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Labour is painful, so it’s important to learn about all the ways that you can relieve the pain. It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you. Ask your doctor to explain what is available so that you can decide what's best for you.

Write down your wishes in your birth plan, but be flexible. You may find that you want more pain relief than you'd planned, or your doctor may suggest more effective pain relief to help the delivery. Different ways of relieving the pain are listed below.

Self-help
The following techniques can help you to be more relaxed in labour, which can help you to cope with the pain:

• Learn about labour. This can make you feel more in control and less frightened about what's going to happen. Read books on delivery and birth, talk to your doctor and go to prenatal classes(if any hospitals provide them)
• Learn how to relax and stay calm. Breathe deeply.
• Keep moving. Your position can make a difference. Try kneeling, walking around or rocking backwards and forwards.
• Bring a partner, friend or relative to support you during labour. If you don't have anyone, don't worry. Your nurse or doctor will give you all the support you need.
• Ask your partner to massage you (although you may find that you don't want to be touched).
• Have a bath.

Hydrotherapy (being in water)
Water can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water should be kept at a comfortable temperature, and not above 37ºC. Your temperature should be monitored.

Gas and air (Entonox) 
This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help to reduce it and make it more bearable. Many women like it because it's easy to use, and you control it yourself.

How it works
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. You'll probably practise using the mask or mouthpiece if you go to an prenatal class. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Side effects
There are no harmful side effects for you or the baby, but it can make you feel lightheaded. Some women also find that it makes them feel sick, sleepy or unable to concentrate. If this happens, you can simply stop using it.

If gas and air doesn't give you enough pain relief, you can ask for an injection as well.

Injections
Another form of pain relief is the intramuscular injection (into the muscle) of a drug, such as pethidine or diamorphine. This can help you to relax, which can lessen the pain. How it works You are given an intramuscular injection. It takes about 20 minutes to work, and the effects last between two and four hours.

Side effects
There are some side effects to be aware of:

• It can make some women feel very woozy, sick and forgetful.
• If it hasn't worn off towards the end of labour, it can make it difficult to push. You might prefer to ask for half a dose initially to see how it works for you.
• If pethidine or diamorphine are given too close to the time of delivery, it may affect the baby's breathing. If this happens, an antidote will be given.
• The drugs can delay the establishment of breastfeeding.

Epidural anaesthesia
An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be very helpful for women who are having a long and/or particularly painful labour, or who are becoming very distressed.

An anaesthetist is the only person who can give an epidural. If you think you may want one, check whether anaesthetists are always available at your hospital.

Anaesthetic is injected into the space between the bones in your spine through a very thin tube. It takes about 20 minutes to set up the tube, and another 15–20 minutes for it to work. The anaesthetic can then be pumped in continuously or topped up when necessary.

How it works
To have an epidural:

• A drip will run fluid into a vein in your arm.
• While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic and numb a small area with some local anaesthetic.
• A very small tube will be placed into your back near the nerves that carry pain from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 20 minutes to set up the epidural, and another 10 to 15 minutes for it to work. Occasionally, it doesn't work perfectly at first, and needs to be adjusted.
• After it's been set up, the epidural can be topped up by a nurse, or you may be able top up the epidural yourself through a machine. Your contractions and the baby's heart will need to be continuously monitored by a machine. This means having a belt around your abdomen, and possibly a clip attached to the baby's head.

Side effects
There are some side effects to be aware of:

• An epidural may make your legs feel heavy, depending on the type of epidural.
• An epidural shouldn't make you drowsy or sick.
• Your blood pressure can drop. This is rare because the drip in your arm will help you to maintain good blood pressure.
• Epidurals can prolong the second stage of labour, when you push and your baby is born. If you can no longer feel your contractions, the doctor or nurse will have to tell you when to push. This means that instruments may be used to help you deliver your baby. However, when you have an epidural, your doctor or nurse will wait longer before they use instruments as long as your baby is fine. Sometimes, less anaesthetic is given towards the end so that the effect wears off and you can push the baby out naturally.
• If you find it difficult to urinate as a result of the epidural, a small tube called a catheter may be put into your bladder to help you.
• About one in 100 women get a headache after an epidural. If this happens, it can be treated.
• You might be a bit sore for a day or two, but epidurals don't cause long-term backache.
• About one in 2,000 women feel tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than an epidural. You'll be advised when you can get out of bed.

Alternative methods of pain relief
Some mothers want to avoid the above methods of pain relief and choose acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques don't provide very effective pain relief. If you'd like to use any of these methods, it’s important to discuss it with your doctor and let the hospital know beforehand. Most hospitals don't offer them for pain relief during labour. If you want to try an alternative technique, make sure that the practitioner is properly trained and experienced and are willing to work with the doctors when needed.