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Breathing and relaxation techniques
What it is: Controlled breathing, hypnobirthing, mindfulness, visualisation and movement.
How it helps: Slow, deep breathing activates your parasympathetic nervous system, reduces stress hormones and changes how you perceive pain. Having a focus for each contraction gives you a sense of control.
Pros
- +No side effects for you or your baby
- +Can be used at any stage, at home or in hospital
- +Free, with many online courses and apps available
- +Works well alongside any other method
Things to consider
- -Requires practice before labour starts to feel natural
- -May not be enough on its own in established labour
Availability: From the very first contraction. Practise with your birth partner in the weeks before.
Birth plan phrasing
“I would like to try breathing and hypnobirthing techniques first.”
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TENS machine
What it is: A small, hand-held Transcutaneous Electrical Nerve Stimulation unit that sends gentle electrical pulses through pads stuck to your lower back.
How it helps: The pulses stimulate your body to release endorphins and interrupt pain signals travelling to the brain. You control a dial for intensity, increasing it as contractions build.
Pros
- +No drugs, no effect on your baby
- +You stay completely in control
- +Works well in early labour at home
- +Widely available to hire or buy from Boots, Argos and online
Things to consider
- -Must be removed for a water birth or continuous monitoring
- -Most effective in early labour, less so once contractions are very intense
- -You usually need someone to apply the back pads
Availability: Buy or hire from around 36 weeks. Use from your first contractions at home.
Birth plan phrasing
“I plan to use a TENS machine in early labour.”
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Water (birth pool or bath)
What it is: Labouring, and sometimes giving birth, in a warm pool of water at around 37°C.
How it helps: Buoyancy takes weight off your pelvis, warm water relaxes your muscles and the calm of being immersed reduces stress. There is good evidence water reduces pain in the first stage of labour.
Pros
- +Natural pain relief with no drugs
- +Good evidence for pain relief in established labour
- +Calming and private environment
- +Available at most midwife-led units and many home births
Things to consider
- -Continuous electronic monitoring is not possible in water
- -Not suitable for some higher-risk pregnancies or certain complications
- -Not every obstetric unit has a birth pool
Availability: Ask your midwife at your 36-week appointment whether a pool will be available.
Birth plan phrasing
“I would like to use the birth pool if it is available.”
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Gas and air (Entonox)
What it is: A 50/50 mix of oxygen and nitrous oxide that you inhale through a mouthpiece or mask.
How it helps: Takes the edge off contractions and makes them feel more manageable, without removing sensation. Works within 15 to 20 seconds of breathing in, and wears off in about a minute once you stop.
Pros
- +Fast-acting and fast-wearing off
- +You control it — breathe in as you feel a contraction starting
- +Can be used at any stage of labour, including pushing
- +Available at every NHS birth unit, midwife-led unit and home birth
Things to consider
- -Takes the edge off rather than removing pain entirely
- -Can cause nausea, light-headedness or a dry mouth
- -Some people feel it makes them feel out of control
Availability: Everywhere. Start breathing it in as a contraction begins, not at the peak.
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Pethidine (or diamorphine)
What it is: An opioid painkiller given as an injection into your thigh or buttock muscle, often with an anti-sickness drug.
How it helps: Dulls pain perception and has a sedative effect. Helpful if you are exhausted and need rest between contractions in a long labour.
Pros
- +Stronger than gas and air
- +Allows rest and sleep between contractions
- +Quick to administer by a midwife, no anaesthetist needed
- +Often available at midwife-led units and home births
Things to consider
- -Can cause nausea (anti-sickness is usually given at the same time)
- -Makes some people feel drowsy, woozy or disorientated
- -Can cross the placenta and affect your baby's breathing if given within a few hours of delivery
- -A reversal drug (naloxone) can be given to your baby if needed
Availability: Generally not offered within 2 to 4 hours of expected delivery. Not suitable for everyone.
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Epidural
What it is: Local anaesthetic delivered through a fine tube (catheter) into the epidural space around your spinal cord in your lower back.
How it helps: Numbs the nerves carrying pain signals from your uterus and cervix to your brain. Usually removes most or all pain from contractions. Can be topped up as labour progresses.
Pros
- +The most effective pain relief available in labour
- +Can be topped up continuously through the catheter
- +Good for long labours where you need rest
- +Can be converted to a spinal for an emergency caesarean
- +Does not usually affect your baby
Things to consider
- -Requires an anaesthetist, who may not be immediately available
- -Can slow labour and increase the chance of assisted delivery (forceps or ventouse)
- -Can cause a temporary drop in blood pressure (monitored closely)
- -Temporary leg weakness means you may need a catheter for your bladder
- -Rarely, a severe headache (post-dural puncture headache) can follow
- -May make pushing harder, especially in the second stage
Availability: Obstetric units only. Average wait in UK hospitals is 20 to 40 minutes once requested.
Birth plan phrasing
“I would like to keep the option of an epidural open.”
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Mobile (walking) epidural
What it is: A lower-dose epidural that numbs pain while preserving more sensation and muscle power in the legs.
How it helps: A reduced mix of local anaesthetic and opioid allows you to stay more mobile and feel more of the pushing sensation. Not all UK hospitals offer it.
Pros
- +Pain relief while keeping more movement and sensation
- +May make pushing more effective than a standard epidural
- +Easier to change position during labour
Things to consider
- -Less effective pain relief than a standard epidural
- -Not offered everywhere — ask at your 36-week appointment
- -You still need continuous monitoring
Availability: Selected NHS hospitals. Ask your midwife whether it is available in advance.
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Spinal block
What it is: A single injection of local anaesthetic directly into the fluid around your spinal cord.
How it helps: Works faster and more completely than an epidural but is a single dose rather than a continuous catheter. Used when full numbness is needed quickly.
Pros
- +Very fast onset of complete numbness
- +Used routinely for planned and emergency caesareans, forceps and ventouse
- +You stay awake and your birth partner can be with you
Things to consider
- -Single dose only — lasts 2 to 3 hours
- -Similar side effects to an epidural (blood pressure drop, rare headache)
- -Not used for ordinary labour pain relief
Availability: Obstetric theatres. Used for caesareans and assisted deliveries.
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General anaesthetic
What it is: Full unconsciousness, usually only for emergency caesareans when there is no time for a spinal, or if spinal anaesthesia is not suitable.
How it helps: You are put fully to sleep and intubated while the caesarean is performed. You wake up in recovery, usually within an hour.
Pros
- +Allows very rapid delivery in a true emergency
- +An option when a spinal or epidural cannot be safely given
Things to consider
- -You are not awake when your baby is born
- -Your birth partner cannot be present in theatre
- -Grogginess and nausea afterwards
- -Breastfeeding and skin-to-skin are delayed until you wake
Availability: Rare in planned births. Only used when clinically necessary.