Pain Management Options for Labour
Pain relief in labour is your choice. It is important that during the pregnancy, you are informed about what
options are available.
Non-pharmcological/Natural Methods
Most of the “natural” methods of coping during labour involve relaxation and a degree of distraction. Here is a list
of different methods that may be helpful, often the methods are combined. The effectiveness of each comfort measure
and relaxation technique will vary between people, births, and the course of any labour.
Relaxation and Breathing: There are many books, videos, and prenatal classes available that can help to teach you
relaxation techniques and breathing exercises. These can be very helpful during labour to help you remain calm and
relaxed. Having the ability to remain calm and relaxed can help lead to a shorter and more progressive labour. Many
people find that self-hypnosis can help during labour. The disadvantage to these methods is that sometimes even with
adequate practice and training it is still difficult to cope with certain stages of labour.
Massage: Massage and touch can provide comfort and encourage relaxation. Examples of helpful massage include
firm pressure on the lower back and shoulder, as well as foot massage.
Hydrotherapy: Studies have shown that immersion in water (having a bath) can reduce the need for pharmacological
pain relief during labour and may shorten the labour. Standing in the shower during labour and directing the water on
your belly or back can also provide relief during labour and uses gravity to aid progress in labour
Staying Active: It is recommended that you move around and change positions frequently when in active labour.
Suggested positions are walking, standing and swaying, standing and leaning over a bed/table, sitting on birth ball,
side lying, sitting on the toilet, standing with one foot up on chair to create a lunge. Changing positions and using
upright positions that utilize gravity can help to encourage normal progress in labour, can increase your ability to
cope with labour and can help baby to move into a favourable position in the pelvis.
Labour Support: Labour support is the close, continuous presence of a person trained in providing emotional and
physical support and encouragement throughout labour and birth. Some studies have demonstrated that if a labouring
person has a trained support person with them, there is a decreased need for pain relief, it encourages normal progress,
and may increase your sense of satisfaction with your birth.
Acupuncture/Acupressure: Some studies have demonstrated that acupuncture or acupressure may help relieve labour pain.
TENS machine (Transcutaneous electrical nerve stimulation): This is a non-invasive therapy provided by a battery-powered
unit which sends electrical impulses through electrodes placed on the body. The electrical current causes a tingling sensation thought to stimulate the body’s production of endorphins and distracts you from the pain of contractions. The machine is
turned on during the contractions and then paused between contractions. A TENS unit can be rented at most Shoppers Home Health care stores and other medical supply stores.
Subcutaneous Sterile Water injections: This method involves injecting sterile water into four sites over the lower back and
has been found to relieve back pain in the first stage of labour.
Pharmacological Pain Relief Methods/ Medications Available
Nitronox (“laughing gas”): This is a mix of 50/50 oxygen and nitrous oxide. Patients self-administer with a mask
and can be used during contractions in the first stage of labour to provide pain relief. The gas is inhaled during contractions. Compared to a placebo in a study that was conducted, the nitronox provided consistent and moderate pain relief and
50% of the people in the study reported significant pain relief. Nitrous oxide can cause nausea, dizziness and sometimes
can affect the memory of the labour.
Narcotics: Narcotics, opioid drugs like Demerol, Morphine, Fentanyl and Nubain, when offered during active labour may
help some people cope with labour pain and anxiety. Depending on the medication, and the stage of labour, it may be
given as an injection or through an IV. Narcotics do not provide complete pain relief but may allow some people to manage
their labour more comfortably. Pregnant people should be advised that receiving narcotics during the later stages of labour
can affect baby’s breathing and behaviour and may affect the baby’s ability to breast/chest feed immediately. Side effects
include sedation, nausea, vomiting, feeling itchy, may affect ability to remember the birth, and in high doses it can cause
breathing problems.
Epidural: The epidural is usually effective in providing adequate pain relief during labour. It can be administered during
active labour. A large study found that epidural analgesia was an effective form of pain relief, but that it increased the
chances of forceps or a vacuum delivery. There were no significant differences in caesarean births, patient satisfaction of
pain relief, long term back pain or Apgar scores. Epidurals have been shown to increase the length of the first and second
stage of labour.
It can take some time to prepare for an epidural. Your midwife needs to draw your routine bloodwork, start an I.V. and give
you fluids. They need to continuously monitor the baby to ensure they are coping well before getting the epidural, and the
midwife is required to call and consult with the Anaesthesiologist. Sometimes an Anaesthesiologist isn’t immediately
available immediately and you may need to wait.
Your midwife may recommend an epidural in certain situations. These may include long, nonprogressive labours, exhaustion and/or having difficulty coping, or for people who are having prolonged back labour. The possible side effects from an epidural include low blood pressure, spinal headache, failure of epidural to work, itchiness, fever, increased need for forceps or vacuum
if you are having your first baby, infection or hematoma (rare), nerve injury (very rare, 1;25,000 risk), or possible risk of drug
toxicity.
If you have an epidural, you need to stay in the hospital bed, but you can often change positions. We keep the external fetal
monitor on to continuously monitor your contraction pattern and baby’s heart rate, and a urinary catheter will be put in to
keep your bladder empty.
For more information on pain relief in labour, talk to your midwife or visit
https://www.pregnancyinfo.ca/birth/labour/pain-management/
http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/PainManagementGuideline.pdf
Pain relief in labour is your choice. It is important that during the pregnancy, you are informed about what
options are available.
Non-pharmcological/Natural Methods
Most of the “natural” methods of coping during labour involve relaxation and a degree of distraction. Here is a list
of different methods that may be helpful, often the methods are combined. The effectiveness of each comfort measure
and relaxation technique will vary between people, births, and the course of any labour.
Relaxation and Breathing: There are many books, videos, and prenatal classes available that can help to teach you
relaxation techniques and breathing exercises. These can be very helpful during labour to help you remain calm and
relaxed. Having the ability to remain calm and relaxed can help lead to a shorter and more progressive labour. Many
people find that self-hypnosis can help during labour. The disadvantage to these methods is that sometimes even with
adequate practice and training it is still difficult to cope with certain stages of labour.
Massage: Massage and touch can provide comfort and encourage relaxation. Examples of helpful massage include
firm pressure on the lower back and shoulder, as well as foot massage.
Hydrotherapy: Studies have shown that immersion in water (having a bath) can reduce the need for pharmacological
pain relief during labour and may shorten the labour. Standing in the shower during labour and directing the water on
your belly or back can also provide relief during labour and uses gravity to aid progress in labour
Staying Active: It is recommended that you move around and change positions frequently when in active labour.
Suggested positions are walking, standing and swaying, standing and leaning over a bed/table, sitting on birth ball,
side lying, sitting on the toilet, standing with one foot up on chair to create a lunge. Changing positions and using
upright positions that utilize gravity can help to encourage normal progress in labour, can increase your ability to
cope with labour and can help baby to move into a favourable position in the pelvis.
Labour Support: Labour support is the close, continuous presence of a person trained in providing emotional and
physical support and encouragement throughout labour and birth. Some studies have demonstrated that if a labouring
person has a trained support person with them, there is a decreased need for pain relief, it encourages normal progress,
and may increase your sense of satisfaction with your birth.
Acupuncture/Acupressure: Some studies have demonstrated that acupuncture or acupressure may help relieve labour pain.
TENS machine (Transcutaneous electrical nerve stimulation): This is a non-invasive therapy provided by a battery-powered
unit which sends electrical impulses through electrodes placed on the body. The electrical current causes a tingling sensation thought to stimulate the body’s production of endorphins and distracts you from the pain of contractions. The machine is
turned on during the contractions and then paused between contractions. A TENS unit can be rented at most Shoppers Home Health care stores and other medical supply stores.
Subcutaneous Sterile Water injections: This method involves injecting sterile water into four sites over the lower back and
has been found to relieve back pain in the first stage of labour.
Pharmacological Pain Relief Methods/ Medications Available
Nitronox (“laughing gas”): This is a mix of 50/50 oxygen and nitrous oxide. Patients self-administer with a mask
and can be used during contractions in the first stage of labour to provide pain relief. The gas is inhaled during contractions. Compared to a placebo in a study that was conducted, the nitronox provided consistent and moderate pain relief and
50% of the people in the study reported significant pain relief. Nitrous oxide can cause nausea, dizziness and sometimes
can affect the memory of the labour.
Narcotics: Narcotics, opioid drugs like Demerol, Morphine, Fentanyl and Nubain, when offered during active labour may
help some people cope with labour pain and anxiety. Depending on the medication, and the stage of labour, it may be
given as an injection or through an IV. Narcotics do not provide complete pain relief but may allow some people to manage
their labour more comfortably. Pregnant people should be advised that receiving narcotics during the later stages of labour
can affect baby’s breathing and behaviour and may affect the baby’s ability to breast/chest feed immediately. Side effects
include sedation, nausea, vomiting, feeling itchy, may affect ability to remember the birth, and in high doses it can cause
breathing problems.
Epidural: The epidural is usually effective in providing adequate pain relief during labour. It can be administered during
active labour. A large study found that epidural analgesia was an effective form of pain relief, but that it increased the
chances of forceps or a vacuum delivery. There were no significant differences in caesarean births, patient satisfaction of
pain relief, long term back pain or Apgar scores. Epidurals have been shown to increase the length of the first and second
stage of labour.
It can take some time to prepare for an epidural. Your midwife needs to draw your routine bloodwork, start an I.V. and give
you fluids. They need to continuously monitor the baby to ensure they are coping well before getting the epidural, and the
midwife is required to call and consult with the Anaesthesiologist. Sometimes an Anaesthesiologist isn’t immediately
available immediately and you may need to wait.
Your midwife may recommend an epidural in certain situations. These may include long, nonprogressive labours, exhaustion and/or having difficulty coping, or for people who are having prolonged back labour. The possible side effects from an epidural include low blood pressure, spinal headache, failure of epidural to work, itchiness, fever, increased need for forceps or vacuum
if you are having your first baby, infection or hematoma (rare), nerve injury (very rare, 1;25,000 risk), or possible risk of drug
toxicity.
If you have an epidural, you need to stay in the hospital bed, but you can often change positions. We keep the external fetal
monitor on to continuously monitor your contraction pattern and baby’s heart rate, and a urinary catheter will be put in to
keep your bladder empty.
For more information on pain relief in labour, talk to your midwife or visit
https://www.pregnancyinfo.ca/birth/labour/pain-management/
http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/PainManagementGuideline.pdf
