• Low blood pressure occurs in 20% women, but is usually easily corrected.
• The baby’s heart rate can drop – again this is usually easily corrected.
• Severe headache afterwards in 1/200 women – can be treated.

Local anaesthetic

Used for women who have not had an epidural but require forceps or vacuum extraction delivery. It is also used for repair of episiotomy or perineal tear.
Pudendal nerve block
This blocks the nerves to the pelvic floor and is applied internally – a little like the blocks used at the dentist.
Perineal nerve infiltration
This numbs the skin on the outside of the vulva | vagina – usually used if stitching is needed

Dr. Mark Sillender. Consultant obstetrician & gynaecologist