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Your Ultimate Birth Toolkit: 16 Powerful Pain Relief Options

Updated: 6 hours ago

Worrying about pain during labour is really common, as a doula and hypnobirthing teacher this is something women and birthing people share with me all the time, anticipatory anxiety is real.


This blog is here to help you feel more informed, confident and empowered for your labour and birth. Here I discus what labour pain actually is, how you. an actually use the pain / sensations you feel to your advantage and the difference between physiological and non-physiological labour pain (yes, there is a difference). Along with a whole menu of pain relief options, both medical and non-medical. Trust me you have LOADS of options, I've got your back.


So, let's get into it...

What is Labour Pain?

The 'pain' or 'sensations' experienced during labour and birth are the result your uterus (womb) muscles contracting to birth your baby. Physiological birth sensations are different to pathological pain e.g. what you experience from a broken leg or tooth extraction. This is because physiological labour is a delicate hormonal process (by physiological I'm referring to a spontaneous labour labour that starts and unfolds on it's own without drugs or interventions). As explained by Dr Rachel Reed "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)


Physiological birth is powered by the love hormone oxytocin and supported by your body's natural pain killing beta-endorphins, 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 muscles having enough oxygen, blood flow and fuel, results in your powerful uterus (womb) muscles working effectively and efficiently to birth your baby. More oxytocin means more pain-killing beta-endorphins which makes labour more comfortable. Understanding how this is happening is really useful to helping you manage labour pain / 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 experiences of labour 'pain' or 'sensations' is unique. Some women and birthing people report not feeling any 'pain' during birth, some 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)

No one can tell you what labour will feel like for you. However Dr Reed also explains, when you understand what the pain / sensations you are experiencing is doing, why it is there and what you can do to help your muscles work effectively and efficiently e.g. boosting oxytocin, this, in and of itself, can be really powerful and help 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)

and here's the research...

“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

What Are My Labour Pain Relief Options?

You have loads options for comfort measures in labour and birth, possibly far more than you realised - 16 pain labour relief options are listed in this blog. 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, but many can be used in all birth settings including at home. Many options listed below 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, or ‘gas and air’ is a mixture of nitrous oxide (laughing gas) and oxygen inhaled through a mouthpiece. Usually available at home births and in hospital settings, it can be used during land or water birth and for pain relief after birth if you require any stitches. 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 at the beginning of a surge/contraction. Gas and air enters the body quickly and leaves the body quickly. You are in control of when you use it and there are no harmful side effects to you or your baby as it doesn't cross the placenta. Entonox can make you feel lightheaded, sleepy, unable to concentrate, nauseous and / or cause vomiting, if this happens to you stop using it and the effects will quickly wear off.


Paracetamol:

Taking paracetamol is often recommended to manage sensations in early labour. However, paracetamol is also known to inhibit prostaglandin synthesis. Prostaglandin is the hormone required for dilating the cervix and establishing labour so taking paracetamol may slow this process down. Some midwives have suggested this is something that requires further research.


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 pethidine, meptid and diamorphine are derived and synthetized from the resin of the opium poppy. These can be administered in hospital by injection into the thigh. These drugs take 20 to 30 minutes to work and last for two to four hours.

Remifentanil, is a very strong, short acting pain killer and can be administered by an anaesthetist who inserts a via a drip which you control using a machine.

If you are planning a home birth you can request a, opioid prescription, such as Dihydrocodeine from your GP to have with you, just in case you'd like stronger pain relief at home.

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)

Timing is key to taking opioid drugs in labour. Pethidine is best taken earlier in labour as it can make you feel drowsy and less able to push effectively. It can affect your baby’s breathing making baby sleepy after birth and it harder to establish early breastfeeding. (Lowth M, 2017)


Sterile water injections (SWI):

Injections of sterile water are inserted into the lower back at 2 or 4 injection points and work on gate control theory. The 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 low-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 surge 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, gas and air, 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.


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. 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 until it is working. Not including the time waiting for the anaesthetist to be available to administer it.

Utilising calm breathing techniques can be hugely beneficial during the insertion of an epidural as it is important you stay very still.

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)


Often having an epidural results in birthing lying on your back which is the least effective position to birth a baby. You can use pillows or a peanut ball to be supported to not lie flat on your back. 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. Alternatively, you may birth flat on your back with coached pushing, which may increase the chance of severe perineal tearing or episiotomy.


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 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:

As previously stated, it’s helpful to understand that 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 reduce 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)

You could use a birth pool – also great for supporting birth hormones due to the natural privacy it provides. A birth pool also supports upright instinctive movement during birth - its easier to birth your baby in an upright position than on your back. If a pool is unavailable you could use a hot water bottle on your lower back, a shower or bath. Again, being in the bathroom is a great private environment which helps to boost your oxytocin (it’s a shy hormone and thrives in privacy - this blog is full of oxytocin boosting tips) and beta-endorphins (see above).


Hypnobirthing:

It is a common misconception that hypnobirthing works as ‘pain relief’ during birth. In actual fact hypnobirthing teaches you to build a tool kit of coping strategies that you can utilise during labour and birth as you wish. These include using self-hypnosis, deep relaxation, visualisations, massage, positive anchors and breathing techniques practiced before birth to positively impact the mind and therefore your body. These techniques encourage you to calm your nervous system and boost the much needed birth hormones oxytocin and beta-endorphins. A 2022 study concluded the skills taught in hypnobirthing antenatal classes had a benefit on pain perception and birth experience (Leutenegger, V., Grylka-Baeschlin, S., Wieber, F. et al. 2022).


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 about how your body works during birth, which can be helpful to reducing birth fear. As well as important decision making and advocating skills to help you and your birth partner ensure your wishes are respected and your voice heard.


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 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 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 the hypnobirthing course and 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. You can practice this calm breathing daily for maximum impact.


Active Birth, Movement & Dancing:

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. A 2025 study shows 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:

Essential oils can help with reducing labour pain and anxiety, according to a 2020 systemic review. Most commonly lavender, which when inhaled has been shown to significantly decrease pain intensity during labour (Tabatabaeichehr M, Mortazavi H. 2020)

Other aromatherapy oils also proved beneficial, such as 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.


Continuous Support & Doula Support:

Having the continuous support from the same person; someone you trust and you know has completely got your back, is proven to be beneficial in labour and birth. A Cochrane review (Bohren MA, 2017) into 26 trials looking at over 15,000 women found that having continuous support from the same person resulted in less need for pain relief, fewer interventions and better outcomes for mothers and babies. Doula support is proven beneficial with studies showing when supported by a doula there was a reduction is in the need for painkillers or epidural during birth, a reduction in the chances of having a caesarean, instrumental birth or induction of labour, shorter labour by an average of 41 minutes along with increasing parental satisfaction with the birth experience


When continuous support is less available in the modern NHS maternity system a really hiring a doula, who is a professional birth supporter, to support both you and your partner can be hugely beneficial to your birth experience, including your perception of labour pain.


I offer nurturing birth and postnatal doula support to help you feel confident and empowered during your pregnancy, birth and postnatal experience. Book a free discovery call here to chat about how I can support you during this transformational time in your life.


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:

This is a battery-operated hand-held device that you control. You attach pads to your back and electrical impulses generated by the TENS machine interfere with and block pain messages sent to the brain. TENS machines are thought to stimulate certain non-pain-carrying nerves and close the 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 also stimulates 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:

Squeezing a comb or spiky aura balls during contractions, so the ‘teeth’ or spikes gently press into your palm is said to work on the Lao Gong acupressure point, releasing endorphins 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 it too hard and hurting your hand, so maybe swap hands from time to time.


I hope you this blog helps in knowing more about the options available to you. It is 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 & asking why?) can help. If you're still not sure what I'm on about, but curious, I guide you through the details of this in my doula support and hypnobirthing classes.


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

Charlotte Watson from Positive Birth Leeds, a white woman wearing a grey jumper, sat in a chair and holding a mug, smiles at the camera.

Check out the latest group course dates here Or get in touch to ask about Private 1:1 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:

  1. 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/

  2. Dr R Reed, Reclaiming Childbirth as a Rite of Passage, 2021, p101

  3. 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

  4. 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

  5. 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

  6. 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/

  7. 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

  8. 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.

  9. 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

  10. 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

  11. Lowth, M, 2017. https://patient.info/pregnancy/labour-childbirth/pain-relief-in-labour

  12. Dekker R, 2018. https://evidencebasedbirth.com/epidural-during-labor-pain-management/


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