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Pain Relief in Labor (Labour): Epidural and Other Options

From breathing and water to gas and air and epidurals: the choices and trade-offs.

Before you use this guide: This is general educational information, not an individual medical assessment. We do not identify a clinician reviewer on this page, so please confirm personal health decisions with your doctor, midwife or paediatrician.

Pain in labour is different for everyone. Some women manage with breathing and movement, while others choose medical pain relief. There is no right or wrong choice. The best plan is to learn about your options in advance, keep an open mind and decide what suits you as labour unfolds.

Non-medical ways to cope

• Relaxation and breathing: slow, deep breaths in and long breaths out, practised before labour, can help you stay calm. Hypnobirthing uses a similar approach.
• Movement and positions: walking, swaying, rocking on a birth ball, kneeling on all fours or leaning on your partner can ease pain and help the baby descend.
• Warm water: a bath or shower, or a birthing pool where available, is soothing for many women.
• Heat and cold: a hot water bottle or wheat bag on your back or a cold flannel on your forehead.
• Massage and touch: counterpressure on the lower back from a partner or doula can bring relief. See what a doula does.
• Music, dim lighting and a quiet environment help you feel safe and calm.
• TENS machine: a small device that sends gentle electrical pulses through pads on your back. It may help in early labour, and you start it early. It does not suit water use.
• Sterile water injections: small injections under the skin of the lower back can ease back pain for an hour or two, in some units.

Gas and air (nitrous oxide)

A mix of nitrous oxide and oxygen that you breathe through a mouthpiece or mask when a contraction starts. It takes the edge off pain rather than removing it.

• Works within seconds and wears off quickly, and you control it yourself
• Safe for you and your baby, and you can use it in a pool in some places
• May make you feel light-headed, sleepy or sick, and some people find it makes little difference
• Not widely available in all US hospitals, but increasingly offered

Opioids (such as pethidine or diamorphine)

Injected into the muscle, these medicines can take the edge off pain and help you rest.

• They can make you feel drowsy, sick or dizzy
• They can make the baby sleepy if given close to birth, which may affect breathing and feeding for a while. The team can reverse the effect if needed.
• They are usually not given late in the second stage. The choice varies by country.

Epidural

An epidural is the most effective form of pain relief. An anaesthetist places a thin tube in your lower back, and local anaesthetic (sometimes with a little opioid) is given continuously or when you need it. You will have a drip and a catheter, and your baby's heartbeat will be monitored.

• It takes about 10 to 20 minutes to place and works in around 15 to 30 minutes
• You stay awake and can feel pressure, though the pain is much reduced. Modern "mobile" or low-dose epidurals may let you move with help.
• It can lower your blood pressure, cause itching, make your legs feel heavy and make pushing harder. You may need help to push, such as forceps or a vacuum, and labour can be longer.
• A small number of women get a headache afterwards. Serious complications such as nerve damage or infection are rare.
• It does not harm your baby, and it does not cause long-term back pain.

Spinal and combined spinal-epidural

A spinal is a single injection used for a caesarean and sometimes for quick pain relief. A combined spinal-epidural gives fast relief, then continues as an epidural.

General anaesthetic

Used only in some emergencies when a caesarean must be done immediately, or if a spinal is not possible. You are asleep, and the baby is delivered quickly. See our caesarean birth guide.

Which option is best for you?

• Think about what matters to you, including how much you want to move around, how long labour may be and what is available at your hospital or birth centre.
• You can combine methods, such as breathing and movement first, then gas and air, then an epidural if you want it.
• You can change your mind at any time. Asking for pain relief is not a failure.
• At home or in a birth centre, your options may be more limited, as epidurals are available only in hospitals. See where to give birth.

Make a plan, but stay flexible

Talk to your midwife or doctor about the options in your hospital, share your thoughts with your birth partner and add your preferences to your birth plan. Labour can be unpredictable, so be ready to adapt.

Where to check current advice

Availability and practice differ by country and hospital, so ask your own team, and check the latest guidance from NICE and the NHS in the UK, the HSE in Ireland, ACOG in the US, the SOGC in Canada and RANZCOG in Australia.

This content is for general information only and is not medical advice. Every pregnancy and every baby is different. Always talk to your doctor, midwife or paediatrician about your own situation, and seek urgent care if you are worried.