Entonox or Gas and Air is a pain relief that is taken via a mouthpiece and breathed in. It is a very safe method of pain relief, that has no lasting effects. Entonox can make you feel slightly dizzy and lightheaded and some people can feel sick whilst using it, but the effects do not last for long. Gas and air is available at home, at the birth centres and in hospital and is usually recommended when you are in active labour.
Pethidine is an injection that goes into your thigh or buttock to help with the discomfort of contractions. Pethidine is an opioid drug, so it can make you feel drowsy or sleepy after it is given. Your midwife will discuss whether it is suitable for you to have Pethidine when discussing your pain relief options. Pethidine passes in small amounts through the placenta to the baby. This is very unlikely to cause any serious harm, but it can make breastfeeding more difficult to establish. Pethidine can be used in early and active labour and is available at birth centres and hospitals.
Epidurals are only offered in an obstetric unit, and usually only once you are in active labour. For an epidural, an anaesthetist puts a needle in the lower part of your back and uses it to place a thin plastic tube (epidural catheter). The needle is removed and the tube left in place next to the nerves in your back. Medication (local anaesthetic) is given through the tube to provide pain relief throughout your labour. Top-ups are given when needed (or you may have a button for top-ups). You may have to wait a short while for the anaesthetist to be available. It can take a while to set up the epidural and around 15 to 20 minutes to start working. You will need to have a drip placed in your arm and continuous monitoring of the baby’s heart rate.
Remifentanil is a second option for women who cannot have an epidural in their back. It is given by a pump directly into a vein through a cannula (drip) in your arm. You control when each dose of painkiller is given, by pressing a hand-held button. The pain-relieving effect is usually felt in 20 to 30 seconds and wears off again within a few minutes. It can only be given in an obstetric unit.
Aromatherapy and massage, using essential oils can be beneficial during labour. This can be an effective form of pain relief in both early and active labour. Some midwives are trained in complementary therapies - check ‘In My Area’ to find out whether this is available.
Of course, you are not limited to one choice. You can try multiple ways to cope during labour, either together or one after the other. Your midwife can suggest coping strategies that fit well together.