Pain Management Options During Labor: What Actually Helps

We ended up trying most of the options on this list during our own 36 hours, in a fairly deliberate order, which is partly why I wanted to write this one honestly rather than just listing pros and cons.

Gas and air (Entonox)

Gas and air is a mixture of oxygen and nitrous oxide, breathed in through a mouthpiece during contractions. It works within 15-20 seconds, won’t remove the pain entirely, but takes the edge off for many people. Side effects can include light-headedness, nausea, or drowsiness, and you can stop using it at any point if it isn’t helping. This was our first step once oral induction doses had built up enough that we needed something more — it helped for a while, and then stopped being quite enough on its own.

Painkilling injections

Pethidine or diamorphine, given as an injection into the thigh or buttock, take about 20 minutes to start working and last 2-4 hours. They can cause wooziness or grogginess, and if given close to delivery, may affect the baby’s breathing or early feeding — something your midwife will factor into timing if you request one.

TENS machines

A TENS machine delivers a mild electrical current through pads placed on your back, which is thought to encourage your body to release its own natural painkillers. It’s most useful in early labour, particularly for lower back pain, and hasn’t been shown to do much once labour is well established. There are no known side effects for you or the baby, which makes it a reasonable option to try early even if you expect to need something stronger later.

Epidural

An epidural — local anaesthetic delivered by an anaesthetist into the space around your spinal cord — is generally the most effective pain relief option available. It takes about 10-15 minutes to become fully effective. It isn’t perfect: around 1 in 8 people need additional pain relief on top of it. Possible effects include heavy or immobile legs, the need for continuous monitoring, temporary difficulty urinating, and rarely, headaches. It’s also not available in every birth setting, so it’s worth checking in advance if it’s part of your plan.

What the evidence actually says about epidurals and labour length

This is worth addressing directly, because it’s one of the most commonly repeated claims about epidurals, and the real picture is more nuanced than either “epidurals definitely slow labour down” or “epidurals have no effect at all.” A large Cochrane review of over 11,000 births found the second stage of labour runs roughly 15 minutes longer, on average, with an epidural, and some individual studies have suggested the first stage may run somewhat longer too. Importantly, though, the same body of evidence found no increased risk of needing a C-section — the modest time difference doesn’t translate into worse outcomes for most people.

I’m including this because our own experience could easily be read the wrong way. During our labour, dilation stalled at 3cm after a series of epidural doses, and progress resumed after we declined a further dose later in the day. It felt, in the moment, like clear cause and effect. But one experience isn’t proof of a mechanism, and the wider research is genuinely more reassuring about epidurals than my gut instinct was that day. If you’re choosing whether to have one, I’d weigh the actual evidence over anecdotes like mine — including my own.

What actually happened for us

We used gas and air first, moved to an epidural once that stopped being enough, and later chose to stop further doses to see if that changed things — the fuller account, including how that decision played out, is here. I don’t think there’s a single “right” sequence; ours was shaped by how our particular labour was progressing, not a strategy I’d recommend copying exactly.

What I wish I’d known

I wish I’d known, going in, that it’s completely normal to combine or switch between these options over the course of a long labour, rather than picking one at the start and sticking with it. I also wish I’d had the research on epidurals and labour length in hand beforehand, so that when things stalled, I wasn’t drawing my own conclusions in the moment without the fuller picture.

Frequently asked questions

What’s the most effective pain relief option in labour?

An epidural is generally the most effective, though it doesn’t fully work for everyone and isn’t available in every birth setting. Gas and air, injections, and TENS are all reasonable options depending on your stage of labour and preferences.

Do epidurals really slow down labour?

The evidence suggests a modest effect — Cochrane data points to roughly 15 minutes longer in the second stage on average — but no increased risk of needing a C-section. It’s a smaller effect than commonly believed, and shouldn’t be the main factor in your decision.

Can I switch pain relief methods partway through labour?

Yes, and it’s common. Many people use gas and air early on and move to an epidural later, or combine methods as labour progresses.

Are there pain relief options with no side effects at all?

TENS machines have no known side effects for mother or baby, though they’re most useful in early labour rather than once labour is well established.

What if my epidural doesn’t fully work?

This happens for around 1 in 8 people. Tell your care team — they can often adjust the dose or position, or offer additional pain relief alongside it.

References

1. NHS — Pain relief in labour. nhs.uk
2. Evidence Based Birth — Effects of Epidurals on the Second Stage of Labor (summarizing Cochrane review data). evidencebasedbirth.com