Your Ultimate Birth Toolkit: 16 Powerful Pain Relief Options
Updated: Sep 30
Worrying about pain during labour is really common, as a doula and hypnobirthing specialist this is something women and birthing people share with me all the time, anticipatory anxiety is real.
The aim of pain relief in labour is to help you feel as relaxed as possible. When you are relaxed, your body can work effectively and efficiently to birth your baby.
This guide lists 16 pain relief options for labour and birth. I also explain what's going on in your body during labour, as well as the difference between physiological pain - e.g. sensations from a labour that starts and continues naturally, without being medically started (induced) or sped up (augmented), and non-physiological pain e.g. from a broken leg, tooth extraction or induced labour.
Sounds complex? Trust me, it'll all make sense in the end...When you understand how your body works, and what your choices are, you can feel more confident and empowered approaching your birth.
So, let's get into it...
Glossery of terms
Physiological labour sensations: sensations from a labour that starts spontaneously without assistance from medical drugs or interventions to start or speed up the process e.g. induction or augmentation.
Induction:
Augmentation:
What is Labour Pain?
On a biological level, the 'pain' or 'sensations' experienced during labour and birth are the result your uterus (womb) muscles contracting or working hard to squeeze your baby down through your pelvis and out of your vagina. Physiological labour pain is a unique feeling because while you're having a contraction it can feel intense, however, once the contraction has passed there is a break in the sensations and time for rest. FYI there is more time spent resting during a physiological labour than contracting.
Physiological labour is a delicate hormonal process. It is started and powered by the love hormone oxytocin. Natural oxytocin is created in the brain and can make you feel fuzzy headed or 'high', sleepy and distort your perception of time - all excellent during labour. When you have high levels of natural oxytocin circulating your body, you also have high levels beta-endorphins - your body's natural pain killer - which are many times more powerful than morphine. (read more about these amazing hormones here). The combination of these hormones working together, along with the uterus muscles having enough oxygen, blood flow and fuel (food and hydration), results in your powerful uterus muscles contracting effectively and efficiently to birth your baby. More oxytocin means more pain-killing beta-endorphins making labour more comfortable.
Oxytocin: the birth super hormone
Natural oxytocin is a shy hormone and your mind and body need to feel safe, unobserved and supported to release it. If you feel threatened, scared or observed by a stranger, your body will release another hormone called adrenaline. Adrenaline is the 'fight or flight' hormone and an oxytocin inhibitor. High adrenaline = less oxytocin and beta-endorphins circulating your body, resulting in contractions feeling more intense or painful, as well as being less efficient and more spread out, making labour longer.
Fundamentally, you need to feel as safe and relaxed as possible durning labour to release as much oxytocin as possible. Understanding this hormonal process is really useful to helping you manage labour pain or sensations.
“Labour pain is different from pathological pain experiences, such as having a tooth extracted. It is functional, purposeful and productive pain that brings a woman closer to meeting her baby” (1. Whitburn et al. 2019)
Is Labour and Birth Always Painful?
Everyone has different pain thresholds and experiences labour 'pain' or 'sensations' uniquely. Some women and birthing people report feeling very intense pain while others describe experiencing birth in an orgasmic way.
"I could feel incredible intensity and powerful sensations throughout my entire being, which I fully embraced, but experienced no 'pain' at all" Marie Molloy (3. Hill, M. 2022 p 73)
Midwife Dr Rachel Reed explains when you understand what the pain / sensations you're experiencing is doing e.g. working your muscles to birth your baby, why it is there and how you can help your muscles work effectively and efficiently e.g. boosting oxytocin and relaxation, this can be really powerful in helping reduce your pain perception.
"Reframing labour pain as productive and having an acceptance for birth pain, working with it using non-medical comfort measures that reduce pain and assist with relaxation can, according to research, reduce pain perception." (2. Reed R, 2021, Childbirth as a Rite of Passage, p101)
Multiple studies reflect the benefits of relaxation to pain perception and birth experiences...
“Skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain.” Leutenegger, V et al, 2022, BMC Pregnancy & Childbirth, 10 Studies reviewed
“HypnoBirthing is associated with a significant reduction in the use of epidural analgesia, greater use of water immersion, and decreased odds of caesarean section. Our study suggests that the use of HypnoBirthing during labour can further support women's aspirations to avoid pharmacological analgesia and achieve an unassisted vaginal birth." Lee et al 2026, National Library of Medicine
Dr Reed also explains "contractions or surges from an induced labour are not physiological and are more likely to require pain medication". (Reed R, 2021, Childbirth as a Rite of Passage, p102) this is because induction, by chemical or mechanical methods, works differently on the body to physiological labour and can alter the delicate hormonal process required to birth your baby.
If you do decide induction of labour is right for you, after reading this guide you'll know many of the pain relief choices available to you and how you can optimise your birth experience.
It's also helpful to understand that pain is information. If the sensations you're feeling are overwhelming and unmanageable, use this as information to change position or choose a new comfort measure.
What Are My Labour Pain Relief Options?
You have loads of options for pain relief in labour and birth, 16 are listed in this guide. Many non-medical pain relief options have studies to show their efficacy. Some of the options listed below are only available in a hospital setting and need to be administered by an anaesthetist or midwife. Many can be used in all birth settings, including at home, and can be used simultaneously for maximum comfort.
Medical Labour Pain Relief Options:
Non-Medical Labour Pain Relief Options:
Medical Labour Pain Relief Options:
Entonox (Gas and Air):
Entonox, commonly known as "gas and air" or "laughing gas", is a mixture of nitrous oxide and oxygen. It is inhaled through a handheld mouthpiece. Gas and air doesn’t remove pain but can ‘take the edge off’. It takes about 15 – 20 seconds to work so it’s best to start inhaling the gas at the beginning, and for the duration of a contraction, for maximum effect.
Gas and air enters and leaves the body quickly, meaning you're in control of when you use it. There are no harmful side effects to your baby as it doesn't cross the placenta. Entonox may make you feel lightheaded, sleepy or unable to concentrate. Some people find it makes them feel nauseous and can cause vomiting. If you do feel nauseous you can stop using it and the effects will quickly wear off once you start breathing fresh air again.
Gas and air can be used for comfort at home birth, hospital birth or alongside using a birth pool. As well as after birth for pain relief if you require any stitches for perineal tearing.
Paracetamol:
Taking paracetamol is often recommended to manage sensations in early labour. It's worth understanding that paracetamol is also known to inhibit prostaglandin synthesis. Prostaglandin is the hormone that softens and opens the cervix, helping labour establish. Therefore taking paracetamol may help with pain management and make you feel more relaxed, but it also may slow early labour down.
Opioid Drugs:
Opioid drugs don’t remove pain altogether, they alter your state of couscous making you feel ‘out of it’ and changing your experience of the pain. Opioids used in labour such as diamorphine, morphine, pethidine or meptid are derived and synthetized from the resin of the opium poppy. These can be administered in hospital by a single injection into the thigh or buttocks. These drugs take 20 to 30 minutes to work and last for two to four hours. Opioid medications can cause nausea meaning anti-sickness injections are often given alongside them.
Remifentanil, is a very strong, short acting pain killer that can be administered via a drip in your hand, you control the does using a button machine. You cannot overdose as the drip machine prevents this.
If you're planning a home birth and would like access to stronger pain relief ay home, you can request an opioid prescription, such as dihydrocodeine from your GP.
Opioid pain relief can alter your mood during labour and help you rest and sleep if you need to during a long labour. (Lowth M, 2017)
Opioid drugs can make you feel drowsy and less able to push effectively, meaning timing is key, and they are best taken earlier in labour. They can also make baby sleepy, slower to breath after birth and it can be harder to establish early breastfeeding. (Lowth M, 2017)
You can use gas and air alongside opioid drugs.
Epidural:
Epidural is a very common and effective form of pain relief in labour. Epidural is a local anaesthetic that is administered by an anaesthetist using a needle to insert a fine plastic tube called an epidural catheter into your back (spine) near the nerves that carry pain messages to your brain. The needle is then removed, leaving just the catheter in your spine. Pain relief medicines are then given through the catheter.
You can ask for a ‘mobile’ or ‘low dose’ epidural if you would like more mobility, however these are not available at all hospitals, more commonly available is a ‘full epidural’, where you won’t feel anything from the catheter down. You would need to discuss these options with your health care providers in pregnancy.
It takes approximately 25 minutes for the epidural to be set up before it is giving effective pain relief. This doesn't include the time waiting for the anaesthetist to be available to administer it.
Using calm breathing techniques can be hugely beneficial during the insertion of an epidural as it is important you stay very still.
Having an epidural can restrict your movement options and you're more likely to be birthing on a bed, on your back. Birthing lying on your back reduces the capacity and movement of your pelvis. You can use pillows or a peanut ball to be supported to lie on your side. This allows your sacrum (back of your pelvis) and coccyx (tail bone) to still be able to move, as it is designed to, during birth.
An epidural alters the tension of your pelvic muscles, which can interfere with the rotation of baby through the pelvis and increase chance of instrumental birth. (Reed R, 2021, p 103) Coached pushing may be required which increases the chance of experiencing severe perineal tearing, episiotomy and instrumental birth.
The website www.evidencebasedbirth.com gives detailed benefits and risks of epidural use in labour.
Non-Medical Labour Pain Relief Options:
If you'd rather avoid using medical pain relief in labour, or simply want to know what other options you have, here are 11 non-medical pain relief options for labour and birth.
Beta-Endorphins: Your body’s built in pain relief system:
Physiological birth (e.g. not induced) is a complex hormonal cocktail. (see this blog post about birth hormones to understand more). If labour is progressing physiologically this hormonal cocktail has built in pain killers. Pretty cool huh!
Beta-endorphins are the body’s natural pain killers and are many times more powerful than morphine. They work in synergy with oxytocin, (the hormone that works your womb muscles to squeeze baby out), to make the sensations manageable. Beta-endorphins build with your labour contractions/surges to help you manage the more intense sensations later on in labour. Quite simply the more natural oxytocin you have the more beta-endorphins you have. Beta-endorphins and oxytocin can make you feel sleepy or in an altered state of conscious, helping you to rest between surges and distort your perception of time.
Water:
Warm water immersion during labour can be very effective in managing pain and labour sensations. A 2009 Cochrane review concluded that those who used water immersion during labour were less likely to need epidurals or spinal pain relief. The review also concluded water may also reduce the duration of the first stage of labour as well as increasing birth experience satisfaction. (Cluett ER, Burns E. 2009)
A birth pool is also great for supporting oxytocin because of the natural privacy and nest like feel it provides. Birth pools also support upright instinctive movement during birth - it's easier to birth your baby in an upright position than on your back. If a birth pool is unavailable you could use a hot water bottle for directional heat relief, a shower or bath to help you relax and get those all important birth hormones flowing.
Hypnobirthing:
During labour the more relaxed you are, the more oxytocin you have and the better your uterus muscles work. Hypnobirthing helps you to build a tool kit of relaxation and mindset tools that you can utilise throughout pregnancy, labour, birth and beyond. These tools include self-hypnosis, deep relaxation, visualisations, massage, positive anchors, affirmations and breathing techniques. It's important these skills are practiced before birth to positively impact your mind and body. These techniques encourage you to calm your nervous system and boost the much needed birth hormones oxytocin and beta-endorphins.
Multiple studies concluded the skills taught in hypnobirthing antenatal classes benefit pain perception and birth experience (Leutenegger, V., Grylka-Baeschlin, S., Wieber, F. et al. 2022) including "significant reduction in the use of epidural analgesia, greater use of water immersion, and decreased odds of caesarean section." The 2026 study "suggests that the use of hypnobirthing during labour can further support women's aspirations to avoid pharmacological analgesia and achieve an unassisted vaginal birth.” Lee et al 2026
Hypnobirthing techniques can be utilised in all birth scenarios so if your birth evolves away from your plan A into something else e.g. a caesarean or instrumental birth, you still have tools you can use to help you remain as calm as possible.
Hypnobirthing also teaches you how your body works during birth, knowledge is power! and when you understand how your body works this can help reduce fear and adrenaline.
I explain all of this during Positive Birth Leeds Hypnobirthing courses, designed to help you and your birth partner get informed and feel confident and empowered for your birth. Visit the website for the latest hypnobirthing group course dates or get in touch for private one-to-one or doula support.
Breathing:
Taking deep breaths in through your nose and exhaling longer out your mouth reduces tension in your body, oxygenates your muscles and helps you remain in your para-sympathetic (rest and digest) nervous system.
A 2022 review of 10 separate studies concluded “skilled breathing and relaxation techniques may positively influence self-efficacy (self-belief), the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain.” (Leutenegger, V., Grylka-Baeschlin, S., Wieber, F. et al. 2022)
Breathwork is one of the many tools taught on a Positive Birth Leeds hypnobirthing course. You can utilise this breath during labour and birth or any time you feel stressed e.g. during an appointment, waiting for a job interview, during any medical procedure.
Here’s how to do it: Inhale through your nose for a count of 4, then exhale through your relaxed mouth for a count of 7. If you repeat this breath, inhaling for 4 and exhaling for 7 five or six times, approximately one minute or one contraction will have passed, and thats one contraction closer to meeting your beautiful baby.
Practicing this breathing daily helps it become second nature and have maximum relaxation impact.
Dancing, Movement & Active Birth:
Remaining active and moving instinctively during labour is a great way to manage labour sensations and also assist baby to descend through your pelvis, hello gravity! You can use anything to help you stay active, birth ball, lean over the bed, using your partner for support, birth pool to support your body weight…anything. You might develop rhythmic movements, as your labour progresses, like a dance, swaying or squatting. During birth movement and active birth allows you to respond the the bio-feedback from the movements your baby is doing to help them be born.
A 2025 study reported the benefits of dancing in labour to reduce labour pain, shorten labour duration, promote natural childbirth and improve satisfaction with labour (Zhang L et al 2025) - and who doesn't love a good dance? Bottom line, you don’t need to over think it, trust your instincts, if you are free to move you will likely adapt positions that feel most comfortable to you. Being active doesn’t mean you have to move non-stop, remember to rest between surges, if that feels right for you.
Aromatherapy:
According to a 2020 systemic review essential oils can help with promoting relaxation, reducing labour pain and anxiety. Lavender is commonly known to promote relaxation, and when inhaled has been shown to significantly decrease pain intensity during labour (Tabatabaeichehr M, Mortazavi H. 2020)
Other aromatherapy oils that can also help during labour are Jasmine, Geranium and Chamomile.
You could use a diffuser or place the oil on a handkerchief. You could also combine aromatherapy with other comfort measures such as massage, acupressure and water.
Acupuncture & Acupressure:
Acupuncture and acupressure come from Traditional Chinese Medicine, a Cochrane review showed acupuncture “may increase satisfaction with pain relief…and probably reduces the use of pharmacological analgesia”. (Smith, CA et al, 2020) Another 2020 study stated “Acupressure is an effective method of pain reduction during first stage of labour.” (Haj Najafi Raana, Xiao-Nong Fan. 2020)
With the Cochrane review also saying that acupressure “probably reduces the caesarean section rate” (Smith, CA et al, 2020)
In both cases the authors said more randomised control trials were needed, however, with no know side effects to the baby. This might be something you’d like to look into.
Doula Support & Continuous Support:
Doula's offer you and your partner informational, emotional, practical and advocacy support throughout your pregnancy, birth and postnatal journey. Receiving support from a trained doula is proven, by multiple studies*, to benefit birth outcomes and perinatal experiences for you, your baby and (if you have one) your partner.
Benefits of receiving doula support include:
39% reduced chance of caesarean birth
15% increased chance of spontaneous vaginal birth i.e. lower chance of induction of labour
10% decrease in the need for painkillers or epidural during birth
Shorter labour by 41 minutes on average
Reduced rate of premature birth
Reduced chance of instrumental birth
31% increase in parental satisfaction with the birth experience
Increased likelihood of successfully establishing breastfeeding & continuing breastfeeding at 6 weeks
Reduced feelings of anxiety and stress
Increased wellbeing of mother and child
Lower likelihood of a low birth weight baby
It's really important you find the right doula for you, someone you feel completely comfortable with and confident they can support your unique wants and needs.
A Cochrane review (Bohren MA, 2017) looking at 26 trials covering over 15,000 women, found that having continuous support from the same person in labour resulted in less need for pain relief, fewer interventions and better outcomes for mothers and babies.
I offer birth and postnatal doula support supporting you to feel informed, confident and empowered for birth and beyond. I offer free discovery calls to chat about where you're at, what you want and how I can help you during this transformational time in your life.
Sobczak A, Taylor L, Solomon S, Ho J, Kemper S, Phillips B, Jacobson K, Castellano C, Ring A, Castellano B, Jacobs RJ. The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review. Cureus. 2023 May 24;15(5):e39451. doi: 10.7759/cureus.39451. Erratum in: Cureus. 2025 Sep 23;17(9):c310. doi: 10.7759/cureus.c310. PMID: 37378162; PMCID: PMC10292163.
Bohren MA, Berger BO, Munthe‐Kaas H, Tunçalp Ö. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012449. DOI: 10.1002/14651858.CD012449.pub2.
https://evidencebasedbirth.com/the-evidence-for-doulas/
Nipple & Clitoral stimulation:
There are really good hormonal reasons why masturbation or nipple and clitoral stimulation can help labour progress – hello oxytocin and endorphins! Self-stimulation, or ‘assistance’ from your birth partner, might feel like the last thing you’d think to do during birth, but if labour is slowing down, maybe get yourself some privacy and try some ‘self-help’ - what do you have to lose? It might feel good. Some women have described their birth as feeling orgasmic. Maybe that could be you?
Gate Control Theory (GCT):
This is the idea that there is a gate mechanism in the brain and spinal cord nerves (the central nervous system). When the gate is open, pain messages get through to the brain and you feel pain. When the gate is closed, these pain messages are blocked and the pain is not felt. Your brain can only focus on one intense sensation at a time, so with GCT, you are exchanging one sensation for another. There are multiple ways to do this…
TENS Machine:
A TENS machine is a battery-operated hand-held device that emits electrical impulses through sticky pads you attach to your back. The electrical impulses from the TENS machine interfere with and block any pain messages sent to the brain. TENS machines are thought to stimulate certain non-pain-carrying nerves and close the pain gate. In effect, the brain is busy dealing with the messages it receives quickly from the TENS machine, rather than the slower (more painful) pain signals that the body is receiving from elsewhere. TENS machine's also stimulate the body to produce natural pain killing beta-endorphins, which I’ve mentioned before are more powerful than morphine. If you don’t like the feeling of the TENS machine you can stop using it with no side effects to you or baby. You wouldn’t be able to use it with water as, well obviously, water and electricity don’t mix so well.
Comb or Spiky Aura Balls:
There are acupressure points in the palm of your hand that help with pain relief. Squeezing a comb or spiky balls during contractions, so the ‘teeth’ or spikes gently press into your palm is said to work on the Lao Gong acupressure point. This releases endorphins, those pain relieving hormones, and acting as a distraction for your brain from one sensation (the contraction) and diverting it to another (your hand). The portable nature of the comb means you can use it anywhere, including in water, and it’s completely within your control. The only risk could be holding a comb too hard and hurting your hand, so maybe swap hands from time to time.
Sterile water injections (SWI):
Injections of sterile water are inserted into the lower back at 2 or 4 injection points and work with gate control theory. The sterile water forms small blisters under the skin to relieve pain in labour and ‘shut the gate’ preventing back pain or labour signals from reaching the brain. A study found women reported a significant reduction in lower-back pain during labour following SWI. (Fouly H et al. 2018)
The injections are painful on insertion with the injection pain lasting about 30-60 seconds, however, SWI can help reduce contraction pain for 2-3 hours. These can be particularly useful if you are feeling a lot of pain in your back e.g. baby is in a back-to-back position.
SWI can be used alongside other pain management options such as water, birth pool, gas and air and hypnobirthing tools.
Midwives can administer these, if they have been trained to do so. Check with your maternity team if this option is available to you.
I hope you this guide helps you understand what pain relief options are available to you during labour. It's up to you do the research and make an informed decision about what feels best for you and your baby. Using your informed decision making tools (BRAIN - Benefits, Risks, Alternatives, Instinct & Nothing & asking why?) can help.
If you'd like to talk about how a Positive Birth Leeds hyopnobirthing course or my doula support can help you and your birth partner feel informed, confident and empowered for your birth get in touch.
I'm always happy to chat.
Charlotte x
Check out the latest group hypnobirthing course dates here Or get in touch to ask about Private 1:1 support & doula support availability. Disclaimer: The information contained in this blog does not constitute medical advice in any way. If you have any specific concerns, talk to your Midwife or maternity team.
References:
Whitburn LY, Jones LE, Davey MA, McDonald S. The nature of labour pain: An updated review of the literature. Women Birth. 2019 Feb;32(1):28-38. doi: 10.1016/j.wombi.2018.03.004. Epub 2018 Apr 22. PMID: 29685345. https://pubmed.ncbi.nlm.nih.gov/29685345/
Dr R Reed, Reclaiming Childbirth as a Rite of Passage, 2021, p101
Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub3. Accessed 22 March 2023. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000111.pub3/full
Leutenegger, V., Grylka-Baeschlin, S., Wieber, F. et al. The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review. BMC Pregnancy Childbirth 22, 856 (2022). https://doi.org/10.1186/s12884-022-05178-whttps://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-05178-w
Zhang, L., Yue, R., Xiao, F. et al. The effects of dance on maternal childbirth: a systematic review and meta-analysis. BMC Pregnancy Childbirth 25, 20 (2025). https://doi.org/10.1186/s12884-024-07132-4
Tabatabaeichehr M, Mortazavi H. The Effectiveness of Aromatherapy in the Management of Labor Pain and Anxiety: A Systematic Review. Ethiop J Health Sci. 2020 May;30(3):449-458. doi: 10.4314/ejhs.v30i3.16. PMID: 32874088; PMCID: PMC7445940. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445940/
Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD009232. DOI: 10.1002/14651858.CD009232.pub2. Accessed 22 March 2023. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009232.pub2/full
Haj Najafi Raana, Xiao-Nong Fan, The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis, Complementary Therapies in Clinical Practice, Volume 39, 2020, 101126, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2020.101126.
Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6 https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
Fouly H, Herdan R, Habib D, Yeh C. Effectiveness of injecting lower dose subcutaneous sterile water versus saline to relief labor back pain: Randomized controlled trial. European Journal of Midwifery. 2018;2(March). doi:10.18332/ejm/85793. http://www.europeanjournalofmidwifery.eu/Effectiveness-of-injecting-lower-dose-subcutaneous-sterile-nwater-versus-saline-to,85793,0,2.html
Lowth, M, 2017. https://patient.info/pregnancy/labour-childbirth/pain-relief-in-labour
Dekker R, 2018. https://evidencebasedbirth.com/epidural-during-labor-pain-management/
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