Labor pain relief 

Pain Relief in
Labor and Childbirth

Pethidine Epidural Entonox?



The Pain Relief for Labor

It is a good idea to be aware of the options for pain relief that are available and to know something about the different methods. You may have a plan for how you hope to manage your labor, but it is best to be prepared to be flexible.

It's great to have a plan, but it's also OK to change it if you need to.

Labor and childbirth is usually a painful experience and women vary in their response to it. Some women are keen to avoid drugs or other medical interventions while others are happy to consider all available options. For a woman having her first baby, the experience of labor (and her reaction to it) is unpredictable.

Labor is divided into three distinct stages:

In the first stage of labor, the cervix dilates (opens) and effaces (thins), allowing the descent of the baby toward birth. The first stage of labor lasts, on average, about 16 hours.
[ maybe longer for first time moms ]

During second stage of labor, the baby passes through the birth canal and is born. The second stage of labor, on average, lasts about one hour.

The third stage of labor involves the delivery of the placenta. These stages are not equal in time or intensity and every birth will follow its own pattern.

- Easy to use Contractions Timer with contractions log print out.

What Pain Relief to ask for during childbirth.

There are three different types of pain relief available generally, and which one you go for depends on how far dilated you are at the time.

  • Pethidine - Latent (Early) stage, before 3 - 4 cm dilation.
  • Epidural - Beginning of the active stage, 3 - 4 cm to 7 - 8 cm dilation.
  • Entonox (Gas and Air) - 8 cm onwards, or while waiting for an epidural.


Pethidine is a pain relieving drug which is given as an intramuscular injection (into your thigh or buttock) and can be given by your midwife. It will start to kick in within about 20 minutes and will last for between two and four hours.

Pethidine is useful in the early stages of labor if exhaustion is more of a problem than pain. For instance, if you have been without sleep because of the contraction and have been pacing around the house for the last two nights and you arrive at hospital exhausted and tearful. It is also useful for pain relief when it is too soon to have an epidural.

The disadvantages to pethidine are:

  • It makes some people feel sick - so you may be given an anti-emetic drug (anti-sickness) at the same time. If you do not like the effects of feeling 'out of it ', you are stuck with it until the drug wears off.
  • It crosses the placenta, so if your baby is born within about three hours or so of you having been given pethidine, baby will be a little drowsy and can effect the breathing; if this happens, another drug to reverse the effect will be given. This is one reason for not having it after you are 3-4 cm dilation.


This is a local anaesthetic, injected into your spine, which completely removes the pain (well, for nearly everyone). The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief.

The advantage of epidurals is that you do not get that 'out of it ' feeling and your baby, and your brain should be fully alert. The best time for an epidural is when you are between 3 and 8 cm dilated. It can be given afterwards, but, 8 cm is leaving it a bit late.

It is important to bear in mind that an aneasthetist will have to be called to set it up. On a labor ward there may be many women who need the aneasthetists help, so they may take up to an hour or so to arrive if they are busy with someone else.

The disadvantages to epidurals are:

  • An epidural will lower the blood pressure, to compensate, most women are given a litre of fluid via intravenous drip in the back of the hand. This will take about 30 minutes to be absorbed and keep their blood volume stable.
  • Your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby's head.
  • It is safer to have an epidural than it is to have a baby. Very, very occasionally, there is a small problem when the epidural needle 'nicks' the membrane that surrounds the spinal cord (dura), and this is called a dural tap. This does not cause permanent paralysis, but can give you a bad headache. After delivery this 'nick' can easily be fixed by taking a small amount of blood from a vein and injecting it into the epidural site.


Also known as Gas and Air (Nitrous oxide and Oxygen), Entonox is a quick acting pain relieving agent which you inhale via a mouthpiece or mask. 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.

Many women like it because it's easy to use and they control it themselves. Gas and air is the most popular method of pain relief used for labour. About 80 per cent of women use it to help them cope. There are no harmful side effects for you or the baby.

The disadvantages of Entonox are:
  • It can make you feel light-headed
  • Some women find that it makes them feel sick, sleepy or unable to concentrate - if this happens, you can stop using it.

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



The First Stage of Labor

Most likely what will happen when you go into labor is that you will begin to feel contractions. With some women the water breaks, and then they begin to have contractions. In the first stage of labor, the cervix will dilate from closed, which is its normal state, to fully open at 10 cm in diameter.

In mothers having their first child, this stage usually lasts 12 to 16 hours.
For women having second or subsequent children, the first stage lasts around 6 to 7 hours.

Stage one can be divided into three phases:
Early labor (dilation up to 4 cm), active labor (4 cm to 8 cm) and transition (8 cm to 10 cm).

The early phase:
During this early phase of labor, you may feel excited and nervous now that the moment that you have been waiting for has finally come. This phase typically lasts around half of the time most women are in labor, so it gives you the chance to telephone people, get your partner back from the golf course or supermarket, and hunt down the crossword you didn't finish this morning.

labor pillow kneesYou may want to rest, walk, shower, or eat lightly. It is very important to keep hydrated by drinking lots of water and juice. You may experience leaking of amniotic fluid or 'show', the expulsion of the plug which may be stained with blood that has kept the cervix sealed.

Contractions in early labor become regular in their occurrence, from 10 to 20 minutes apart and lasting 30 to 60 seconds. Contractions are measured from the beginning of one to the beginning of the next.
early phase labor
  • The cervix dilates between 0 and 4 cm.
  • Contractions start farther apart, 10 to 20 minutes apart.
  • Contractions are short only lasting 30 to 60 seconds long.
  • Contractions radiate from back to front.
  • She will be excited, talkative, having spurts of energy.
  • Mother usually stays at home or somewhere she feels comfortable.
  • The bag of water or amniotic sac is usually intact.
  • Primary effacing (or thinning out) phase.
  • Early labor is on average half of labor time, 2 to 20 hours.

The active phase:
Active labor is the next phase, and you will notice a change when you hit this stage. contractions become regular and form a pattern of increasing frequency. You will do best if you are able to relax and concentrate on what your body is doing. Stay active, just as it is called. Relax during your contractions, with simple, regular breathing patterns. They will not stop with change of movement or position and they become progressively stronger.

birth ball laborpillows chair knees labor
Keep moving and changing positions, using gravity positive postures. Discomfort can often be helped by body positions that allow gravity to speed dilation, such as walking, squatting, kneeling forward on a chair or birth ball, or lying on your side. This will help the baby move down in the pelvis faster and less painfully.

  • Dilation 4 to about 8 cm is completed.
  • Contractions closer together 3 to 5 minutes apart.
  • Contractions are lasting longer 60 to 90 seconds.
  • Mom becomes more serious, quiet, apprehensive.
  • Mother should proceed to her birthing facility once this stage has been established.
  • A bloody show may occur with cervical dilation or after a vaginal exam.
  • (Remember a bloody show is normal. A large amount of bleeding is not).

The transition phase:
Though labor may be difficult at this point, you are getting close to the birth of your baby as you enter that final phase of stage one, known as transition. Transition, or the turning point right before birth is the hardest and most intense. It is also the shortest of the 3 stages, lasting from 10 to 45 minutes.

You will have a contraction every two minutes or so and each one will last a minute or more. You may at this point decide to yell and holler. The tried and true method is to squeeze your partner's hand until he is yelling too, or to tell him what a bastard he is for getting you in this condition.

This is your body's last effort to open the cervix fully to allow for birth. Your hormones are working with your baby's at full speed to prepare for delivery. Once you have dilated to 10 cm, you will begin taking an active participating role in what your body is doing.
transition phase labor
  • Dilation 7 to 10 cm is completed.
  • Contractions are close together 1 to 3 minutes.
  • Contraction are lasting 90 to 120 seconds, with possible multiple peaks.
  • Mother is tired and irritable.
  • Mother may cry and begin to lose control at this time.
  • She may panic or feel disoriented.
  • Feeling a lot of rectal pressure.
  • Nausea and vomiting may occur.
  • Uncontrollable trembling of the legs.
  • Hot or cold flushes.


The Second Stage of Labor - Birth

Second Stage LaborYou have finally arrived at the second stage of labor - the birth. Your body will feel the urge to push the baby out and you will bear down in order to bring your baby into the world. The baby's head will appear as the baby is 'crowning' and your medical attendants will guide you through the last few pushes to deliver your child.

There is no one correct position for pushing. There are several, each with advantages and disadvantages. It is highly recommended that you practice each one, through a couple of practice contractions, just to see for yourself whether you find them comfortable, or practical. Do not actually practice pushing, as this can put unnecessary strain on your cervix.

The second stage of labor usually takes a couple of hours for new moms; women who have already had children may shorten that time somewhat.


The Third Stage of Labor

Between 5 minutes to 1 hour after your baby is born, you will complete the third stage of labor by delivering the placenta and membranes that have nourished and contained your baby throughout your pregnancy. These contractions are milder and occur as you are marveling at your child and feeling the support of your loved ones and caregivers.

However these stages progress, your experience will be unique to you and your child and will be the beginning of a beautiful new stage in the life of your family.

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