There is no universal way to describe labour pain. For some women, contractions may feel like intense menstrual cramps that gradually become stronger. For others, the sensation may be more concentrated in the lower back, pelvis or abdomen.
The position of your baby, the strength and frequency of contractions, how long your labour lasts, whether labour is induced, and your previous experiences can all influence how labour feels.
Your emotional environment matters too. Feeling frightened, unsupported or uncertain can make an intense experience feel even more overwhelming. Feeling informed, safe and supported can help you feel more in control.
This is why pain relief during labour is not simply about “how much pain you can tolerate”. It is about having access to appropriate options and being able to make decisions that suit your circumstances and preferences.
The World Health Organization (WHO) recommends that women receive woman-centred care during labour, including appropriate information about pain relief and access to both pharmacological and non-pharmacological methods (WHO, 2018).
Options That Do Not Involve Medication
Non-medication approaches can be used on their own or alongside medical pain relief. They can also give you something active to focus on during contractions.
Depending on your maternity setting and your individual circumstances, you require a specific set of things and there are non-medicated options available.
These options may include:
- Controlled breathing and relaxation techniques
- Movement and changing positions
- Massage or counter-pressure
- A warm shower or bath
- A birthing ball
- Music or mindfulness
- Continuous emotional and physical support
- Water immersion where available
These approaches do not necessarily remove the sensation of contractions. Instead, they may help you cope with the intensity and create a greater sense of control.
Evidence for individual techniques varies. A Cochrane overview found some evidence that immersion in water, relaxation, massage and other non-pharmacological approaches may improve labour pain or satisfaction, although the quality and quantity of evidence differs between techniques (Liu et al., 2019).
Continuous support can also make a meaningful difference. A Cochrane review involving more than 15,000 women found that women receiving continuous support were more likely to have a spontaneous vaginal birth, less likely to report a negative childbirth experience and less likely to use intrapartum analgesia (Bohren et al., 2017).
This does not mean that support replaces pain medication. Rather, it highlights the importance of the environment around you.
Options That Involve Medication
Nitrous Oxide: A Lighter Form Of Medical Pain Relief
Nitrous oxide, sometimes called “gas and air”, is inhaled through a mask or mouthpiece during contractions. It does not completely numb labour pain. Instead, it can make contractions feel more manageable and may help reduce anxiety around them.
One of its advantages is that you control when you inhale it. It also wears off relatively quickly once you stop using it. Some women experience nausea, dizziness or drowsiness. Its availability and the way it is administered vary between maternity units.
Nitrous oxide can be particularly useful for women who want some medical pain relief while remaining relatively mobile and actively involved in their labour.
Opioid Pain Relief: Another Option During Labour
Opioid medications can be given during labour to reduce pain and help you relax. Depending on the medication used and local protocols, they may be given by injection or through an intravenous route.
Examples include medications such as fentanyl or other opioid analgesics.
They can be useful when stronger pain relief is needed but an epidural is not wanted or is not appropriate. However, opioids can cause side effects such as drowsiness, nausea, dizziness and vomiting. Because opioids can cross the placenta, timing and dosage are considered carefully, particularly close to birth.
WHO includes parenteral opioids among the available pain-relief options for healthy pregnant women requesting pain relief during labour, depending on individual preferences and circumstances (WHO, 2018).
Your obstetric team will consider factors such as how advanced your labour is, how close you may be to delivery and your baby’s condition when discussing whether an opioid is appropriate.
Epidural Analgesia: Powerful Pain Relief When You Need It
An epidural is one of the most effective forms of pain relief available during labour.
An anaesthetist places a fine catheter into the epidural space in your lower back. Medication can then be delivered through the catheter to reduce pain from contractions while allowing you to remain awake and involved in the birth.
An epidural does not necessarily mean that you will be completely unable to move. Modern low-dose techniques can allow some movement, although the amount of sensation and mobility varies depending on the medication, dose and individual response.
It can take time to insert and establish an epidural, so if you think you may want one, it is worth discussing this with your obstetric team before labour.
The latest patient guidance from the Royal College of Anaesthetists notes that epidurals do not make caesarean birth more likely and do not cause long-term back pain. Around 90 out of 100 women in the evidence presented did not require additional pain relief, while approximately five out of 100 required the epidural to be re-sited (Royal College of Anaesthetists, 2025).
As with any medical procedure, epidurals have potential side effects. These can include temporary low blood pressure, difficulty passing urine, itching, fever or headache. Rare complications can occur, which is why epidural analgesia should always be discussed with an appropriately trained anaesthetist.
It is also worth noting that evidence has evolved over time. An earlier Cochrane review found epidurals provided better pain relief than non-epidural methods but were associated with some increased interventions, including instrumental birth in the studies reviewed (Anim-Somuah et al., 2018). Current Royal College of Anaesthetists guidance, based on more recent evidence, does not find that epidurals increase the likelihood of forceps or ventouse delivery.
This is one reason why conversations about birth interventions should be based on current evidence rather than old assumptions.
How Medical Pain Relief Can Affect the Hours After Birth
Pain relief can make labour more manageable, but some forms of medical pain relief can also have effects that continue for a short time after your baby is born.
The effects depend on the medication used, the dose, how close to delivery it was given and how your body responds.
For example, an epidural can temporarily affect your leg strength and sensation. You may need assistance moving around until the medication has worn off, and you may have a urinary catheter while the epidural is in place because sensation in the bladder can be reduced. Your blood pressure may also be monitored closely because epidural medication can sometimes cause it to fall.
Opioid medications can cause drowsiness, dizziness or nausea in the mother. When opioids are given close to birth, some of the medication can cross the placenta and may temporarily affect a newborn’s alertness or breathing. This is one reason your healthcare team considers the timing and dose carefully.
Nitrous oxide generally wears off quickly once you stop inhaling it, so its effects are usually short-lived.
Importantly, experiencing these effects does not mean that you have made the wrong decision. Pain relief is used because it can provide meaningful benefits during an intense and unpredictable part of birth. Your healthcare team will weigh those benefits against potential side effects and continue monitoring both you and your baby.
The hours immediately after birth are also a period of transition. You may be tired, emotional, shaky or simply relieved. Your mobility, alertness and comfort may change as medication wears off and your body begins recovering from labour.
This is why postpartum monitoring is part of good maternity care — not an indication that something has gone wrong.
How Do You Decide What Pain Relief Method Is Right for You?
There is no single pain relief option that is best for every woman.
Your decision may depend on what matters most to you, how your labour is progressing and what is medically appropriate at the time.
Before labour, it can help to think about your preferences across three areas:
What matters to you?
Perhaps remaining mobile is important to you. Maybe your priority is having the strongest possible pain relief, or perhaps you want to begin with breathing, movement and other non-medication approaches and reassess as labour progresses.
There is no wrong priority.
What is medically appropriate for you?
Your medical history, pregnancy, baby’s wellbeing, stage of labour and any complications can influence which options are available or advisable.
For example, an epidural may be particularly valuable when a woman wants or needs substantial pain relief, but certain medical circumstances may affect whether regional anaesthesia is appropriate.
What is available where you are giving birth?
Pain relief options differ between hospitals and maternity units. Some facilities may offer epidurals, nitrous oxide, injectable medications, water immersion and other approaches, while availability can depend on staffing, timing and clinical circumstances.
Understanding this before labour can prevent an unexpected lack of access from becoming an additional source of stress.
Think of your birth plan as a framework, not a promise
It is completely reasonable to enter labour with a preference. It is equally reasonable to change that preference. You might begin with breathing, movement and massage, then decide that you would like medication.
You might initially want an epidural and later decide that you are coping well without it. You may have a strong preference but need to adapt because of how your labour or your baby’s condition develops. Your decision is not a test of strength.
A good birth plan leaves room for informed flexibility.
The most useful question is not:
“How do I avoid pain medication?” Or “How do I make sure I get an epidural?”
The most useful questions include:
“What options are available to me, what are their benefits and risks, and what might work best for me in the circumstances?”
This approach allows you to make decisions based on your own values rather than expectations from social media, family members, friends or other people’s birth stories.
Your obstetrician, midwife and anaesthetist can help you understand the options, but the decision should be made with you — not simply for you.
There Is No Prize For Giving Birth Without Pain Relief
One of the most important things to remember is that choosing pain relief is not a measure of how well you have given birth.
Some women enter labour hoping to use breathing, movement and other non-medication approaches. Others know from the beginning that they would like an epidural. Some change their minds once labour begins.
All of these experiences are valid. A birth plan can help you communicate your preferences, but it should not become a test you have to pass. Labour is unpredictable, and circumstances can change quickly.
You may plan to avoid medication and later decide that an epidural is the right choice. Equally, you may plan to have an epidural and find that you are comfortable using other approaches instead.
The goal is not to follow a perfect plan. The goal is to have a safe birth in which you understand your choices and feel supported in making them.
From The Consulting Room
We often encourage women to think of their birth plan as a conversation rather than a contract. You do not need to decide exactly how your labour will unfold months in advance, but you need to know your options and possibilities available to you.
The Best Pain Relief Plan Is One That Can Change
Learn what is available, understand the advantages and limitations of each option, discuss your preferences with your healthcare team and give yourself permission to adapt.
Pain is personal. So is birth. What matters most is that you have access to safe, appropriate care — and that you feel empowered to make informed decisions as your labour unfolds.
How To Prepare For Your Pain Relief Preferences
Before labour, we see women unsure of where to go in the case of making a decision that would be suitable. You don’t have to have it all figured out because your team is there to guide you and make the important decisions with you.
For your own peace of mind and clinical understanding of what would potentially need to be done for you, consider discussing these questions with your obstetrician or maternity team:
What pain relief options are available where I am giving birth?
Not every hospital or maternity unit offers exactly the same options.
When can I request an epidural?
Understanding how the process works can help you make decisions before you are in the middle of a contraction.
Will an anaesthetist be available 24/7?
This is particularly important if you are considering an epidural.
What happens if my preferred option is not suitable?
Knowing your alternatives can make unexpected changes feel less overwhelming.
Can I change my mind at any point?
In most circumstances, your pain relief plan can adapt as your labour progresses, provided the option remains medically appropriate.
Your healthcare team should explain your choices, benefits, risks and alternatives in a way you can understand. Good maternity care is not simply about managing contractions. It is about helping you feel informed, respected and involved.
The Maxima Takeaway
Pain relief is a medical tool. Used appropriately, it can help you rest, cope, participate in your birth and feel more comfortable during an intense physical experience.
At the same time, every intervention has potential benefits, limitations and side effects. The right choice depends on you — your health, your pregnancy, your labour, your preferences and what is available at the time.
The most empowering thing you can take into labour is not a rigid plan. It is knowledge. Know your options. Know what matters to you. Know what may change during labour. Know that you are allowed to change your mind.
Your healthcare team is there to help you navigate those decisions safely, not to judge the way you choose to experience birth.
Ready To Feel More Prepared For Birth?
Talk to your obstetrician about your pain relief options before labour begins.
Book a consultation with Maxima Women’s Health to discuss your pregnancy, birth preferences and questions about labour.
A conversation during pregnancy gives you time to understand your choices without having to make decisions in the middle of a contraction.
Your birth does not have to follow someone else’s plan — it should be informed by your health, your baby and your choices.
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