It is always best to decide in your birth plan which methods of pain relief you want and which you want to avoid. This is because it allows you to make the decision with a clear head having carefully weighed up the pros and cons.

On the day, however, be prepared to change your plans. You never know (even if this is not your first baby) how you will cope with the pain. You should not rule out any form of pain relief unless you are positive you do not want to use it. On occasion the choice may be taken out of your hands, for example the need for a general anesthetic or an epidural if an emergency C-Section is needed.

So what are your options?

Entonox: Entonox is more commonly known as “gas and air” and is one of the forms of pain relief with the least side effects but also with the lowest level of pain relief. It is a 50/50 mixture of oxygen and nitrous oxide. It is inhaled through a tube which you put to your mouth whenever you want some.

Entonox does not so much stop the pain as it does change your perception of both pain and time. It is similar to being slightly drunk. Most hospitals will let dad have a try too! You begin to inhale as you feel a contraction start then take a break between contractions. You are often asked to stop when you begin the pushing stage of labour as it can slow down your reactions and sense of urgency which in turn means that you aren’t pushing hard enough.

Pros: You are in control, you can stop it as quickly as you want, it passes through your system very quickly, it contains oxygen which is good for you and baby, you do not block out the feeling of the contractions, it can be used for home births, hospital births and water births

Cons: It is the least strong pain relief, it can make you thirsty, it can make you feel sick, it is not ideal for people who do not like the spaced out feeling of being drunk

Pethidine: Pethidine is a drug which is a pain killer and an anti-spasmodic so it helps with the pain and helps you to relax. It can be used with Entonox or on it’s own. It is similar to morphine and is administered via injection or intravenously. Pethidine can be used in the first stage of labour but not in the final stages as it can harm your baby.

Pros: It heps you relax, it is an effective pain killer, it is used by some midwives for home births

Cons: It can make you feel sleepy, dizzy or sick, it can slow down labour, it can’t be used in the final stages of labour, it can affect baby’s breathing or make him/ her sleepy for a few days after birth, you and baby may struggle to get started with breastfeeding

Epidurals: Epidurals are administered via a thin tube which is inserted (through a needle which is then removed) between the vertebrae in your spine. It numbs the lower half of the body (often including your legs) and stops all contraction pains. Although you can have an epidural at any time most midwives advise not to bother in the final stages of labour as baby will usually be out by the time the epidural has been arranged and taken effect.

Pros: It is a complete pain blocker, you stay alert and are often better able to remember everything about the birth, it can provide a relaxing stress free delivery, you are already prepped in case a C-Section is needed

Cons: It may not always work e.g. only parts of your body may go numb, it can be frustrating to have numb legs, you may go shivery, you are restricted to your bed, you may need a catheter, it can increase the length of the labour, you do not get the same urge to push, you may have several tubes in your body (the epidural, a catheter and a drip), the chance of a forceps or ventouse delivery are increased, some women have headaches or trouble passing urine afterwards, if the staff aren’t avaiable when you go into labour you may not have the option of an epidural

Mobile Epidurals: A mobile epidural is similar to an epidural but with lower dosage. This means that the legs are less likely to be numbed allowing you to walk around. You can opt for a mobile epidural in early labour.

Pros: A high level of pain relief but maintained mobility, more able to push and less likely to need an assisted delivery than with an epidural

Cons: There may still be reduced movement, you may be itchy and have difficulty passing urine, you may still need an assisted delivery, you may still have trouble pushing effectivley

TENS: Transcutaneous Electrical Nerve Stimulation is administered via a TENS machine, a small box which is attached to parts of the body with wires and pads. Electrical impulses are sent through the wires to nerve endings to prevent the pain messages which are being sent by your womb and cervix from reaching your brain. You put a pad on either side of your spine at bra level and one at either side of the base of your spine just above your buttocks. You can then control the stength of the pulses. It should be used from as early in labour as possible as it can take an hour to take effect.

Pros: It is completely drug free, you can control the pulses, you can still use other forms of pain relief, there are no side effects, it can be used at home and you can practice when getting Braxton Hicks or in very early labour, it can be used after the birth for any adult suffering from muscle pain

Cons: Not everyone likes the sensations, not everyone feels like it works for them, it may become annoying or not enough in late labour, very few hospitals make them available so you will have to buy or hire one (from the internet or your local pharmacy), it may disrupt the monitor used to check your baby’s heartbeat, you cannot use it for water births

Spinals: Spinals are an injection of local anesthetic into your spine. They can be used to numb the pain of pushing or assisted deliveries and also numb the pain of contractions.

Pros: Quick, simple, effective pain relief

Cons: Only lasts a couple of hours, you can’t feel your legs, you may get a headache, feel ithchy or shivery or have difficulty passing urine, you can only have one

Armed with the facts you can now make an informed decision but if you still do not know what you want do not worry. When you go into labour you will get a better idea of what pain relief you want and your midwife can help you to decide. A good approach is to start with Entonox or TENS then decide as you go along whether you want something stronger. Just remember the time limits for some of the methods of pain relief.