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Pain and pain relief

Many women worried about pain in labour and what kind of pain relief to use, if any, especially in a first pregnancy. It was difficult to imagine what the pain would be like and how effective the different types of pain relief would be. Some people wanted to try giving birth with as little pain relief as possible, but most felt it was important to keep their options open and some emphatically wanted it to be as pain-free as possible.

Common choices included inhaling gas and air, pethidine injections, using a TENS machine and having an epidural anaesthetic. Some chose to relax in a warm bath or birthing pool, and some asked their midwife or birth companion for massage, sometimes with aromatherapy oils.

 

Relaxing in a birthing pool helped her rest during labour, but she wanted to get out for the...

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Age at interview: 25
Sex: Female
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The midwife unfortunately arrived right when the contractions had slowed down, and that meant that the inf-, on the information that she received when she arrived home she concluded that I was in early labour, which I wasn't. But that was, that was, I was definitely showing the signs of being in early labour because I had slowed right down and, but so I misled her a bit there, and she went off to have breakfast. And we ended up phoning her in, well, my husband ended up phoning her, I should say, in a bit of a panic about 45 minutes after she went to get her breakfast elsewhere, away from the house, because I really began to feel that I needed her. I needed her for some advice about when to get into the birth pool, and I needed her because I was a bit, I was a bit frightened by the fact that I was feeling these urges to push and I knew that it, it wasn't time yet, but I needed help in restraining myself.

So she quickly came back from breakfast and advised me to get in the pool, which helped me to resist these urges to push. It helped enormously. All the time I would say that the pain was great, the pain was great but I never really thought about using any pain relief. It was a huge relief to me to get into the water but at no point did I feel that it was out of control and that I really needed any, any extra help. The support of my husband and my sister and the independent midwife who was with us was, was really helpful as well.

So is the baby actually born in the pool?

The baby was not born in the pool. I came to a point during the labour and, after having been in the pool I would say probably an hour, although my memory fails me slightly, that I was basically dead to the world. I was flopped over the edge of the, of the pool and I had expended all my energy in trying to resist this urge to push for such a long time. I was very tired and my midwife really helpfully suggested that, if I could, 'Go and sit on the loo for a while, just have a change of, of scenery, and drink a little bit of water and have some honey on a spoon'. And that, that helped me a lot to get my, to get my energy back. Probably just the effect of having been in warm water for such a long time. If you imagine taking a bath for an hour, really nice warm bath for an hour, it does wear you out a bit actually. So, so that was really helpful to just have a change of scenery. And once I'd been out of the pool for a few minutes it had served its purpose, I was up and running again and with a lot more energy. And then, then I was ready to push and the, and the second stage of labour really started in earnest.

Each of these approaches worked well for some people but not for others. It is hard to predict how individuals will react. Looking back, many people said they had not anticipated how exhausting the effort and pain of labour could be, and several were glad to have an epidural to get through the final stages, even if they had not planned it. Some people had firmly intended to have an epidural, including a woman who was concerned that getting too exhausted might trigger an epileptic seizure.

 

Her birth plan was to be as natural as possible but to be open to everything. She got very tired...

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Age at interview: 24
Sex: Female
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My birth plan was to try and have a natural birth, natural labour unless I had any complications, and I'd known during my pregnancy that the baby was back to back, and that might make the contractions much more uncomfortable and less effective. And so if the baby hadn't turned, then I made, then I said that I was quite open to any sort of pain relief. I was hoping that he'd turn round and that I could try and have a, use a water bath as a form of pain relief and stay in a birthing suite rather than - in a midwife-run suite rather than in the delivery, doctor-orientated one. 

But because I had to go in to be induced, even though I wasn't induced in the end, but I was monitored right from the beginning of my contractions starting, from the beginning of labour and so I couldn't go anywhere near water because I had all the things on. And because the baby's heart rate dropped a couple of times with the contractions so they wanted to keep monitoring me. And because the contractions were really ineffective, I did decide to have pain relief, so my birth plan was to be open to everything, and in the end I was really relieved that I hadn't been really firm about not having an epidural because it was brilliant and it made the whole thing so much better. 

But during, during the labour I remember vaguely wanting to carry on not having an epidural, and my partner talked me into having an epidural because, because I wanted to carry on trying to do it naturally and I was getting exhausted, and so I did have to be talked into it, but I knew that I wasn't, I knew that that was my original plan, so it wasn't like I was compromising myself, because I'd decided that if it was complicated in any way then I would be open to having an epidural. And it was complicated, so I felt that I, it was due to me to have the pain relief so, yeah.

 

She needed to avoid getting too exhausted in labour in case it triggered an epileptic seizure....

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Age at interview: 33
Sex: Female
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Initially I, before - we didn't discuss it at the hospital, in regards to the epilepsy, until probably 24, 26 weeks - and initially I'd thought I perhaps might have to have a caesar because they didn't want me going through the strain of labour, because it's sort of - you're getting very tired, all of those things, all of which are triggers to my epilepsy. And, but that transpired that, no, I could, there was no reason why I couldn't have a normal delivery. That they would obviously monitor very closely how long it went on, and how exhausted I got. I know we discussed if I, perhaps I went into labour at ten at night, so I was approaching needing sleep already, to then go for eighteen hours and not really getting anywhere, then they might decide, you know, I'd gone on, it had gone on long enough.

But we were due to go and meet the whole team - went in for one of my appointments at thirty six weeks and we were due to go and meet the whole anaesthetics team and things that day. And discuss the epidural and all of that, which I wouldn't imagine the normal - you know, if you just had community midwifery, you wouldn't have that opportunity. But they wanted, you know, they wanted me to do that, so that I knew exactly what was going to happen, because I, that was very much the option I wanted, an epidural. I didn't want any pain. And I just thought I wanted to enjoy it and I, you know, I thought about the pros and cons of an epidural, the risks. You know, I have a good friend who's an anaesthetist. The risk, the risks are very low, even though they have to tell you about them. And I wanted to enjoy it, and I didn't want to be, I didn't have a great desire to be the new age mother who'd done the whole thing with only gas and air, and biting on her husband's hand. So you know, I wanted the easy option. If it's there, take it.

 
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The epidural felt “weird” to begin with, but Tina was able to get some sleep with the pain relief.

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Age at interview: 33
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So do you want to talk a bit about your labour, if you could bear to remember it?

I, my waters broke at half past seven on, at night on the Tuesday. So I thought I was and then, so my partner’s mum took me to hospital, drove me to hospital because my waters had obviously broke, and they said they were, “You’re not, you’re not having any contractions or anything like that?” I said, “No”. And so they sent me home again and this was all on the Tuesday, and I came home and I started getting real bad pains in my stomach and I left it for a couple of hours thinking I would, because I was counting and that, and then, and then I phoned my partner’s mum and said that they’re getting, they’re getting worse, they’re getting worse. So I, she drove me up to the hospital again and this was at two o’clock in the morning and she I, they kept me in and I didn’t actually go into labour until nine o’clock in the morning on the Wednesday and I gave birth to my daughter at half past six on Wednesday at night.

And you’ve had an epidural?

Yeah.

And that, what was that experience like?

It, it was, like I wasn’t too bad, it, I did feel weird to begin with because it was the way it, because it went all the way to my spine and things and I felt awkward, but then that sort, because I felt it going in and I thought, ‘Oh God’. And then, then because of the pain that I was going through anyway, that, that’s, that stopped the, me worrying about what was in there really [laughs].

Hmm.

Because of the pain there [laughs].

And that helped with the pain, did it?

Yeah, it made it, I was able to relax for a little bit, I was able to fall asleep for about half an hour.

Epidurals did not work well for a few people, including some who felt pain mainly in their backs. For some people it took the edge off the pain but they could still feel the contractions through it. Others felt completely numb and needed help to know when to push.

 
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She had such bad back pain in labour the midwife persuaded her to have an epidural, but it did...

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Age at interview: 29
Sex: Female
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And by this stage I couldn't conceivably sit still with contractions, you know, I was - and so we did the kind of, about 20 minutes of, you know, get your husband to massage your back and sitting on one of those nice physio balls, and I think they got me one of those hot bran bag things and said, "Put that on your back', because all the pain was in my back. And that really didn't last long at all. And she came back in and said, "You're in a lot of pain'. You know, I couldn't probably speak and she said, "Have you thought about having an epidural?" And I said, "Well it's pretty early." She said, "Well, yes, I know it's pretty early but you're in a lot of pain and, you know, you've got a long way to go in this much pain." And so I said, "It's too early." So she went away again for about another fifteen minutes and she came back and she said, "I think you need some, you might need someone to make this decision for you," and I said, "Yes, I think maybe." 

And she said, "OK, I'm calling the anaesthetist now," and it was very, you know, very kind of, very little discussion. And I think probably I must've been in quite a lot of pain to, for that to just go through. She said, "You're not going to be able to keep still long enough to get an epidural in if we leave it much longer," and went off and that was all. And so I had an epidural, which was done brilliantly by whoever happened to be asleep up the corridor, who was very nice and then I had a very long labour and it turned out that it was all because he was OP [occipitoposterior presentation], facing the wrong way.

Hence the back pain?

And hence the back pain. And in fact the epidural didn't work particularly well, I still had back pain all the way through, although, you know, not nearly as severe as it would have been, obviously. And they kept getting me to try and lie on that side when they did top ups to try and get, because they thought maybe the tube was kinked and the drugs weren't sinking to the one side of my back. And every hour I said, "No, no, no, that makes the pain worse, lying on that side, not better." And they just put in more and more and more epidural, and I got sicker and sicker [laughs]. 
 

One mother chose an epidural because she was trying a vaginal delivery after a previous caesarean and thought if she needed another emergency caesarean the epidural could be topped up, avoiding a general anaesthetic. A few people were worried about possible side effects from epidurals or afraid of needles.

 

The epidural meant she couldn't feel the contractions and had to be told when to push, but she...

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Age at interview: 40
Sex: Female
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It's difficult because I haven't really felt labour so - because I had the caesarean last time I never got to the second stage - so it's hard to compare. But I couldn't really feel anything. I didn't have any desire to push which, you know, you're, they say you have. And I had sort of, I had these pains in my ribs, so they got me on my side to try and alleviate the pain in the ribs, which worked. But I couldn't really feel anything, but the midwife was very good and she talked me through what I needed to do, like put my chin down on my chest and sort of really push hard and everything. She said, 'You won't feel like anything's happening, but it is.' And she would, they had a monitor on the baby's head by this stage and she said, and the cord, she said you could see it coming further and further out. It was, so she said, 'We can tell that it's working.' So she was keeping me informed of what was happening and that everything, I was doing everything correctly, otherwise I wouldn't have known anything, really. 

I mean, looking back over that because it was you suggesting that you have the epidural. It didn't sound like anybody had actually talked to you about whether this might affect your ability to have a...

Well

To be able to feel the push?

No. I hadn't, they didn't mention it to me, but I had spoken to other women who'd given birth with an epidural and I'd asked them what it was like. 

So I guess it's a toss up, isn't it, because it could have meant that... 

I know.

Because you couldn't feel the pushing it was...

It was. It was one, I knew the, what would happ-, that I wouldn't be able to feel anything, but on the other hand I didn't want to have a general anaesthetic if it went wrong. So it was, it was a difficult decision, but I'd rather it was that way. And in fact the pain was so intense when I got there it was quite, you know, secretly relieved that [laugh] I was having an epidural, really.

 
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Before the birth she worried about pain and the possible side effects from an epidural, but...

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Age at interview: 16
Sex: Female
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Did you have any pain relief during the delivery? Nothing?

No.

Didn't want any?

No. I was scared of the epidural because I was scared that it might paralyse us, because I've heard of it happening. And I didn't really, well, I didn't really need none. But everyone was saying to get the epidural because it was, the labour was so painful. But then when I, once I was in labour, before I went to the hospital I was, I'd been getting my pains like every five minutes for the past couple of hours, so I'd got used to it all. And I was just walking around the room, just to stop my legs from hurting. That was all.

So you found the pain manageable?

Yeah.

Was there ever a point in the pregnancy where you felt, I don't know, frightened or thinking, 'Oh, my God, what's going on?' or...?

Near the end. I think it was about a week before my due date.

Tell me about that?

I just, I was scared of the labour because everyone was saying that it was painful, so I was scared of that. And because everybody, nearly everybody else had had epidurals, they were just telling me to get one because I'll fly through it and it won't be painful and things like that. And it just frightened me, because my boyfriend's mum, when she had an epidural, they'd clipped her spine and left her paralysed for like a couple of days, and I didn't want to have the epidural just in case it happened to me. And then I didn't want the gas and air because, when I was watching it on the TV, it's the thought of the mask going on your face, I didn't like that. So I didn't really, I wanted pain relief like about a week before my due date, but then once I was in there, well, I was fine.

One woman was pleased to manage without an epidural because she wanted to be fully aware of the sensations of birth. Pethidine helped her more than gas and air, but some people liked gas and air. Other people found pethidine or gas and air could make them feel disoriented or sick, and a few vomited.

 

She was pleased to manage without an epidural because she wanted to be fully aware of the...

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Age at interview: 36
Sex: Female
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I had 50mg pethidine when I was about 5cm dilated. I did try gas and air then. I found the pethidine, it worked very well for about an hour. My plan beforehand was to just have gas and air but the problem with having been induced with a drip, because there are different ways of being induced, and being induced with a drip meant that I, I had to have bands across my belly to monitor, monitor the baby's heartbeat and that's very uncomfortable. Those, those become uncomfortable after about 20 minutes but I had to have them on throughout the labour and I wasn't able to move around as much as I'd hoped. And the contractions were being controlled completely by the midwife, who was controlling the drip so they did, they, traditionally they say they're very painful but - or more painful than natural contractions - but I'm sure that a contraction is a contraction however it's coming about and I won't know if there is a difference unless I have the opportunity to go through it again.

So, after the, the pethidine, that wore off after about an hour or two and then I did try to suck on the gas and air but I did find at that point I wasn't able to, to breathe properly, really. I was taking short, shallow breaths as you do when you're in pain. So really I used, I used the gas and air as a bit to bite on more than anything [laughing]. That was it's best use. And I did find it, I did find it all far more painful than I'd realised. I mean, incredibly painful. A pain that sends you to a different place mentally and, obviously, I'd never experienced that before.

Because in the modern world, if you're going to experience a pain like that then you'd be anaesthetised [laughing]. But I was determined that I didn't want to have an epidural because I realised that this might be my only opportunity to experience childbirth so I wanted to experience it. And by the time it came to pushing the baby out, about 5 hours had passed since I'd taken the pethidine so it had long since worn off. So I felt quite privileged to be able to feel the, to feel the whole, to feel the whole thing because I'd spoken to some friends who'd said they hadn't been completely aware of the moment of birth even, because there hadn't been enough feeling and I didn't want that to happen. So I was completely aware of, of all the movement and the moment of birth, etcetera.

 

The midwife kept telling her to take gas and air but she knew it would make her sick. Then she...

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Age at interview: 30
Sex: Female
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While this was going on, who was looking after you? Who was in the delivery suite with you?

I had 4 different midwives over the, the 2, 2 or 3 days and none of them I knew, not one of them. I'd never met any of them.

How were they?

One lady in particular was an older lady and she was like the first one to look after me. She was a little Irish lady and she kept saying to me, “Take the gas and air.” But I knew from the previous one that I couldn't take the gas and air because it makes me sick. And she kept putting this thing in my mouth and telling me to suck on it and I kept saying, “I can't because it makes me sick.” And she just didn't listen at all so eventually I took the gas and air off her, blew into it and then vomited all over her because she wasn't listening and I'd told her at least half a dozen times that I couldn't take it, it would make me sick. I had to show her, so I did.

So you made your point?

Yes.

Okay. So once you'd been sick all over her, I presume then she believed you, that you couldn't..

Yes, she did. Then she, you know, then, then I think she gave me a pethidine and then I was hooked up to a diamorphine, then I had another pethidine, I was hooked up to another diamorphine. 

Several people who tried a TENS machine said it had little effect or only worked for a while, but a few were very happy with it, including one woman who used TENS and gas and air to help with a painful induction.

 

She had a painful induction which was not what she wanted, but she was pleased to have managed...

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Age at interview: 36
Sex: Female
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So did you feel disappointed about the way the labour went?

No, I don't think so. I mean at the time it was, it seemed a very long time but I was quite, I mean my main priority was not to, not to have an epidural or to, you know, I wanted to be aware of the whole process. And that was fine, that, that happened. I suppose it would have been, it would have been nice if it had been shorter and if we'd had a more cooperative midwife for the bulk of it. But in fact, you know, I was very pleased that, that I'd done it sort of almost without too much intervention in terms of pain relief and, yes, no, I mean it was, it was fine really.

Tell me again what did you do for pain relief?

I just used a TENS machine which I'd hired myself and then gas and air in, that the hospital provided.

Do you want to just explain what a TENS machine is?

A TENS machine is, it's a machine that you strap onto your back that, with little sort of pulses that you can then control the flow, it's sort of electrical pulses that dampen down your pain sensations and you have control over how quickly or how strongly the impulses are sent to you. So you can actually sort of switch it on and off to help you through your contraction and it's, it does actually help quite, quite well to block the pain out. And you can hire it in advance so you practise with it, but then obviously when the, when you're in labour it's, it's a whole new experience [laugh] sort of trying to work out when the contractions are coming and operate it. But, no, it was, it was quite useful.

Several people who had an induction said the contractions seemed especially painful and intense (see Interview 16 above). One woman was in so much pain she could not keep still enough for an epidural, and also had a painful episiotomy (a cut in the skin between the vagina and anus to help the baby's head out).

 

She was in so much pain she could not keep still enough for an epidural, and also had a painful...

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Age at interview: 27
Sex: Female
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They put this jelly up inside you and, basically, that brings on the contractions, brings, makes you contract straightaway. So I was contracting straight away and that wasn't too bad. And they were really, really busy, I remember, and the midwife kept buzzing off and leaving me, me and my partner. And sometimes we were left like a couple of hours at a time, which wasn't too good. I wasn't impressed about that bit, actually. And yeah, the contractions, they obviously got more and more stronger as the day went on and the birth itself, because, because I was induced, the contractions started to get quickly, more quickly than we thought and I really wanted to have - oh God, what was it called? A - oh, the pain relief when they inject you in the back, what that's called?

Epidural?

Epidural, yeah, and I really wanted an epidural and by the time the anaesthetist had come round and to do it, because they were so busy, it was too late, basically. And he was trying and trying, he tried to put the needle in my back about 10 times and it's a big, thick old needle and I just couldn't keep still for him to do it because I was contracting too quickly. So in the end I had to have him naturally. I didn't like the gas and air at all and I thought it was horrible so I, I couldn't, couldn't have that either. It made me feel sick. And yeah, so like I say, he come, he come out naturally and it was quite painful.

So you had no pain relief at all?

No pain relief at all and they had to, to cut me all the way to my bottom, basically, and that was quite horrific. But the actual birth itself didn't, didn't hurt. It was the contractions and this guy trying to put needles in my back [laughing]. That was the most painful thing, definitely. And also afterwards, it took an hour and a half for my placenta to come away and I had various people tugging on it and injecting me and oh, that, and that was the worst bit, actually, the stitches afterwards and the placenta, trying to remove the placenta. That was definitely the worst bit and that, that was it, really. But I'm sure people have had worse pregnancies but that seemed quite bad [laughing]. Not pregnancies, births, that seemed quite, quite bad to me for a first one. I just wish I had pain relief. That would have been much better, I think, definitely. 

Having stitches or internal examinations can also be painful. One woman said the midwife's attempt to rupture her membranes to speed up labour was very painful, so it was postponed until she had an epidural.

A few people were upset that staff did not seem to realise how bad the pain was and seemed unsympathetic.

 

A midwife upset her by saying she was not coping well with the pain. At one point it was...

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Age at interview: 36
Sex: Female
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And we had a couple of bad experiences in the middle. I mean, I wasn't coping very well with the pain, but that's, you know, a very subjective experience, because nobody knows the pain I was feeling, and I don't know the pain anybody else is feeling. So really, nobody can say, 'You're not coping.' But the midwife actually spoke to a doctor in front of me, and said, 'She's not coping very well with the pain', which made me feel I was a very bad person. And I'd tried everything. I'd had paracetamol, pethidine, baths, TENS machine, epidural, absolutely everything. The epidural was fine, but nothing was happening. And after about, I think it was about 7 o'clock the next evening, so I'd been through the whole day in labour, about 7 o'clock they decided to start giving me I think it's Syntocinon [oxytocin], which speeds up the contractions.

Anyway, I had an epidural so I'd had a little bit of sleep, but still I was incredibly tired, because it was now Saturday evening and I hadn't slept since Thursday night. And I did ask several times if I could have a caesarean, you know, would they consider it? And I kept being told, 'Well, we think we should try for another 4 hours. We don't give caesareans based on family history. It's much better for you to have this baby naturally, so let's keep going'. And at that point, I was quite happy to do so because the epidural was working quite well.

Then suddenly it stopped working and the pump on the epidural box failed, and an anaesthetist came up to try and fix it, and said it was working absolutely fine and he left. And I was still in absolute agony, and I kept saying to the midwife, 'Can you please do something about this? I'm in absolute agony', you know, my hips felt like someone was dislocating them. You probably don't really want this on your tape, it's putting people off having babies [laughs]. But eventually some, another anaesthetist, a more senior anaesthetist came up and said, 'I'm not surprised you're in agony because this epidural pump is obviously broken and it clearly hasn't been working for a few hours.' And she said 'I'll fix it for you', by which point I'd just had enough. It was now 3 o'clock on Sunday morning and I said, 'I'm sorry, I cannot wait any more. I'm not prepared to try another 4 hours. I want you to give me a caesarean at this point'. And they did eventually come back, and the doctor sort of came in and examined me and said, 'OK, we'll give you a caesarean'.

(See also 'Looking back - vaginal birth' and 'Looking back - caesarean birth').

For more information see our pregnancy resources.

Last reviewed May 2017.
Last updated
May 2017.

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