Pain Management in Labour: What Are Your Options?
A straightforward guide to understanding your options and writing your birth preferences
Pain in labour is something lots of people feel nervous about.
And that makes complete sense. If you have not experienced labour before, it can feel really hard to imagine what it might be like, what you might want, or what support you might need.
One of the biggest myths around birth is that there is a “right” way to manage pain.
There isn’t.
Some people want to use breathing, movement and water for as long as possible. Some people know they would like an epidural. Some people change their mind during labour. Some people use a mixture of different options.
All of that is okay.
Pain management in labour is not about proving anything. It is about understanding what is available, knowing the benefits and considerations of each option, and feeling able to make decisions that are right for you at the time.
Why it helps to know your options
Labour can feel intense, and it is much harder to take in new information when you are already in the middle of it.
That is why learning about pain management before labour can be so helpful.
It gives you time to think about:
what might help you feel calm
what options may be available where you give birth
what you feel comfortable trying
what you would like your birth partner to know
what questions you might want to ask your maternity team
It can also help when writing your birth preferences.
Your birth preferences are not a fixed plan. They are a way of communicating what matters to you.
For example, you might write that you would like to try water, movement or breathing first. You might want to know more about gas and air. You might want an epidural as soon as it is available. You might want your birth partner to remind you of your options if you feel overwhelmed.
There is no right or wrong answer.
The aim is not to predict exactly what will happen. The aim is to help you feel more informed and supported if decisions need to be made.
Breathing techniques
Breathing is one of the first things many people think about when it comes to labour.
It is not about doing one perfect breathing pattern. It is about using your breath to help you stay calm, focused and grounded.
Breathing techniques can help you work with contractions, reduce tension in your body and give your birth partner something practical to support you with.
Some people find breathing really helpful throughout labour. Others find it helpful in early labour but want other options later on.
Both are completely normal.
Movement and positions
Your position can make a big difference to how you feel in labour.
Being upright, leaning forward, using a birth ball, kneeling, rocking, swaying or changing position can all help some people feel more comfortable.
Movement may also help your baby move down and find a good position for birth.
You do not need to know exactly what position you will want. In labour, your body may naturally guide you. But knowing that you can move, change position and ask for support can be really reassuring.
Water
Water can be a lovely option for labour pain management.
Some people use a bath or shower in early labour. Others use a birth pool if one is available and suitable for them.
Warm water can feel calming and soothing. It may help you relax, soften tension and move more easily. The NHS describes water in labour as soothing and notes that it can make it easier to move around.
Not everyone will want water, and not everyone will be able to use a pool depending on where they give birth or what is happening in labour. But it is a useful option to know about and ask about in advance.
TENS machine
A TENS machine is a small device with sticky pads that go on your back. It sends small electrical pulses through the skin.
Some people find it helpful in early labour, especially for backache or lower back discomfort.
It is often something people hire or buy before labour, so it is worth looking into during pregnancy if you think it might be something you want to try.
The NHS says TENS has not been shown to be effective in active labour, when contractions are longer, stronger and more frequent, but some people still find it useful earlier on.
Gas and air
Gas and air, also called Entonox, is a mixture of oxygen and nitrous oxide that you breathe in through a mouthpiece or mask.
It does not usually remove pain completely, but it may help take the edge off contractions and give you something to focus on.
One of the benefits is that it works quickly and wears off quickly. Some people love it. Some people find it makes them feel light-headed or sick. Some people try it and decide it is not for them.
Again, that is why knowing your options is useful. You do not have to know in advance exactly what you will like.
Opioids
Opioid injections, such as pethidine or diamorphine, may be offered in some maternity settings.
They can help some people rest, especially if labour is long or they are feeling exhausted. They may make you feel drowsy, sick or a bit out of it, and they can sometimes affect the baby for a short time after birth depending on when they are given.
Availability can vary depending on where you give birth, so this is something worth asking your midwife about.
If opioids are something you might consider, you can include that in your birth preferences. You could also note whether you would like to be told about the possible effects before deciding in labour.
Sterile water injections
Sterile water injections are a pain management option that some people have not heard of.
They may be offered for back pain in labour. Small amounts of sterile water are injected into the skin or just under the skin in the lower back.
They can sting at first, but some people find they help with labour back pain.
NICE recommends considering sterile water injections for women in labour with back pain, and says they can provide relief from around 10 minutes after the injection for up to 3 hours, although there may be an initial stinging sensation.
They are not usually described as an option for all labour pain, but specifically for back pain in labour. NICE’s evidence review notes that the evidence of benefit was mainly for back pain, which is why the recommendation focuses on back pain rather than general labour pain.
Availability may vary, so it is worth asking your midwife or maternity unit whether sterile water injections are offered where you plan to give birth.
Epidural
An epidural is a form of regional anaesthesia. It involves placing a small tube into your back so medication can be given to numb the nerves carrying pain signals from the lower body.
For some people, an epidural is exactly what they want. For others, it is something they want to keep as an option if needed.
An epidural may be very effective for pain management, but it also comes with practical considerations, such as needing monitoring, having a drip, and usually staying on the bed. It may not be immediately available in all settings, especially if you are planning to give birth at home or in some birth centres.
If an epidural is important to you, it is worth checking what is available at your chosen place of birth.
What if I change my mind?
You are allowed to change your mind.
This is so important.
You might go into labour thinking you want one thing and then feel completely differently once labour starts. That does not mean you have failed. It means you are responding to what your body, your baby and your situation need at the time.
Birth preferences should be flexible. They are there to help guide conversations, not to trap you into decisions you made weeks earlier.
A helpful way to think about it is:
“What would I like to try first?”
“What would I like to know more about?”
“What would help me feel safe and supported if plans change?”
How pain management links with birth preferences
Pain management is a really useful section to include in your birth preferences.
You might want to include:
options you would like to try first
options you would prefer to avoid unless needed
whether you would like to be offered pain management options or prefer to ask
whether you want your birth partner involved in conversations
what helps you feel calm
whether you want support with breathing, movement or positions
whether you would like to know about sterile water injections if you have back pain
whether you would consider an epidural
anything that makes you feel anxious or unsupported
You do not need to write a perfect plan. You just need to communicate what matters to you.
And if you are not sure what matters to you yet, that is okay too. That is exactly why antenatal education can help.
Questions you can ask
Here are some useful questions to ask your midwife or maternity team:
What pain management options are available where I plan to give birth?
Is there a birth pool available?
Can I use a TENS machine?
Is gas and air available?
What opioid options are offered?
Are sterile water injections available for back pain in labour?
When would an epidural be available?
Would any of my options change if I am induced?
What happens if I start in one place of birth but want something only available elsewhere?
These questions can help you write birth preferences that are realistic for your chosen setting.
There is no prize for coping without support
This is something I really want parents to hear.
There is no prize for managing labour in one particular way.
Using breathing techniques does not make you better than someone who has an epidural.
Choosing an epidural does not mean you have done anything wrong.
Using several options does not mean your body has failed.
Pain management is personal. What matters is that you feel informed, respected and supported.
How Little Village Antenatal can help
At Little Village Antenatal, we talk through pain management in a calm, honest and non-judgemental way.
We look at practical options, medical options, what might be available in different birth settings, and how your birth partner can support you.
We also talk about how to use tools like BRAIN to ask questions and make informed decisions:
Benefits
Risks
Alternatives
Intuition
Nothing — what happens if we do nothing for now?
Understanding your options can help you feel more confident when writing your birth preferences and more prepared if plans change during labour.
Because every parent deserves to feel informed, supported and part of a village.
We Cover This in Our Antenatal Courses
Our courses are small, warm, and comprehensive, running from our base in Erith and serving families across Bexley, Dartford, Sidcup, Belvedere, and the wider Southeast London and Kent area. Partners are fully included throughout. We're FEDANT registered (National Register Entry Number: 13969).
View our upcoming course dates and book your place here.
Because the more you know, the calmer you'll be, and the calmer you are, the better labour tends to go.
This blog is for informational purposes only and does not replace the advice of your midwife or maternity team. If you are ever unsure whether you are in labour, or if you have any concerns at all about your health or your baby's wellbeing, always contact your maternity unit or midwife. In an emergency, call 999.