Pain relief in labour: epidural, TENS, water and breathing options

Feeling pain during birth is common, but how you experience it and what you need varies a great deal from person to person. Some people find comfort in natural methods, some ask for an epidural, and some combine the two. All of these are respected choices, and changing your mind during labour is also usual.

What shapes pain

Labour pain is shaped by how strong the contractions are, the baby's position, tiredness, fear and the support around you. Feeling safe often makes it easier to cope. That is why trust in where you give birth and in the person beside you matters.

Drug-free methods

These options can help early on and as labour goes on:

• Breathing and relaxation: Slow, deep breaths and letting your shoulders, face and jaw soften between contractions
• Movement and position: Walking, swaying, a birth ball, all fours, lying on your side
• Heat and water: A warm shower, a hot compress or, where available, a birth pool
• Massage and pressure: Massage or counter-pressure on the lower back
• Music, dim light, quiet: Making the room calm
• A support person: Your partner, a relative or a doula by your side

Some of these depend on what the hospital offers. Asking beforehand shows what is possible for you.

TENS

TENS is a small device that sends mild electrical pulses through pads placed on the skin. It may ease back pain, especially in the early and middle stages. Some people benefit and others do not notice much. There is no evidence that it harms the baby, but not every hospital has it. It is not used in water.

Epidural

An epidural is a regional pain-relief method in which an anaesthetist places a thin catheter in the lower back. Afterwards the feeling of contractions is greatly reduced, and you stay awake.

• Possible benefits: It markedly reduces pain for most people and can allow rest during a long or tiring labour.
• Possible effects: Lower blood pressure, numb or weak legs, itching, fever, and sometimes less awareness of the urge to push.
• Rare situations: A headache, or the medicine not working well enough.
• The process: You are asked to stay still while it is placed. The team monitors you and your baby more often.

An epidural does not mean you need a caesarean, but it may affect the length of labour or the need for assisted birth. You can talk it through with your doctor for your own situation.

Other options

Hospitals may offer other methods too. Ask your team which are available, whether they suit you and what effects they may have.

What influences the choice?

When deciding, factors include whether labour may be long, your earlier birth experience, your health and your personal preferences. Some people try drug-free methods first and move to an epidural if needed. Others want an epidural from the start. Neither path means failure or superiority; each simply answers different needs. Your team should listen to you and keep you informed at every stage.

When to contact your doctor

Tell your team at once if, after an epidural or during labour, you notice:

• Numbness or weakness in your legs that lasts
• A severe headache, especially if it gets worse when you stand
• Swelling, pain or discharge where it was placed
• Fever or shivering
• Pain that is not eased enough or is concentrated in one spot

If these appear after you go home, contact a doctor; for shortness of breath or fainting, call 112 (or your local emergency number).

What you can do

• Try breathing and relaxation techniques in your birth class.
• Ask your doctor and the anaesthetic team your questions about epidurals.
• Write your pain-relief preferences into your birth plan and stay flexible; the birth plan in the app can help.
• Tell your support person which methods help you.
• Remember that changing your mind during labour is not a bad thing.

In pain relief there is no single right choice, only what suits you. This article is for information only; your doctor's and midwife's advice for your own situation comes first.