Your pain relief options in labour
Managing pain during your hypnobirthing birth
If you’re pregnant and your due date is getting closer, you might be feeling a little anxious about giving birth, of course you are, it’s a new thing, right?. It’s the big unknown that’s daunting, what will it feel like? Will it be painful? How will I cope? These feelings are all normal. We’ve all had our friends, relatives, or sister’s boyfriend's third cousin tell us their unwelcomed horror stories, cheers for that! So let's talk about some of the things that you can do to manage pain, or pressure, as we like to call it, during labour.
Reframing pain
In hypnobirthing, we avoid the use of the word pain and instead refer to the power or pressure of your surges (contractions). This isn’t because we’re trivialising what you might be feeling, but because ‘pain’ during labour is very different to pain you might have experienced up until this point. Typically, pain is a negative thing. You feel it when you’re hurt, it indicates a threat and it sends a message to your brain to say stop! However, in labour, the sensation you are feeling is an indication that your body is doing what it needs to, to birth your baby - it’s normal and purposeful. It’s a powerful, strong sensation, your uterus muscles are contracting and your cervix is dilating. You need to work with this feeling, rather than fight against it - which is counter to everything you’ve been taught about pain until now! For example, if you burn yourself, you need to flinch and get away from that pain - that's normal and a helpful reaction to the pain you feel. During labour, you need to use techniques to work with your body and actually just allow your body to get on with the job at hand. So it can be helpful to replace the word pain with pressure and think about how powerful a surge is, it just makes it feel less threatening and will stop your brain freaking out and searching for pain! You can write this on your birth preferences and ask your midwives to ask about the strength of the pressure or ‘how comfortable are you?’ rather than the level of pain.
So how can we work with that pressure, to help your body progress through labour as it becomes more powerful?
Know your options
It’s important to know your pain relief options before you go into labour, it’s also helpful to think of them as ‘comfort measures’, sounds a lot more appealing, so that you’re prepared to make choices that suit you. We like to think of the metaphor of different pain relief options being like a ladder. At the bottom, you have non-pharmacological or natural pain relief options and if your needs build, you can climb the ladder to consider different medical pain relief that will have stronger impacts on you. Some people stay at the bottom of the ladder and manage the pressure of labour with breathing and other natural methods and some want to take options higher up the ladder. It’s important to remember that there is no right or wrong, there’s simply what’s best for you and your labour. While you might have a preference for which options you would like to be offered, it can also help to keep your mind open as every labour is different.
So let’s start at the bottom of the ladder.
Natural pain management techniques
Natural pain relief management for labour is often referred to as non-medical pain relief because it offers exactly that, non medical methods you can use to relieve some of the pain and symptoms you feel during labour. These include things like: reflexology, using massage and heat, water immersion (either in a birthing pool, a bath or shower), relaxation, light touch massage, aromatherapy, acupuncture, TENS machines or using the practices you learn during hypnobirthing. That’s quite a hefty list of things that are super accessible!
Natural pain management methods are non-invasive and don’t involve the use of medications or medical interventions, therefore they can reduce the risk of side effects for both you and your baby. Natural pain relief methods can also provide asense of control during labour. By actively participating in your own pain management, you may feel empowered and more connected to your body. Lastly, these methods can be used in various birth settings, such as home births, birthingcentres, or hospitals, making them accessible options for you regardless of where you choose to give birth.
Types of natural pain management:
Hypnobirthing techniques
Hypnobirthing techniques are a great natural way to manage pain throughout labour. These are taught in our Hypnobirthing Pack in detail, but we have listed a few techniques below for you to try to begin with.
Hypnobirthing breathing techniques are amazing and can be used to help you breathe through your surges. There are different breathing techniques to be used in the two stages of labour. In the first stage, you should use up breathing and in the second stage, use down breathing. These are easy to master and you can use your pregnancy to practice them! You can also use surge timers, like the Freya app, to guide you through your breathing techniques all the way through labour.
Positive affirmations are a really powerful tool to help control your mindset throughout labour. Using phrases such as ‘My surges cannot be stronger than me because they are me’ really help to teach your mind that what your body is doing is absolutely normal and purposeful, helping you to stay relaxed and your body to do its thing. Remember, where your mind goes, your body will follow! You can get your own pack of affirmations here, or listen to them on the Freya app. Stick them around your birth room for little messages of positivity throughout labour too, this will also help to create a really lovely birthing environment.
Birth positions are also really important for comfort during labour. Move around and try out different positions, don’t feel compelled to lay on the bed and listen to your body! Remember this - U.F.O - upright, forward, open. Gravity is your friend in labour so you should always try to use it! You can find more about positions that might help you, including how to use a birth ball to get comfortable, on our Instagram page.
Massage/acupressure & heat
Massage and acupressure techniques can be amazing for managing pain during labour. Gentle and targeted touch can help relieve muscle tension, promote relaxation, and release endorphins, which, by the way, are natural pain suppressants and they hang around in your body, a real super hormone. Back massage, using circular motions or counter pressure can also be great especially if you’re experiencing pressure in your back. This can be really helpful if your baby is back to back.
Applying pressure to specific acupressure points, such as the webbing between the thumb and index finger or the lower back, can help relieve pain and promote relaxation, your midwife might be able to help with this.
Hot or cold compresses can also be used during massage or acupressure to provide additional pain relief. These techniques are a great way to get your birth partner or doula involved throughout your labour, though, of course, you can do this yourself too.Remember, physical touch from your partner can be super powerful on it’s own, it will make you feel comfortable and safe and keep that Oxytocin pumped up.
TENS machines
A TENS (Transcutaneous, Electronic, Nerve, Stimulation) machine is a small machine that is stuck to your back and sends tiny electrical pulses to block pain signals sent from your body to your brain. These are available in lots of midwife led units and labour wards too, but check first in case you need to bring your own. If you need to bring your own or are giving birth at home, you can hire or purchase them. You might even want to consider having one at home for use in early labour.
Some of the pros of using a TENS machine for labour are that you are in control of it yourself, it doesn’t affect your baby and you can use it alongside other pain relief options (though this excludes any water relief pain options because of the risk of electrocution). TENS machines don’t offer relief to everyone, so it’s a case of trying to see how this feels to you.
Waterbirth
Using water during labour can be a great way to relieve some of the pain and tension you feel during labour. Being in water, especially if it’s warm, helps with relaxation, reducing stress hormones and promoting the oxytocin you need to help your labour flow. It’s also lovely to feel weightless and be able to switch positions with ease and also get into that deep squat! In the early stages of labour, a warm shower or bath can help you too, especially if you’ve enjoyed these as part of your relaxation during pregnancy. Birth pools can be used at home, in a midwife-led unit or on labour ward - check how many are available in your local hospital. Lots more information on water births can be found here everything you need to know about water births here.
Types of medicated pain management
Gas & air (entonox)
The first rung on the ladder of medicated pain management during labour is gas and air. Gas and air is a mixture of oxygen and nitrous oxide gas. You breathe it in through a mouthpiece and it can be used throughout labour to relieve the pressure felt during your surges. Evidence suggests it is most effective during the early stages of labour, though experiences differ for everyone.
A great thing about gas and air is that it doesn't cross the placenta, so it doesn’t impact the baby. It's also available everywhere, including home births when your midwife attends. It also works super well with your up breathing!
Gas and Air can make you feel nauseous or light-headed and it’s definitely not for everyone but the effects wear off quickly so it’s worth a go!
There have been studies recently that show there is a potential impact on healthcareworkers that are exposed to gas and air without proper ventilation, so the use of it has been restricted in some places. Check with your midwife so you can understand if this impacts your NHS Trust. Read our blog here that details exactly what’s been going on.
Opioids - diamorphine or pethidine
The next rung on the medicated pain relief ladder are opioids, typically pethidine or diamorphine, which are injected into a muscle (usually into your thigh or arm). The effects of opioids are felt for 2-4 hours and are often used when labour is taking some time and the birthing person needs to rest as they make you feel relaxed and can even help you to sleep. It is said that they make the sensation of pain or pressure feel more distant.
The side effects of opioids can be drowsiness, nausea and vomiting. Opioids can also cross the placenta and so some babies born after the use of opioids can be drowsy, making them slow to feed and in rare cases have breathing difficulties. These impacts are short term, but something to be aware of.
Opioids are widely available and can be administered by midwives, so you will beable to have them in a hospital and maybe even some midwife-led units. Check withyour midwife if they are available for a home-birth, in some cases they are. If you take opioids, you will be advised not to labour in water as they can make you drowsy.
Read more about NHS guidelines of Pethidine here.
Epidural
Finally, at the top of the ladder is an epidural. An epidural is an injection of local anaesthetic that’s placed into your back. It numbs the nerves and prevents the pain impulses being sent to the brain. Most people report feeling complete pain relief with an epidural, which will numb your tummy, legs and possibly your chest.
Epidurals take about 30 minutes to be administered and for the pain relief to kick in. They need to be administered by an anaesthetist, so there can be a little wait to get to the top of the list. If you think you would like an epidural, it’s good to put this on your birth preferences so that your midwives can make sure they time it well. You don’t want it to kick in after you’ve given birth! The effects of an epidural will wear off after a few hours.
Epidurals can make you feel nauseous, lightheaded and itchy and they are likely to limit your movement, meaning you will need to lie down on a bed.
Epidurals are not available for home births because they need to be administered by an anaesthetist. There are some types of epidurals that are “mobile” which means you are able to walk around during labour - check with your hospital or midwife-led unit to see if these are available for you.
Writing your birth plan for pain relief options
Everyone is different and everyone’s labour is different. When it comes to writing your birth preferences, make sure you have a good understanding of the options available to you and are clear about what you would like to be offered during labour. You might want to be aware of the pain relief options but not be offered the ones that you would rather not take. Or, you might want to be really clear that you plan to have anepidural, so your midwives keep an eye on the timing of that. Speak to your birthpartner about this too, so they can protect your wishes and advocate for you. It’simportant for birth partners to understand what you might be feeling. You don’t wantthem to be panicking and demanding pain relief for you if it’s not what you want. We have a great birth preferences template that is free as part of the Hypnobirthing Pack.
Making decisions about which pain relief to accept
When considering your pain relief options, use the B.R.A.I.N framework to help you make informed decisions and navigate conversations with your healthcare providers.
B.R.A.I.N. stands for Benefits, Risk, Alternative, Instinct, Nothing.
In this case, the conversation would mean:
What are the Benefits of using this particular pain relief method?
What are the Risks of using it?
What is the Alternative?
What does my Instinct tell me?
What happens if I do Nothing (and don’t use it)?
Watch the video where Siobhan explains how to use the B.R.A.I.N framework
For more birth tips and to make your birth better check out The Hypnobirthing Pack