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What is the issue? To assess the effects of water immersion (waterbirth) during labour and/or birth (first, second and third stage of labour) on women and their infants. Why is this important? Many women choose to labour and give birth in water (water immersion) and this practice is becoming more popular in many countries, particularly in midwifery-led units.

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It's natural to feel worried about the pain of labour, especially if you haven't given birth before or previously experienced a painful labour without the right support to help you cope.
Reading up on your options in advance can help you feel more in control, but remember that it's always a good idea to talk to your midwife or consultant doctor if you feel very anxious at the thought of giving birth.

We explain the different pain relief options, as well as the advantages and disadvantages of each method.

Gas and air (entonox)

Entonox, also known as gas and air or laughing gas, is an odourless mixture of nitrous oxide and oxygen which is inhaled using a mouthpiece. It's the most popular type of pain relief and works by temporarily reducing the pain you're experiencing without blocking it altogether.

Pros

You're in control of how you use it: you can take it as often and for how long as you like and hold the mouthpiece yourself.

It's safe for you and your baby: you don't need any extra monitoring while you're using gas and air and no side effects have been reported in babies of mothers who use gas and air.

It can be used alongside other pain relief methods: if you're using natural pain relief methods, there's nothing to stop you using gas and air as well. Many women also find it helpful to use gas and air when having an epidural administered.

The effects stop quickly if you stop taking it: if you don't like the feeling of using gas and air or find that it doesn't help you manage the pain, you can stop taking it immediately and the effects don't last.

Cons

There are no lasting side effects associated with using gas and air, but some women find that it causes them short-term discomforts.

You may become disoriented, sleepy or confused: this is a common effect of entonox, especially if you inhale too much of it.

Feeling nauseous: some women find that entonox makes them feel queasy or actually makes them vomit.

Dry lips, mouth and throat: a lot of women find that the gas and air makes them very dry in the mouth. You can try to counter this by packing lip balm in your hospital bag and taking frequent sips of water during labour.

The pain relief effect is mild: while some women find it a helpful method of coping with pain on its own, many others do not find it effective enough and go on to use other methods.

Epidural

This is powerful and popular form of pain relief where a local anaesthetic is injected into part of your spine to temporarily numb the nerves carrying pain messages.

Pros

Very effective pain relief: an epidural gives very good relief from the pain of contractions. This may also help you to relax which in itself can help your baby to be born as your pelvis will be more relaxed.

No drowsiness or disorientation: an epidural only numbs you from the waist down, so you won't feel anything other than the usual tiredness from labour.

You can still stand and move around: If you have a mobile epidural, you should still be able to sense touch and feel your baby being born even though you won't feel pain

Cons

Your labour might slow down: although you're still able to push, you can stop feeling the urge to do so which can slow your labour down.

Increased chance of interventions: if you have an epidural you may have an increased chance of having an assisted delivery such as a forceps or ventouse delivery than if using opioids. However, this effect has not been seen in studies comparing the different pain relief methods since 2005.

Headaches: about 1% of women experience a severe headache following an epidural, which can last for days if not treated.

A catheter in your bladder: your loss of feeling can mean that you don't feel when your bladder is full. If this happens you'll have a thin tube called a catheter inserted into your bladder, which allows your urine to drain into a bag.

Loss of mobility: even though many epidurals now use a combination of drugs to help keep you mobile, your legs might still become a bit wobbly or weak. This can make it harder to stay upright and walk around throughout labour.

Pain-relieving drugs

There are a number of different opioids which can help ease labour pains, here are the most common ones you may come across:

Pethidine: This is a drug similar to morphine which is given by injection. It can help you relax and be less bothered by the pain of contractions, although some women also feel drowsy, disoriented or out of control. Your baby's breathing can be affected by pethidine, particularly if the birth happens soon after the injection was given. For this reason, it's best not to have pethidine too close to the baby's birth.

Diamorphine: Diamorphine is a purified version of heroin that can be safely used in the right doses. It can be a more powerful pain killer than pethidine, but it can also have a negative effect your baby's breathing.

Meptid: This is a similar drug to diamorphine which is less likely to have side effects for the baby, but it can cause more nausea and vomiting for you.

Oramorph: This is a liquid solution or tablets of morphine sulphate which can be used in early labour to help you rest and preserve your energy. Some women go home to rest after taking it rather than staying in the maternity unit.

Remifentanil: Remifentanil is a strong opioid drug that can be used instead of an epidural. It is given via a drip in your hand or arm, which is connected to a pump that you control yourself. Unlike pethidine, remifentanil starts working very quickly, and also the effects wear off quickly.

Natural pain relief and self-help methods

Natural or non-medical methods, like being immersed in water, relaxation techniques, massage, aromatherapy and acupuncture, can help you cope with the pain of labour with few or no side effects.

Pros

They can be used in any birth setting. Wherever you're planning to give birth, you can use methods like massage, breathing techniques and different positions to help you cope. Many women also find that relaxation techniques like hypnobirthing are useful during a c-section.

They can be used alongside other pain relief. You can combine different types of natural pain relief, or switch between them as your labour progresses. You can also use them alongside medical pain relief if you want.

They won't interfere with your labour or baby. Some types of medical pain relief, like epidurals, can slow your labour down while others, like certain opioid drugs, can make your baby more sleepy after birth. With natural pain relief methods, that's not a concern.

You can prepare in advance. Medical pain relief is in the hands of your health professionals, but most types of natural pain relief you can plan and have ready in advance of the birth, which can help you feel more prepared and relaxed.

Cons

While there aren't the same side effects of certain medical pain relief options to worry about when using natural methods, there are some potential disadvantages to consider:

They don't remove the pain. Natural methods can help you cope with the pain of the contractions, but they don't remove the pain itself, unlike medical options like epidurals or opioid drugs.

You won't know how effective they will be. You may find that the methods you've chosen are not as effective as you had hoped once you go into labour. There's not really a way to know that in advance, as the experience of using these forms of pain relief vary a lot between different women.

You may have to transfer to have medical pain relief. If you're planning a natural birth at home or in a birth centre but find that the pain is too much to handle, you'll have to transfer to a labour ward to have an epidural or stronger drugs.

What pain relief will I have access to?

Every maternity unit has access to different types of pain relief, so it's always best to ask your midwife or consultant what's available where you're planning to give birth.

However, epidurals can only ever be given on the so won't be available if you're planning to give or in a .

Here is a quick overview of which pain relief options are available in different birth settings:

Coronavirus update

There's no evidence to suggest that women with suspected or confirmed coronavirus can't have an epidural or spinal block to help them deal with the pain of labour.

Previous guidance from the Royal College of Obstetricians and Gynaecologists suggested that the use of Entonox (gas and air) may increase aerolisation - when particles are dispersed in the air in a fine mist - and spread of the virus.

However, a review of the evidence suggests that there is no evidence that Entonox is an aerosol-prone procedure so there's no reason you cannot use it in labour.

When you're in early labour, your maternity team will discuss pain relief options with you.

Page last updated 02/03/2021. Please check out Royal College of Obstetricians and Gynaecologists for any more recent updates.

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It's natural to feel worried about the pain of labour, especially if you haven't given birth before or previously experienced a painful labour without the right support to help you cope.

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If you're wondering if a more natural pain relief is for you during labour, find out what a hit of Entonox will do for you

Entonox, also known as gas and air, is the most popular pain relief during labour with around 80 per cent of women choosing to use it. They must be on to something, right?

What is Entonox?
Entonox is an odourless gas made up of half oxygen and half nitrous oxide that will provide you with good pain relief during labour. It's also known as laughing gas, and it has a calming effect that will help you cope with contractions. You inhale it through a mouthpiece, or a mask, which you will be in control of throughout your labour.

When would you use it?
You can use gas and air whenever you want once you are in labour. Gas and air is easy to use. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly until you feel slightly light headed then take it away.

Biting down on the mouthpiece can also help you cope with the pain of contractions. After a few seconds you'll feel normal again.

Why you should choose Entonox?

You can have gas and air when, and as much, as you want during labour.

It is a fast-acting way of relieving your labour pains.

It's completely safe for your baby and the extra oxygen you breathe in can actually be good for you and your baby.

You are completely in control of when you use it.

It won't stay in your system. As soon as you stop breathing it in, it's cleared by your lungs and any side-effects you might feel will stop.

If you want to feel your birth, and know when to push, gas and air will take the edge of your pains rather than blocking it out completely.

Why might Entonox not be for you?

It is quite a mild pain relief, compared with epidural, and you may find you want something stronger

It can cause you to feel drowsy and sick, and make your mouth feel dry if you use it for long periods of time

It takes around 30 seconds of breathing for the gas and air to get into your system so it might take you a while to get the timing right so that it's effective at the peak of your contractions.

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Natural Pain Relief: Is Gas And Air Your Best Option In Labour?

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If you're wondering if a more natural pain relief is for you during labour, find out what a hit of Entonox will do for you Entonox, also known as gas and air, is the most popular pain relief during labour with around 80 per cent of women choosing to use it.

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tens machine hire for pain relief during labour - babycareTENS.com

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TENS machine hire pain relief experts for expecting mothers

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