When comparing pain relief options during labour in the UK, there is no single “best” choice. What feels right depends on how labour progresses, where you give birth, how much mobility you want and whether you prefer to avoid medicines or want stronger relief. NHS options vary between home birth, midwifery units and obstetric units.
Think of pain relief as a menu rather than a fixed plan. You might start with movement, water or TENS, add gas and air as contractions strengthen, then choose an opioid or epidural later. Changing your mind during labour is normal.
How the main labour pain relief options compare
Compare four things: strength of relief, speed, effect on movement and where it can be given. Non-drug methods preserve mobility but may not be enough in established labour. Gas and air is quick and controllable. Opioids can help you relax but may cause drowsiness. Remifentanil needs close monitoring. An epidural usually provides the strongest relief but requires an anaesthetist and an obstetric unit.
Movement, water and TENS
Early in labour, upright positions, slow breathing, massage, support from a birth partner and a warm bath may improve comfort and control. Paracetamol may also help if your maternity team says it is suitable for you.
Water for labour pain relief
Warm water can encourage relaxation and make contractions easier to cope with. NICE recommends offering the opportunity to labour in water for pain relief. Water birth pain relief is more about comfort, movement and reducing tension than numbing pain. You may need to leave the pool if closer monitoring becomes necessary.
TENS machine in labour
A TENS machine sends small electrical impulses through pads on your back. You control the intensity, often with a boost button during contractions. It is drug-free and may help in early labour, especially with back discomfort, but has not been shown to work well once labour is established. You may need to hire or buy one. TENS cannot be used in water.
Sterile water injections for back pain
NICE says sterile water injections can be considered for labour-related back pain. A trained midwife injects small amounts into or just under the skin of the lower back. They can sting initially but may ease back pain for a few hours. Availability varies.
Gas and air: quick and flexible
Gas and air in labour, or Entonox, is oxygen mixed with nitrous oxide and breathed through a mouthpiece or mask. It starts working within about 15 to 20 seconds, so breathing as a contraction begins helps with timing. You control the mouthpiece yourself.
It usually takes the edge off contractions rather than removing pain completely and wears off quickly when you stop using it. Some people feel lightheaded, sleepy or sick, but these effects normally settle rapidly. Gas and air can often be combined with other pain relief.
Opioid injections such as pethidine
Pethidine is an opioid usually injected into the thigh or buttock; some NHS services use diamorphine instead. It takes about 20 minutes to work and can last two to four hours. It may help you relax or rest rather than remove contraction pain completely.
Opioids can make you feel woozy, sick or forgetful, and anti-sickness medicine may be given. If used close to birth, they can affect a baby’s breathing or early feeding, so timing matters. NICE also advises against entering a birthing pool within two hours of an opioid dose or while you feel drowsy.
Remifentanil PCA: fast relief with monitoring
Remifentanil is a short-acting opioid given through a vein using patient-controlled analgesia, or PCA. You press a button for a dose. It works quickly and wears off within minutes.
Because remifentanil can slow breathing and reduce oxygen levels, NICE recommends it only in obstetric units where monitoring and anaesthetic support are available. It may suit someone who wants stronger ongoing relief but does not want, cannot have, or is waiting for an epidural.
Epidural: the strongest commonly used option
An epidural delivers local anaesthetic and pain-relieving medicine near the nerves in the lower back through a fine catheter. It generally gives more effective relief than opioids and can be useful during a long, difficult or induced labour.
Questions about an epidural during pregnancy often focus on mobility and intervention. An epidural can reduce movement and requires monitoring. It may need adjusting or replacing if pain relief is incomplete. NICE advises that epidurals are not associated with a longer first stage of labour or a higher chance of an unplanned caesarean, but they are associated with a longer second stage and an increased chance of forceps or ventouse birth.
Epidurals are available only in obstetric units and must be inserted by an anaesthetist. If you are planning a home birth or birth centre, ask in advance how transfer would work if you later want one.
A practical way to choose during labour
Imagine beginning labour while moving around and using TENS. As contractions strengthen, you try a birth pool and gas and air. Hours later, you are exhausted and want stronger relief. You could then discuss an opioid, remifentanil or an epidural depending on your setting, progress and medical circumstances. This step-by-step approach avoids making one permanent decision before labour starts.
During pregnancy, ask your midwife which options are available at your planned place of birth, whether remifentanil or sterile water injections are offered, and what happens if you want an epidural after starting in a midwifery unit. You may also want to review your birth plan checklist, hospital bag checklist and signs that labour has started before your due date.
Frequently asked questions
Can I change my mind about pain relief during labour?
Yes. A birth plan records preferences, not a binding decision. You can ask for different pain relief as labour changes, although some options depend on timing, your health, your baby’s condition and available facilities.
Can I have gas and air before an epidural?
Usually, yes. Gas and air can be used while you are waiting for an epidural and may also be used alongside other options. Your midwife can advise what is appropriate for you.
Is an epidural available during a home birth?
No. Epidurals require an anaesthetist and are provided in obstetric units. If you start labour at home and later want an epidural, you would need to transfer to hospital.
Can I use a TENS machine in a birth pool?
No. A TENS machine should not be used in water. It is better suited to early labour before you enter a bath or birthing pool.
Choosing what feels right for you
Labour pain relief works best when you understand the trade-offs rather than trying to predict exactly what you will need. Water, movement and TENS preserve freedom and control; gas and air is fast and flexible; opioids may help you rest; remifentanil offers rapid, monitored relief; and an epidural provides the most effective option for many people. Discuss availability with your maternity team, keep your preferences flexible, and make decisions based on how you and your baby are doing at the time.