VBAC (Vaginal birth after C section)
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Alison Ross
Registered Midwife, DipHe, BSc (Hons) Was a midwife at Kingston Hospital and Specialist Midwife in Perinatal Mental Health.
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Birth and labour

What are the different pain relief options available?

Every labouring woman has her own unique experience of birth. Some find they sail through with no pain relief and others need a lot of help – there is no right or wrong approach.
In Short
Don’t assume that what your friends say was right for them will suit you or your particular labour.

For example, you might have a very straightforward birth yet still feel the need for an epidural.

It's a good idea to learn about the options in advance and keep an open mind.

Pregnant women can come under a lot of pressure from other people – who might tell you that you will be failing if you don’t have a natural birth without pain relief, to those who insist that an epidural is the only way to give birth.

Try to keep an open mind– you might need more or less pain relief than you first thought, a chosen option mightn’t suit you, or the delivery team might need to suggest you change for a particular reason.

Try to do some research in advance. Talk to friends or midwives and then write down your thoughts in your birthing plan. Discuss these options with your birth team. Go to your antenatal classes, read about your options and ask questions, so you know what to expect. That way you’ll feel more in control. Active birthing classes can really help you to trust and use your body in the early stages of labour to help labour progress.

You might also want to do some research on how the different options can impact on initiating and establishing breastfeeding.

At the start of the labour, it’s good if you try to do as much as you can naturally. The midwives will encourage you to move around – try to if you can – gravity is a great force and will help move things along. There are several natural methods of pain relief: breathing, visualisation, massage, TENS and water. For some women, these are enough to see them through. There are further pain relief options available if not.

Breathing techniques

The idea is to take a deep breath at the beginning of a contraction – breathe in through your nose and out through your mouth, keeping your mouth soft and slightly open. Try to keep a rhythm going – with a regular even in-breath and out-breath – don’t worry if it’s slow or fast, just try to keep them the same. You might try to do an extended out-breath during a contraction to stop you hyperventilating or panicking. Practice breathing and relaxation methods before the birth, so you can use them through the labour. You can do this in an antenatal class, or by asking friends or your midwife. You may wish to attend hypnobirthing classes, a form of self-hypnosis which will teach you ways to stay in control and remain calm throughout labour. Many women find this very helpful and by remaining calm and in control the birthing process time may be reduced.

Most mums are very good at coping with pain, finding their own way of breathing to cope.

birthing partners can help their partner by helping her to be aware of avoiding “breath holding.”

We then to do this automatically when we are in pain and sometimes don’t even realise we are doing it. Breath holding means that oxygen is not circulating around the body proficiently and can cause an increase in pain as cells are not being oxygenated properly. When we breath hold we also contract our muscles which doesn’t allow for dilation.


Visualisation can help you to manage pain and anxiety psychologically; anxiety can produce a fight or flight response, which can slow down or stop labour. Try to visualize your body birthing your baby; you might visualize your cervix opening like a flower or the baby easing through your birth canal.

Water for pain relief

Baths are a lovely pain relief during EARLY labour. Being in water during labour can be very relaxing and can help with the contractions. You are also weightless, which gives you the freedom to move into different comfortable positions without getting tired holding them. Giving birth in water can result in a very gentle passage for you and your baby and there is some evidence to suggest it reduces your risk of tearing.

Birthing in a bath is not recommended. If you are planning a waterbirth at home you can hire a special birthing pool. If you are planning a hospital birth, most birthing centres will have birthing pools in the room.

TENS machine

TENS stands for transcutaneous electrical nerve stimulation. These machines are supposed to work by stimulating the body’s own natural painkillers, called endorphins. They are also believed to reduce the number of pain signals sent to the brain via the spinal cord. Ask in advance whether your hospital has them. If not you’ll need to hire one. It is useful to have it at home for a while before the birth so that you can learn how to use it.

TENS can be relaxing during the early stages of labour, but there’s no evidence of it being effective during the later, active stages of labour. You can’t use a TENS machine in water.

Gas and air (entonox) or laughing gas (“analgesics”)

This is a mix of oxygen and nitrous oxide gas given through a mouthpiece. You breathe it in just as a contraction begins and it takes about 20 seconds to work. You’re in control – you hold the mouthpiece and breathe in as much or little as you need. You can practice using the mouthpiece in advance if you want to at an antenatal class or ask your midwife. There are no harmful side effects known. It can make some people feel sick, sleepy or light-headed.

The midwife can bring this to a home delivery.

Pethidine and other pain relief drugs

The aim of these drugs is to relax you to help you cope with labour. They are intramuscular drugs that are injected into your thigh or bottom. Pethidine – another “analgesic” – is the most commonly used but it could also be diamorphine or meptazinol. The drugs usually take about 20 minutes to work, then last around two to four hours. Some women say the drugs make them feel sick. They can make it very difficult to push if the effect hasn’t worn off by the time the baby is ready to be born. A half-dose to start with can be a good idea for this reason. If the drugs are given too close to the time of birth, they might affect the baby’s breathing and can interfere with baby’s ability to breastfeed for the first 24-36 hours.

Epidural (or spinal anaesthesia)

An epidural is an anaesthetic, usually given to the mother in bed, that can only be given if you are in a hospital labour ward as it must be administered by an anaesthetist. Mobile epidurals (a low-dose epidural), which can allow you to use active birth positions, are available in some hospitals. The anaesthetist numbs a small area of your back with a local anaesthetic and then introduces a needle into your spine. A tube goes through the needle and the anaesthetic is passed through the tube. The tube will be taped to your back and the epidural can be topped up as necessary. An epidural takes about ten minutes to set up, and another 10 or 15 minutes before it starts working, and it needs adjusting afterwards.

A lot of epidurals now are controlled by the patient – known as PCA “patient controlled analgesia.” This means mums are in control of when they feel they need a top up and all regulated so that they can never get too much. PCA works very well as you are in control of your pain relief rather than having to wait for your midwife to administer.

You will also have a small cannula (needle) inserted into your wrist or arm and may be connected to intravenous fluids in case of any reaction to the epidural such as a sudden drop in blood pressure which may require medication. Unless you have a mobile epidural you will not be able to move around. Your contractions and the baby’s heart rate will need to be constantly monitored using an EFM. You will either have two belts around your abdomen or possibly a clip monitor attached to the baby’s head.

Epidural usually gives complete pain relief, although around 12 percent of women say they need another form of pain relief as well. An epidural can prolong the second stage of labour. Since you won’t be able to feel your contractions, the midwife will have to tell you when to push. In addition, as your pushing won’t be as effective, ventouse or forceps may be needed to get the baby’s head out. However, it may be possible to request that the epidural level is reduced towards the end so you can push the baby out naturally. Rarely, your blood pressure may drop, but this will be monitored.


Hypnobirthing is an approach that allows women to discover their natural ability to give birth. You work with your birth partner to practice positive mental affirmations about your ability to birth your baby. Your birth partner will have a very active role in the birth and help you to achieve a state of deep relaxation, calm and concentration as you birth your baby.

NHS studies of hypnobirthing have reported that pregnant women who had hypnobirthing classes tended to have shorter labour, needed less pain relief and less medical intervention in the birth (forceps, ventouse, caesareans).

Alternative methods of pain relief

There are many alternative methods of pain relief, including treatments such as acupuncture, aromatherapy and reflexology. You can discuss these with your midwife or a specialist in advance if you are interested. There is little peer-reviewed evidence that these provide effective pain relief, although this may be because comprehensive large scale assessments haven’t been done.

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This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.