36 week guide
Pain relief in labour
Labour pain is real, and there is no prize for coping in one particular way. Some patients want to stay as unmedicalized as possible. Others know they want stronger pain relief early. Many change course as labour unfolds.
This page continues the 36 week labour guide with a deeper look at coping without medication, when those approaches help most, and the medical options available if you want more effective pain relief.
Overview
Pain relief usually works best when you think in layers, not in one irreversible decision
Patients often feel less anxious once they know the first layer does not have to be the final layer. You may begin with movement and support, then add gas, medication, or an epidural later if labour asks more of you than expected.
First layer
Coping methods often work best before panic takes over
Breathing, reassurance, showers or baths in first stage, massage, movement, and a calm environment are not minor extras. They often reduce stress hormones and make contractions feel less overwhelming.
Middle layer
Some medical options take the edge off without fully numbing labour
Gas and air, opioids, or PCA may help you rest, focus, or cope better without producing the same effect as an epidural.
Most effective option
An epidural gives the strongest pain relief but changes how labour is managed
It is often the best option when labour is long, especially intense, induced, or becoming more medical, but it also means monitoring, reduced mobility, and a different second-stage conversation.
Coping without medication
These methods do not erase labour pain, but they often improve coping, control, and progress
Non-drug methods are often most effective when used early and combined rather than treated as one small extra. Open each method for the deeper explanation.
Continuous support and environment Whole labour
A steady support person often matters more than patients expect. Feeling safe lowers stress hormones and can help oxytocin work more smoothly.
What it is
Your partner, doula, midwife, or another supportive person staying with you, helping you breathe, sip water, change position, and feel less alone.
Why it helps
Lower stress often means less adrenaline, better coping, and sometimes a smoother labour pattern.
Good to know
This is useful across the whole labour, not only when pain starts feeling severe.
Movement and position changes All stages
Walking, leaning, rocking, kneeling, squatting, side-lying, or using a birth ball can make contractions feel more workable and may help the baby descend or rotate more efficiently.
Why it helps
Gravity, pelvic opening, and less muscle tension can all improve comfort and descent.
How it feels in practice
Walking between contractions, kneeling over the bed, rocking on a ball, or switching to side-lying if you are tired.
Limitations
Mobility becomes more limited if you have an epidural or if continuous monitoring is needed.
Massage, counter-pressure, and acupressure Especially good for back labour
Firm pressure or massage can reduce muscle tension and give some patients a much stronger sense of relief than they expected.
What it includes
Long massage strokes, pressure into the lower back or hips during contractions, or pressure at selected points like the hand or ankle.
Why it helps
Touch increases endorphins, reduces tension, and can make back labour much more bearable.
Limitations
Not everyone wants to be touched during contractions, and it works best when your support person knows what feels good to you.
Heat and cold Any stage
Warmth can relax tight muscles and cold can numb specific painful areas, reduce swelling, or interrupt a spiral of increasing discomfort.
Useful examples
A warm pack over the lower belly or back, a shower, or an ice pack pressed into the lower back.
Benefits
Low-cost, simple, and often easy to combine with other comfort measures.
Safety point
Protect the skin and avoid extreme temperatures.
Breathing, relaxation, and visualization Works well early and active labour
Slow, rhythmic breathing often reduces panic and helps you conserve energy. It does not need to look complicated to be effective.
Why it helps
Shallow, panicky breathing tends to increase tension and pain perception. Slower breathing settles your body.
How it looks
Breathing in through the nose, out through the mouth, and focusing on a word, image, or rhythm through contractions.
Limitations
It works best if you have practised it or at least discussed it before labour starts.
Warm bath or shower in first stage First stage only in my practice
Warm water can provide immediate relief in the first stage of labour by relaxing muscles, easing pressure, and making the body feel lighter. In my practice, this means a bath or shower for pain relief during labour, not planning to give birth in water.
What it is
A warm shower or a short bath during the first stage of labour to help with coping and pain relief.
Benefits
Many patients feel calmer quickly and some need less additional pain relief while warm water is helping.
Limitations
It is for first-stage pain relief rather than birth in water, and it may not be practical if closer monitoring is needed.
Music and distraction Any stage
For some patients, the right music or another distraction changes the emotional tone of labour more than expected and helps breathing stay steady.
What it can include
Playlists, affirmations, dim light, conversation, familiar sounds, or anything else that makes the environment feel steadier.
Benefits
It is personal, non-invasive, and easy to combine with other methods.
Limitations
Not everyone likes music in labour. Some prefer silence once contractions become intense.
Other complementary methods Selected situations
Some patients also use aromatherapy, hypnosis or self-hypnosis, or TENS in early labour. These are usually most helpful when they are familiar rather than brand new on the day.
Aromatherapy
Lavender, peppermint, or citrus may reduce anxiety when used safely and diluted appropriately in pregnancy.
Hypnosis
Often helps patients who have trained in it beforehand and respond well to structured relaxation.
TENS
A small device gives mild electrical impulses to the back and often helps most in early labour.
Medical options
There is no single right choice. The best option depends on the stage, intensity, and the wider labour picture
These summaries keep the practical questions front and centre: how strong is the pain relief, how much mobility do you keep, what are the trade-offs, and what does it mean for labour itself.
The scale below shows the usual strength of pain relief or analgesia, not which option is best or recommended.
Epidural or spinal analgesia Relief strength
This is the strongest pain relief available in labour. It is often the best fit when labour is especially long, induced, or intense, or if there is a good chance a more medical birth route may be needed.
Pros
- Strongest pain relief available.
- Can be topped up and adjusted.
- Safe for the baby.
- Can also be used if caesarean becomes necessary.
Cons
- Takes time to place and needs an anaesthetist.
- Requires monitoring and bed-based care.
- You cannot walk freely.
- May increase the chance of assisted birth by lengthening the second stage.
Rare but serious risks such as severe headache, infection, bleeding, or nerve injury should still be mentioned even though they are uncommon.
Systemic medicines (opioids) Relief strength
Opioids such as morphine, pethidine, or fentanyl are less invasive than an epidural and can be helpful when you need some rest or relief but do not need full regional analgesia.
Pros
- Easy to give and widely available.
- Can help you rest in early labour.
- Less invasive than an epidural.
Cons
- Does not remove pain completely.
- Can cause nausea, dizziness, drowsiness, and vomiting.
- Crosses the placenta, so the baby may be sleepy or slower to breathe at first.
- Less ideal if birth is close.
PCA (patient-controlled analgesia) Relief strength
With PCA, usually using remifentanil, you press a button to receive small doses yourself. It works quickly and can feel more flexible than injections.
Pros
- You remain in control of dosing.
- Relief begins within seconds.
- More flexible than single injections.
Cons
- Not as strong as an epidural.
- Needs one-to-one nursing and close monitoring.
- Can make you drowsy and may affect breathing.
Nitrous oxide (gas and air) Relief strength
Gas and air works fast, wears off quickly, and gives you direct control. It is often a useful middle step when you want something more than breathing and movement but do not want or need an epidural yet.
Pros
- Works quickly and wears off quickly.
- You control the mask.
- Safe for the baby.
- Can usually still be used while moving and changing position.
Cons
- Does not remove pain completely.
- May cause nausea, dizziness, or feeling out of it.
- Works best if timed properly with contractions.
Pudendal block Relief strength
This is a special-case local injection used late in labour. It is not for contraction pain through the whole labour.
When it is used
- For the end of labour, stitches, or assisted birth with forceps or vacuum.
Important limit
- It is not designed to manage contraction pain across labour as a whole.
Strongest relief
Epidural gives the most effective pain control, but with more monitoring and less mobility.
Most flexible middle option
Gas and air or opioids can be useful when you want some help without changing the whole labour setup.
If labour becomes more medical
PCA or epidural usually make more sense when labour is prolonged, induced, or there is a higher chance of assisted birth or caesarean.
If the route changes
Pain relief is also part of the backup-plan conversation
If labour slows, the baby needs closer monitoring, forceps or vacuum are discussed, or caesarean becomes the safer route, the pain-relief conversation changes with it.
A good labour plan leaves room for this. Epidural may become more useful, a local anaesthetic or pudendal block may be needed if assisted birth is part of the day, and spinal anaesthesia is usually used if a caesarean becomes necessary.
Assisted birth guide Caesarean section guide Vaginal birth guide
Frequently asked questions
Common pain-relief questions in labour
Do I have to decide on pain relief before labour starts?
No. Many patients begin with breathing, a warm shower or bath in first stage, movement, massage, and support, then add gas, medication, or an epidural later if labour becomes more intense or more prolonged.
Is an epidural the only strong pain-relief option?
An epidural gives the strongest pain relief overall, but PCA can also be quite effective in some settings. Opioids and gas are usually better thought of as moderate or partial relief rather than full pain control.
Will an epidural make me more likely to need a caesarean?
Not necessarily. Epidurals do not appear to increase caesarean rates overall, but they can lengthen the second stage and may increase the chance of assisted birth in some labours.
Can I still move if I use gas and air?
Usually yes. Gas and air wears off quickly and most patients can still move and change positions while using it.
Are opioid injections bad for the baby?
They can cross the placenta, so the baby may be sleepier or slower to breathe at first, especially if birth happens soon after the dose. That is one reason they are used more carefully if delivery seems close.
Can non-drug methods really help if labour is very painful?
Yes, but often as part of a combination rather than as a magic solution. They can reduce panic, improve coping, and make contractions feel more manageable even if you later choose medication as well.
Next steps
The best pain-relief plan is usually informed and flexible
Patients often feel less anxious once they know they are allowed to change course. A useful antenatal conversation is not about proving how you will cope. It is about knowing what help is available and when it makes sense to ask for it.