Medicated Relief Choices for Labour

In hospitals, birth centres and within homes, those in labour have the right to request and be given appropriate pain relief in labour. The medications covered here are widely available in all trusts, but can only be prescribed by a Midwife or Doctor. All information taken from Obstetric Anaesthetists' Association/OAA for mothers website.

Different drugs offer different benefits and/or risks and the full explanation of what these drugs do and can't do, should be provided. See B.R.A.I.N.S and H.E.A.R.T blog post to remind you how to make decisions. Use this time before labour to think about what you would be open to and how/when you'll signal this in labour. This work should help solidify your choices in your Birth Plan.

Entonox/gas & air (Inhaled)

What is it?
A gas mixture of nitrous oxide and oxygen.
What do you do?
Breathe it through a mask or mouthpiece with a valve.
How much pain relief?
Moderate help.
How long does it take to work?
Immediate.
Any extra procedures?
None.
Risks to baby?
None.
Side effects for mother/pregnant person?
Some nausea. Can feel ‘spaced out’. Can be tiring and make your mouth dry.
Effect on labour and delivery?
None.
(There has been recent restrictions to it’s usage due to concerns regarding Healthcare Professionals continual exposure).

Pethidine or diamorphine injection

What is it?
Pethidine or diamorphine is injected into the muscle in your arm or leg.
What do you do?
Have an injection in your arm or leg.
How much pain relief?
Often mild. May reduce anxiety.
How long does it take to work?
Five minutes to prepare the injection, then 30 minutes before it starts to work. The effects last a few hours.
Any extra procedures?
None.
Risks to baby?
May be slow to breathe. May be drowsy and find it difficult to feed at first.
Side effects for mother/pregnant person?
Feeling sleepy or sick. Delay the rate at which food is digested so you get a full stomach. May slow your breathing.
Effect on labour and delivery?
None.

Patient - controlled intravenous analgesia (PCIA)

What is it?
Small dose of fentanyl or remifentanil given from a pump into a drip in your hand.
What do you do?
Press the button to give yourself a dose every time you feel a contraction starting.
How much pain relief?
The amount of pain relief varies. Women often need to use Entonox as well.
How long does it take to work?
10 to 15 minutes to set up then works in a few minutes.
Any extra procedures?
You will be on a drip. You may be connected to a monitor to check your baby’s heartbeat. Checks on your oxygen levels. You may need

Risks to baby?
May be slow to breathe at first.
Side effects for mother/pregnant person?
Feeling sleepy or sick. Slow breathing - you will have to stop using it if it makes you too sleepy. Stopping breathing or slowing your heart rate (rare).
Effect on labour and delivery?
May increase the need for forceps.

Epidural or combined spinal epidural (CSE)

What is it?
Local anaesthetic and a painkiller given through a fine tube in your back to numb your nerves, via a needle. May not be recommended very early or late in labour.
What do you do?
Sit still in a curled-up position for five to 10 minutes while the tube is put in..
How much pain relief?
Usually very good. One in 10 times, it may not work well and may need replacing.
How long does it take to work?
Up to 20 minutes to set up. Then 20 minutes for epidural to work (a CSE will be quicker than this as you will also have a spinal injection).
Any extra procedures?
You will be on a drip. You may have a urinary catheter. You may be connected to a monitor to check your baby’s heartbeat.

Risks to baby?
You may have low blood pressure and this can affect your baby’s heart rate if not treated.
Side effects for mother/pregnant person?
Low blood pressure is common. Difficulty passing urine. Bad headache (one in100 women). Increase in temperature. Temporary nerve damage (one in 1000 women). Permanent nerve damage (one in 13,000 women). Severe complications (one in 250,000 women).
Effect on labour and delivery?
Can make it harder for you to push. May increase the need for forceps.

See other blog post on non medicated pain relief choices.