Epidurals and pain relief in labour

First, the options: a quick map

Pain relief in labour comes in two broad families: things you do (breathing, movement, water, a doula, the right positions) and things the hospital gives you (gas and air, injections, and the epidural). Most women use a combination — perhaps breathing and a birth ball in early labour, and an epidural later if they want to rest. There is no prize for using fewer tools.

It's worth knowing that availability differs between hospitals. Many offer epidurals around the clock, but not every hospital keeps an anaesthetist on site at all hours, and gas and air (Entonox) is not universally available. Ask your hospital early: Is an epidural available at any hour? Is Entonox offered? These two questions should be part of your hospital decision, not a surprise on the day.

Non-medical comfort: powerful, and the foundation of everything else

Before the medical options, know that how you're supported changes how labour feels. Movement and upright positions let gravity work and shift the pressure; warm showers relax tight muscles; breathing techniques slow the rush of adrenaline that makes contractions feel sharper; and steady, calm support — a doula, a prepared partner, a kind midwife — measurably lowers how much pain women report.

These tools work at every stage and even alongside an epidural: before it's placed, in the hour it takes to reach full effect, and if it needs topping up before a caesarean. See breathing in labour, labour positions that actually help and the fear–tension–pain cycle for the practical side.

• Movement and position changes — free, always available, and often the fastest relief.
• Warm shower or bath — ask what water facilities are available and when they can be used.
• Breathing and relaxation — can support calm, rhythm and pain coping.
• A TENS machine — small pads on your back deliver pulses that you control; ask whether you should bring your own.
• Touch, counter-pressure and encouraging words from a doula or partner — underrated and effective.

Gas and air (Entonox)

A 50/50 mix of oxygen and nitrous oxide that you breathe through a mouthpiece or mask, in and out with each contraction. It takes the edge off rather than removing pain — most women describe it as helping them feel calmer and a little distant from the contraction.

It works and wears off quickly, so you control when you use it and can stop at any moment. Research has not shown important effects on labour progress or newborn wellbeing when it is used as intended. Some women feel light-headed, drowsy or nauseated. Availability varies, so ask your hospital rather than counting on it.

Injections: pethidine and similar opioids

An injection into your thigh or buttock (usually pethidine or a similar medicine) that helps you rest and relax through strong contractions. It's less common now than it once was, because it can make you feel drowsy or sick and, if given close to birth, can briefly affect your baby's breathing — hospitals time it carefully for that reason.

It usually takes the edge off rather than making labour pain-free and is less effective than an epidural. Some hospitals use it when a woman is exhausted and needs rest. Ask what your hospital offers, how timing matters, and what monitoring your baby may need afterwards.

The epidural: how it actually works

The epidural is the most effective pain relief available in labour and often removes most contraction pain, although some blocks are patchy and need adjustment or replacement. A thin, flexible tube (catheter) is placed in your lower back after the area is numbed; medicine can then be adjusted or topped up. You stay awake and may still feel pressure, although sensation and the urge to push vary.

It involves an intravenous line, regular blood-pressure checks and continuous monitoring of the baby's heart rate. Placement and full effect commonly take around 30 minutes altogether, but timing varies with the anaesthetist's availability and how easily the epidural is placed.

Honest answers to the questions women actually ask

Does it slow labour? It can lengthen the pushing stage. Evidence does not show that epidurals increase caesarean birth. Older studies found more forceps or ventouse births, while results with modern low-dose epidurals are less clear. Turning an epidural down routinely for pushing has not been shown to improve outcomes and may allow pain to return, so this should be an individual discussion.

What are the side effects? Blood pressure can drop, so it is checked frequently and treated if needed. Itching, shivering, nausea, fever, difficulty passing urine and temporary heavy legs can occur. A severe post-dural-puncture headache is uncommon but needs assessment and treatment. Epidurals are not shown to cause long-term back pain, although temporary soreness at the insertion site can occur.

Will it affect my baby or feeding? Serious newborn effects are uncommon. Research on breastfeeding is mixed because epidural use is difficult to separate from labour length, other medicines and birth circumstances. Skin-to-skin and skilled feeding support are useful after any birth, especially if either parent or baby is sleepy.

Am I too late? Usually not. Epidurals are placed in active labour at almost any dilation, even very late, as long as there's time for the anaesthetist to arrive and for it to take effect. And you can ask at any point in labour and still change your mind.

Deciding without pressure — in either direction

There is no virtue in white-knuckling labour, and no shame in an epidural. Equally, some women deeply want to feel their birth without one, and that is worth protecting too. The decision that serves you is the one made with information, not fear or pressure from anyone — including well-meaning friends and social media.

A useful exercise: write two sentences in your birth preferences — what you'd like, and what would need to change for you to accept the other option. For example: "I'd like to try without an epidural using breathing, movement and support; if labour becomes very long or I'm exhausted, I'm open to an epidural and would like to discuss it." This is your decision, and a sentence like this tells your team and your partner exactly how to support you. Your birth partner and doula can help you talk it through in the moment — reminding you of your wishes, explaining what's being offered, and supporting you fully whichever way you go.

How a doula fits in when you have an epidural

Some women worry that asking for an epidural means they no longer "need" support. The opposite is true. While it is placed and takes effect, calm information and reassurance still matter. Afterwards, support can focus on rest, regular supported position changes, preparing for pushing, and protecting the golden hour. The catheter is removed after it is no longer needed; return of strength and safe mobility varies, so wait for the clinical team to help you stand.

Whether you use every comfort tool in the hospital or ask for an epidural in the first hour, my support is exactly the same: book a free discovery call and we can talk through your hospital, your wishes and what support looks like for your birth.

Comparing common options at a glance

There is no single best option. The right choice depends on how you feel, how labour is unfolding, your health, and what is available where you give birth. You can combine options and change your mind.

• Movement, breathing, massage, TENS and continuous support — Benefits: keep you mobile, can begin immediately and can be combined with medical pain relief. Considerations: usually help you cope rather than remove pain, and TENS appears most useful in early labour. Ask: Which positions and comfort tools can I use with your monitoring equipment, and may I bring my own TENS machine or doula?
• Warm water — Benefits: a bath, pool or shower may improve relaxation and pain coping, and labour immersion is associated with less use of some medical pain relief. Considerations: a pool may not be available or suitable in every situation; water immersion during labour and giving birth in water are separate choices. Ask: Do you offer a pool or shower, when can I use it, and what circumstances would mean leaving the water?
• Gas and air (nitrous oxide/Entonox) — Benefits: works quickly, wears off quickly and is controlled by you. Considerations: usually reduces pain rather than removing it and may cause dizziness, nausea or drowsiness. Ask: Is it available here, when can I start, and can I use it alongside movement or other options?
• Opioid medicines such as pethidine — Benefits: may reduce distress and help with rest when labour is long or exhausting. Considerations: usually provide partial relief, may cause nausea or sleepiness, and medicines given near birth can temporarily affect the baby's alertness, breathing or early feeding. Ask: Which medicine do you use, how long does it last, how does timing matter, and what monitoring would follow?
• Epidural — Benefits: the most effective labour pain relief and can be adjusted or topped up. Considerations: takes time to place and work, requires closer monitoring and usually limits independent walking; side effects can include low blood pressure, itching, fever, difficulty passing urine or incomplete pain relief. It can lengthen pushing, while evidence does not show that it increases caesarean birth; findings on assisted vaginal birth vary with technique and study period. Ask: How quickly is an anaesthetist usually available, what monitoring and movement will be possible, and what happens if the block is patchy?

Evidence and further reading

This overview has been checked against reliable clinical evidence. You can read the Cochrane review of epidural pain relief for further information. These are general findings, not personal medical advice; your own benefits and risks depend on your health and labour.