What types of pain relief are available during labour and birth?

It's normal to have some amount of discomfort and pain during labour and birth. However, every birth experience is different.

There are medical and non-medical ways to help manage your pain when you are in labour.

In 2023, 4 in every 5 women received some form of pain relief medicine during labour.

Pain relief preferences are different for everyone, so it's a good idea to discuss your preferences with your doctor or midwife before your labour begins.

Non-medical pain relief

Non-medical pain relief may include:

• relaxation
• active birth (moving around and changing positions during labour)
• massage
• heat packs
• water immersion (warm baths or showers)

Other non-medical pain relief options include devices or techniques such as:

• transcutaneous electrical nerve stimulation (TENS)
• water injections
• acupuncture

Non-medical pain relief methods can be used on their own, or together with medical pain relief methods.

Medical pain relief

Medical pain relief uses medicines to help manage your pain during labour and birth.

Nitrous oxide gas

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Nitrous oxide gas (also known as 'laughing gas'), is a medicine that you inhale (breathe in) using a mouthpiece or mask. It works quickly to help reduce your pain during contractions, and wears off after roughly one minute.

Nitrous oxide gas may cause some short-term side effects, including:

• feeling nauseous
• feeling lightheaded
• a dry mouth

There are no long-term effects of using nitrous oxide gas during labour, for you or your baby.

Nitrous oxide gas is not suitable for people who have certain conditions such as pernicious anaemia (vitamin B-12 deficiency). Ask your midwife or doctor if it's right for you.

Opioids

Opioids, such as morphine, are strong pain relief medicines. Opioids are usually given through an injection. Some opioids can cause short-term side-effects, such as:

• drowsiness
• nausea and vomiting
• urinary retention (being unable to fully empty your bladder)
• slower breathing

Opioids can make you feel less alert. Sometimes, this can mean you are less able to take part in decision-making during labour.

Certain opioids are not recommended to be given late in your labour. This is because they may affect your baby's breathing and alertness after birth.

Epidural

Epidural pain relief is when a small amount of an anaesthetic is injected into the space around your spinal cord (known as the epidural space). This reduces or removes the feeling of pain from your waist down. You are still awake.

An epidural provides very effective pain relief and can be used at any stage of labour. An epidural may cause short-term side effects, such as:

• headaches
• dural headaches (a type of headache that occurs after a spinal procedure)
• numbness below the waist
• urinary retention (being unable to fully empty your bladder)

Serious complications such as infection or permanent nerve damage are possible, but very rarely occur.

In Australia, your healthcare rights mean that you can ask questions and make decisions about your labour and birth. If you are unsure which pain relief is right for you, talk to your doctor or midwife. You might also change your mind along the way, which is very normal.

What should I consider when choosing pain relief?

Pain relief preferences during labour and birth are different for everyone. They may be influenced by your:

• background
• culture
• tradition
• religion

Here are some factors to think about when making your birth plan:

• A water birth requires a birthing pool, which is not available at every birthing unit.
• If you are planning a home birth you will not be able to have an epidural, as it requires an anaesthetist (a highly specialised doctor).
• If you have a pacemaker or spinal rods (metal supports in your spine), you will not be able to use TENS for pain relief.

If you are not sure which pain relief options might be suitable for you, ask your doctor or midwife.

What pain relief preferences should I have in my birth plan?

Your birth plan should include:

• your preferred method of pain relief
• alternative pain relief options in case circumstances change
• any pain relief options you would prefer to avoid

If you are not receiving continuity of care (seeing the same doctor or midwife throughout your pregnancy) it can help to bring a written copy of your birth plan on the day. This helps your healthcare team quickly understand your preferences.

You can learn more in an in-person or virtual antenatal class.

What if I change my mind during labour?

It's completely normal to change your mind about pain relief during labour. This might be because your labour experience is different from what you were expecting. It might be because of a change in the medical needs of you or your baby.

If you change your mind during labour, tell your healthcare team and your support people. Your pain should be taken seriously, and your healthcare team will do their best to support your preferences.

It's not always possible to change from one type of pain relief to another during labour. Here are some things to keep in mind:

• You cannot use water immersion as pain relief for 4 hours after having opioid pain relief medicines. These medicines can make you drowsy, which makes being in the water unsafe.
• Once you have had an epidural, you cannot use active birth techniques or water immersion for pain relief. This is because you need to remain still after having had an epidural.
• If your labour is advanced (far along), opioid pain relief may not be recommended. This is because it can affect your baby's breathing if used too close to birth.

It's a good idea to learn about all the available pain relief options, even if they're not part of your preferred birth plan.

Who can I talk to for advice and support?

Before your labour begins, you may find it helpful to speak to:

• your friends and family about their experience with pain relief during labour
• your doctor or midwife, to discuss your birth plan
• a childbirth educator or antenatal class instructor, to help you prepare for labour

Resources and support

The Royal Women's Hospital Victoria offers information on ways to manage pain during labour.

Languages other than English

The Australia and New Zealand College of Anaesthetists provides resources on pain relief during labour and birth in multiple languages.

The Royal Women's Hospital has information on epidural pain relief during labour in languages other than English.