Worried about how you will cope with labour pain? You are not alone. Pain is one of the biggest concerns many expectant parents have when thinking about birth. You may be wondering whether natural or non-pharmaceutical comfort measures will be enough, whether you might want medication, or whether you need to make a decision before labour even begins. The good news is that you have options, and you can change your mind.
Pain is personal
The sensation of pain is different for everyone. The physical sensations of labour are real, but how we experience and respond to them can be influenced by our surroundings, our sense of safety, our previous experiences, and the people supporting us. This is why labour pain relief is not one size fits all.
Before we talk about pharmaceutical pain relief options, please know that there are many ways you can support your body through labour without medical assistance.
Natural and non-pharmaceutical pain relief during labour
Breathing, movement and hands on support
I teach different breathing, movement and hands on techniques for every stage of labour in my Prenatal Yoga Course and Breathe Move Birth Workshop. The simple things I would encourage you to take away here are:
- Learn how to breathe three dimensionally.
- Move with your intuition.
- Let your birth partner learn how to use touch, whether that is gentle or sometimes firm, to support you.
Water
A warm shower or bath can be soothing during labour. For some people, being immersed in warm water can create a sense of privacy and safety while giving them more freedom to find comfortable positions.
TENS
A TENS machine uses small electrical impulses to help modify pain signals. It is often particularly useful in early labour and can be used at home before you go to your place of birth.
Your voice
And yes, this includes moaning, groaning, humming, breathing loudly and even swearing. You do not have to look calm or quiet while giving birth. Finding your own sounds, particularly low pitched sounds, can be a way of releasing tension and staying connected with your body rather than fighting against every sensation.
Other comfort measures for labour
There are many other tools you can add to your labour toolkit, including:
- Heat packs, which can be particularly useful for back discomfort
- A cold cloth on your face or neck
- Essential oil scents in the room
- Visualisation
- An eye mask and headphones if you find yourself becoming overstimulated
- Affirmations in the birthing room
- Gadgets such as birth combs
Remember, you will still have breaks between contractions. During these moments, breathe and allow yourself to take a short rest.
Three things that can influence how you experience labour pain
There are three things I think are particularly important when we talk about experiencing labour differently: your mindset, your birth team and your environment. Let me share a little about my own first birth.
Your mindset
I knew labour was likely to be one of the hardest physical things I would ever do, but I had decided that I would do it and that I would have a beautiful birth. That mindset did not make the sensations disappear. But I went into labour believing that my body was capable of doing it.
Your birth team
I had a birth team who believed in me. During active labour, my midwife could simply sit beside me and wait. When I needed her, she would come and rock with me.When things got challenging, she did not say to me, “This seems to be very hard for you. Would you like some pain medication?”
During pushing, I remember having a cheerful team around me, including doctors who were encouraging me. Even my usually quiet husband was incredibly excited and cheerful. That positive energy mattered.
Your environment
And then there was the space itself. I remember walking into the birthing room and feeling that it was my space. As labour intensified, I took off my clothes and made myself comfortable in the way I would have at home.
These things do not take the pain away. They are part of the bigger picture of how you experience labour.
What about pharmaceutical pain relief in labour?
Sometimes your own toolkit is not enough, or you simply decide that you want more support. That is completely okay.
Here are some of the pharmaceutical pain relief options you may encounter in Aotearoa New Zealand.
Gas and air: the “breathe in” option
Gas and air is a mixture of nitrous oxide and oxygen that you breathe through a mouthpiece. It can help you cope with contractions. It works quickly and wears off quickly, so it can be used with individual contractions.
It does not completely remove pain, and some people feel light headed or nauseous while using it. These effects generally disappear quickly once you stop breathing the gas.
Morphine: the “take the edge off” option
Morphine is given by injection and is intended to help you feel more relaxed and better able to cope with labour pain.
It does not block the pain completely. It can make you and your baby drowsy, which is why it is generally not given close to birth.
Remifentanil: the “fast in, fast out” option
Remifentanil is set up by an anaesthetist. It is a strong, short acting opioid that can be given through an intravenous patient controlled system. You can press a button as a contraction approaches. It works quickly and wears off quickly.
Unlike an epidural, it does not numb the lower body. However, it can cause drowsiness, dizziness and affect breathing, so close monitoring of you and your baby is required.
Remifentanil is not available in every maternity service, so ask if your care provider what is offered where you plan to give birth. In some New Zealand maternity settings, it may be used as an alternative when an epidural is not suitable or cannot be used.
Epidural: the “numbing” option
An epidural is administered by an anaesthetist. A small catheter is placed in your lower back so medication can be given to numb pain from the lower part of your body.
It is generally the most effective form of pain relief among these options. An epidural usually involves additional monitoring, such as an intravenous drip and continuous monitoring of your baby's heart rate. A bladder catheter may also be needed because you may have reduced sensation in your bladder.
A modern low dose or mobile epidural may allow some movement, such as changing position, rolling onto your side or sitting up, depending on the medication, your individual circumstances and the protocols at your maternity unit. It is worth asking your anaesthetist what mobility you can expect rather than assuming every epidural will feel the same.
Bear in mind that if you decide to have an epidural during labour, depending on the circumstances, it might take some time for the anaesthetist to reach you. It may then take around 40 minutes from preparing and inserting the epidural to feeling the full effect of the pain relief.
An option you may not have heard of: sterile water injections
Sterile water injections are sometimes used to help with back pain during labour.
Small amounts of sterile water are injected into points on the lower back. The injections can sting quite strongly at first, which is why some people describe them as the “sting before the relief.”
They are not offered everywhere, so ask your care provider whether they are trained to provide them. More research is still being done on their effectiveness.
You can change your mind
Perhaps the most important thing I hope you can take away from this is:
You can change your mind.
You might plan to use no medication and later decide that you want it.
You might plan to have an epidural and discover that you are coping well without one, or that labour is progressing too quickly for an epidural.
You might use gas and air for a while, try warm water and movement, and then decide you want something stronger.
Changing your mind is not failing.
Labour is dynamic. Your circumstances, your baby's position, your energy levels and how you feel can all change. Your birth plan is a set of preferences, it can change too. I have had mums plan to have an epidural and find that it was too late to have one by the time they reached the hospital, they described this as one of the most powerful experiences they have ever had. I have also had mums who wanted to give birth without medication but changed their minds during the process, and still felt empowered because their decisions were respected.
Questions to ask your care provider about pain relief
Whether you are planning to have pain relief medication or not, consider finding out what is actually available where you plan to give birth. You could ask your care provider before labour:
- What pain relief options are available here?
- When can I access each option?
- How quickly does it work?
- How long does it last?
- How might it affect me and my baby?
- What monitoring or other interventions come with it?
- Will I still be able to move?
- For those of us planning to have no medication, if I change my mind during labour, what are my options?
Knowing the answers beforehand can make decisions feel much less overwhelming when you are in the middle of labour.
For me, birth preparation is not about teaching you to avoid pain relief. It is about helping you understand and connect with your body, know your options, practise practical tools and prepare your birth partner to support you. The more tools you have in your toolkit, the more confidently you can choose what you need when the moment comes.
Whether you are hoping for a physiological birth, planning to use pain relief, or simply want to understand your options, you deserve to feel informed and prepared for how labour might unfold.
Birth does not always follow the plan, but knowing your options means you do not have to face those decisions without preparation.
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