Pain Relief for Labour
Date issued: December 2024
For review: December 2026
Ref: B-533/JS/Maternity/Pain Relief for Labour
PDF: Pain relief for labour.pdf[pdf] 170KB
Unfortunately, pregnancy loss is not a rare tragedy and encompasses miscarriage, termination for medical reasons and stillbirth. In 2021: There was 1 stillbirth for every 243 births in the UK and it is estimated there were over 100,000 miscarriages in England.
The information provided in this leaflet is intended to try to help you through the physical discomfort of the delivery of your baby. Your midwife, obstetrician and anaesthetist are all here to help support you through this difficult process.
If you have not yet been in touch with our bereavement midwifery team, they will contact you shortly and are a great source of practical advice and support for you and your family.
The organisation SANDS (Stillbirth and Neonatal Death Charity) is a national charity available to help and support anyone affected by the death of a baby.
The contact details of SANDS and the bereavement midwifery team, are included at the end of this leaflet alongside contact details for the Miscarriage Association and Pregnancy Crisis Care.
Options for pain relief in labour
Your anaesthetist will be happy to discuss all options of analgesia with you. This leaflet gives a summary of things you may wish to try.
Often in cases of pregnancy loss, medications are required to start off (induce) labour. This may make contractions more painful.
Simple painkillers such as paracetamol and NSAIDs (e.g. ibuprofen or diclofenac) can help reduce the intensity of your pain, particularly in the early stages of labour.
Non-drug measures such as TENS machines may also be of benefit to some people, you are welcome to use a TENS machine if you have one.
Other forms of pain relief which are commonly used are discussed below:
Entonox
Entonox is a gas made up of 50% nitrous oxide and 50% oxygen, sometimes known as ‘gas and air’.
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You breathe Entonox through a mask or mouthpiece.
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It is simple and quick to act and wears off in minutes.
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It sometimes makes you feel light-headed or sick for a short time.
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It may not take the pain away completely, but it should help.
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You can use it at any time during labour.
You control the amount of Entonox you use, but to get the best effect it is important to get the timing right. You should start breathing Entonox as soon as you feel a contraction coming on, so you will get the full effect when the pain is at its greatest.
You should not use it between contractions or for long periods as this can make you feel dizzy and tingly.
What extra pain relief may I need?
The amount of pain relief you are likely to need will depend partly on the gestation of your baby. If your pregnancy loss is less than 34 weeks then most women will manage with simple painkillers, Entonox and opioids (see below). If you are more than about 34 weeks, then many women require an epidural or Patient Controlled Analgesia (PCA).
Opioids
Opioids are pain relief drugs which work in a similar way to morphine. We usually use diamorphine or morphine at UHP.
Morphine
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Usually given directly into the vein via a PCA.
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A PCA uses a pump controlled by yourself via a button, to give yourself small doses of morphine when you feel you need it.
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You have control over the amount you use, for safety reasons the PCA pump limits how quickly you take the drug. If used correctly it can be very effective.
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If you use the PCA for a long time, morphine may build up in your body which may increase the side effects.
Diamorphine
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Your midwife can give diamorphine by injection into a muscle in your arm or leg.
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You will start to feel the effects after about 30 minutes, and they may last a few hours.
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A repeat dose may be given after 3 hours if required.
Side effects of opioids
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Drowsiness.
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Sickness (you will usually be given anti-sickness medication to stop this).
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They may slow down your breathing - you may be given oxygen through a face mask and have your oxygen levels monitored.
Epidurals
Epidurals are the most complicated but also most effective method of pain relief and are carried out by an anaesthetist.
An epidural catheter (very thin tube) placed near the nerves in your lower spine is used to give you local anaesthetic to numb the nerves during your labour.
Most people can have an epidural, but certain medical problems (such as spina bifida, or a previous operation on your back) may mean that it is not suitable for you.
Also, if you have an infection or problems with blood clotting, both of which are not uncommon in cases of pregnancy loss, you may be advised against having an epidural. Your anaesthetist will discuss this with you.
More detailed information about epidurals and other forms of pain relief can be found online. Visit Labour pains for pain relief choices during labour
What does an epidural involve?
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A cannula (fine plastic tube) will be put in a vein in your hand or arm. You will then need to sit up on the edge of the bed bending forwards, your back will be cleaned with an antiseptic solution.
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Your anaesthetist will inject local anaesthetic into your skin, so that putting in the epidural is not usually sore. The epidural catheter is put into your back near your nerves in the spine. Your anaesthetist must be careful to avoid puncturing the bag of fluid that surrounds your spinal cord, as this may give you a headache afterwards. It is important to keep still whilst the epidural is being inserted.
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Once the epidural catheter is in place, you will be given local anaesthetic (pain relief medication) through it. It usually takes about 20 minutes to set up the epidural and 20 minutes for it to give pain relief. While the epidural is starting to work, your midwife will take your blood pressure regularly. Your anaesthetist will usually check that the epidural pain relief is working on the right nerves by putting an ice cube or cold spray on your tummy and legs and asking you how cold it feels. Sometimes, the epidural doesn’t work well at first and your anaesthetist needs to adjust it, or even take the epidural catheter out and put it in again.
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During labour, you will have pain relief through the epidural catheter to keep you comfortable.
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It is usually possible to reduce the pain of labour without making the lower part of your body very numb or making your legs feel weak, but this varies from person to person.
| Type of risk | How often does this happen? | How common is it? |
|---|---|---|
| Significant drop in blood pressure | 1 in 50 | Occasional |
| Not working well enough (additional pain relief required) | 1 in 8 | Common |
| Not working well enough for C-section (other anaesthetic required) | 1 in 20 | Sometimes |
| Severe headache | 1 in 100 | Uncommon |
| Nerve damage |
Temporary 1 in 1000 Permanent 1 in 13,000 |
Rare Rare |
|
Epidural abscess (infection) Meningitis Epidural haematoma (blood clot) |
1 in 50,000 1 in 100,000 1 in 170,000 |
Very rare Very rare Very rare |
| Accidental unconsciousness | 1 in every 100,000 | Very rare |
| Severe injury, including being paralysed | 1 in every 250,000 | Extremely rare |
Further help and support:
Bereavement Midwives
Office: 01752 433148
Email: plh-tr.bereavementmidwives@nhs.net
SANDS (Stillbirth and Neonatal Death Charity)
Telephone Helpline: 0808 164 3332
Email: helpline@sands.org.uk
Visit SANDS the Stillbirth and Neonatal Death Charity
Miscarriage Association
Visit the miscarriage association
Pregnancy Crisis Care
References
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Pain relief in labour. Obstetric Anaesthetists Association. Go to Labour pains organisation.
