Labour pain relief management and your options

Updated August 2023 | 4 min read
Expert contributor Dr Reawyn Teirney, obstetrician, Royal Hospital for Women
Words by Lucy E Cousins

Learn about labour pain relief management and your options, from natural painkillers to epidurals.

Labour is one of the most momentous and memorable events that women can experience, and knowing the pain relief options ahead of time may help you feel better prepared for childbirth.

Preparing your mindset

With a child born about every 1:43 minutes in Australia, it’s little wonder birthing stories are a common topic for new mums. However, according to midwife Edwina Sharrock from Birth Beat, women shouldn’t give much credence to other people’s experiences.

"The conversation we have in Australia as a society is that birth is something to be feared, when actually we need to be educated about the physiological process instead," she explains.

Obstetrician and gynecologist Dr Reawyn Teirney at the Royal Hospital for Women, Sydney, agrees.

"We know that the more stressed you are, the more pain you’ll experience. So it’s important to have a really good idea of what you might expect during labour, and how relaxation techniques can help."

One way to do this is to take antenatal classes or prenatal courses. These classes can help expectant parents learn more about and prepare for labour. Parents can learn how to identify signs of labour, the stages of labour, different birthing positions, breathing techniques, and much more. A small study shows that women have a much more positive labour experience if they take antenatal classes before giving birth.

Women who find the right pain relief option and method of delivery for them often report higher levels of satisfaction in their labour experience. A 2018 study showed that women who chose water immersion and water births experienced less pain during the early stages of labour. Even though women who chose natural and medical pain relief report the same levels of pain in the latter stages of labour, women who had natural pain relief and chose water birth reported the highest satisfaction levels among all studied for their labour experiences.

What are your pain relief options during labour in Australia?

What we know about labour is that it can be painful but the pain levels vary from woman to woman. There is a range of pain relief options for women during labour, whether you go to a public or private hospital. Your GP, obstetrician or midwife can help you find the right option for you and explain the benefits, side effects and possible complications of labour pain relief.

Natural pain relief

During the early stages of labour, there are some non-invasive complementary therapies that can be used for initial pain relief.

Although complementary therapies have had few large-scale medical trials, a 2016 study found that patients who used certain therapies had significantly reduced epidural use and deliveries by c-section.

These therapies included acupressure, visualisation, relaxation, breathing techniques, massage, yoga poses and facilitated partner support, where birthing partners help to calm the mum-to-be’s stress levels.

Edwina also believes the most effective pain relief for early labour can be done at home.

"There are a lot of strategies you can do prior to going to hospital," she says. "One combination I recommend is heat (including baths and showers), massage and movement, which are evidence-based natural pain relief options that, in conjunction with breathing techniques, actually [can help]."

Medical pain relief

Once labour has progressed, and if you’ve requested medical pain relief, there are several options available, depending on whether you’re at a hospital or birthing centre.

Nitrous oxide

Generally the first medical pain relief after paracetamol is nitrous oxide, known as laughing gas, which contains a mixture of nitrogen and oxygen. You inhale it during contractions, so you can control how much you have and how often.

"Nitrous oxide acts pretty quickly and can take the edge off the pain," explains Dr Teirney. "However, it can make you feel drowsy and a little bit confused. It doesn’t affect your baby in a negative way."

Injections

Another form of pain relief available may be a pethidine injection into the muscle of your thigh or bottom, which takes about 20 to 30 minutes to take effect. It can be given every four hours and lasts two to four hours. Diamorphine is another pain relief injection sometimes used.

"Pethidine is quite good at helping with pain," says Dr Teirney. "You’ll definitely feel relaxed but you can feel pretty drowsy afterwards and it can make your baby feel sleepy too. We don’t administer it if we think the baby will be born soon."

That’s because when administered too close to delivery – or when dosed repeatedly – pethidine can also affect your baby’s breathing, however this effect can be reversed by an injection given to your baby.

Epidural

An epidural, which numbs you from the waist down, delivers long-lasting, reliable and effective pain relief.

A local anaesthetic is given via a needle into the epidural space near the spinal cord and while it does come with some risks, the procedure is generally seen as very safe.

Often fluids are given to avoid a drop in blood pressure and some women lose feeling in their bladder, meaning a catheter is required. The epidural takes about 20 minutes to set up by an anaesthetist, and another 20 minutes to take effect. When it starts to wear off, you can have top-ups that last between one and two hours.

Women who have epidurals have a higher rate of assisted birth, where the baby is delivered with the help of medical instruments, such as forceps or a vacuum.

If you have a caesarean section, the most common type of pain relief is a spinal anaesthetic, which blocks the pain from your chest down.

When it comes to planning your pain relief, talk to your healthcare team to find out which methods are recommended and available at your chosen birthing centre or hospital.