Pain relief in labour

Pregnant woman gas and air

Epidurals aren't the only form of pain relief available during labour. And while there are many natural forms of pain relief you could consider, if you’re looking for something a bit stronger (but without the downsides of an epidural), there are several other options on the table to get you through from the first twinge to the final push.

Gas and air in labour

Gas and air (also known as “Entonox”) is a very commonly used method of pain relief for labour. Whether or not gas and air helps with pain during labour is a subject of debate. Some mums find it makes their contractions less painful and swear by it, others find it does very little. It tends to “take the edge off” rather than block out all pain like an epidural will, but often that's enough to get you through.

What is Entonox?

I used gas and air. It was bloody marvellous. I had Mr Men hallucinations through my contractions, with the figure morphing from Mr Messy in between to Mr Sneezy at the peak. Bizarre!

Remember the laughing gas you used to get at the dentist? Well, that's similar to Entonox. It's a mild painkiller made up of a 50/50 mix of nitrous oxide (laughing gas) and oxygen. You simply breathe it in through a mouthpiece or a mask placed over your nose and mouth as soon as you feel a contraction starting. It will make you feel a bit woozy – at which point you should stop using it until you next feel the need – but this only lasts a few seconds.

When can I have gas and air?

At any point at all. You might even be given it afterwards while they stitch you up. The midwives will, however, probably try to put you off tearing into it too early on because it's not recommended you use it for prolonged periods and labour can sometimes “go on a bit”. In early labour you're better off trying to just distract yourself and breathe deeply and saving gas and air for when you need to pull out the big guns.

The midwives may also suggest you don't use it when pushing as you really need to put all your focus and energy into that instead.

How do you use gas and air in labour?

Woman labour gas air

As soon as you feel a contraction starting, put the mouthpiece in your mouth or the mask securely over your nose and mouth and breathe in and out slowly and deeply. When the contraction begins to subside or you start to feel a little woozy, put it down and breathe normally.

What are the advantages of gas and air in labour?

  • It's easy to use – just breathe in deeply.
  • You control how much you have and when.
  • It doesn't harm your baby – in fact the oxygen in it is good for your baby.
  • It doesn't hang around in your system, so you aren't stuck with a horrible sensation for hours if you find you don't get on with it.
  • You can keep sucking for all your worth even when you're in a birthing pool and you can have it at a home birth, too.

Are there any side effects or disadvantages of gas and air?

  • It makes some people feel nauseous, but this generally passes after a few seconds.
  • It dries your mouth out, so make sure you have little sips of water or suck ice chips in between tokes.
  • It's quite a mild pain relief option.
  • It can take a few goes to learn to use it effectively.

If gas and air doesn't cut it, you have a couple of (stronger) options: pethidine, diamorphine and meptazinol.

How do pethidine and diamorphine work?

I had gas and air and pethidine (which was bliss) during the early stages, but found the pushing stage easier to cope with without pain relief. It just felt as though my body had a job to do and was getting on with it.

Pethidine and diamorphine are strong, very effective pain-relievers. These opiates are usually delivered via an injection into your buttock or thigh.

They work very quickly – within about 10 minutes – last a few hours and can give you a real “high” (hence the fact they're often given to surgical patients postoperatively).

It's recommended you only use diamorphine in early labour as its effects last longer. Pethidine can be used at a slightly later stage.

What are the advantages of pethidine and diamorphine?

  • They work fast and last for around four hours.
  • They can be administered by a midwife at home or in a birthing centre so you can use them wherever you choose to give birth.
  • You can be more mobile than you are with an epidural.
  • They offer a chance to get a bit of “rest” from the pain of labour. Some women even drift off to sleep a bit.
  • They may help you avoid an epidural.

Are there any side-effects or disadvantages to pethidine and diamorphine?

  • They can make you feel sick, drowsy, dizzy and generally pretty weird. And once you’ve had the injection you have four hours before it wears off so if you don’t like the sensation you're stuck with it.
  • They don't cut out pain altogether, only dull it – and they can make you feel like you care about it all a bit less.
  • You can't go in the pool or a bath within two hours of having pethidine or diamorphine, or if you feel drowsy having taken them.
  • More importantly, they may also affect your baby as they cross the placenta, making him or her sleepy and/or reducing their ability to breathe well after birth. The latter may need urgent treatment and it can also affect their ability to feed in the hours and days after birth.
Newborn baby

What is meptazinol (Meptid)?

Although also delivered via injection, meptazinol is a bog-standard analgesic rather than a potentially addictive opiate like pethidine or diamorphine. It has the same swift pain-killing effect and can also make you feel sick and dizzy.

The plus is that it's far less likely to affect your baby and so can be used late into the first stage of labour. It is less commonly available than pethidine, however, so if you're keen on giving it a go check in advance whether your hospital offers it.