What are your options for pain relief at home? Which drugs are available - and what else can you use? Will you be able to manage without an epidural?
Mothers who have home births are less likely to use drugs for pain relief than mothers who have hospital births. Whilst this may be partly because the the home birth mothers are more likely to want a natural labour (ie no drugs or interventions at all), it is also partly because mothers generally find labour and birth less painful at home, because they are more relaxed and free to move.
There is some research to support the anecdotal evidence that women find labour less painful at home. For example, Home birth and hospital deliveries: a comparison of the perceived painfulness of parturition By Morse and Park, 1988, found that women giving birth in hospital rated labour significantly more painful compared to other events, than women giving birth at home.
The National Birthday Trust Report into home births in the UK found that 95% of home birth mothers said they enjoyed the birth, compared to 76% of hospital birth mothers. Since these mothers enjoyed their births, we must assume that they found whatever pain relief was available to be adequate for them, on balance. In the same study, 62% of home birth mothers felt completely in control during labour, compared to 29% of hospital birth mothers; and a fortunate 14% of home birth mothers felt either no pain or very little pain, compared to 8% of hospital birth mothers.
'Antenatal Preparation for Home Birth' includes some suggestions for things you can do before your labour starts, which can help you to manage your labour and to give yourself the best odds of a good birth. This page looks at things which can help once you are in labour.
You cannot know how you are going to experience the pain of any one labour until you are actually in labour. It makes sense to have a 'toolkit' of pain relief options available before you go into labour, whether this includes drugs or not. You do not have to use any particular technique, gadget or substance on the day, but knowing that it is available may help you. Here are some to consider:
Drugs available at home births will vary according to where you live. They include Entonox ('gas and air' - a mixture of Nitrous Oxide, or laughing gas, and Oxygen), and Pethidine, also called Demerol.
Entonox appears to be a harmless drug which is quickly cleared from the mother's body. It is inhaled by the mother from a mouthpiece or mask. Midwives will routinely bring it to home births in many areas of the UK. The only problems associated with it seem to be if the mother gets too 'high' and cannot push effectively in the second stage, or if she finds herself depending on the drug and then the canister runs out. You will find a number of birth stories here where the mothers have commented on their experience of Entonox in labour. Many found it invaluable, although if you have trouble breathing deeply, it may be hard for the drug to help you - eg Shona had a chest infection.
It is fairly common for supplies of Entonox to run out at home births and you may have to wait some time for a new canister to arrive from the hospital - see Kirsty's story. It is also fairly common for canisters and mouthpieces to be faulty, so if you feel very strongly that you want to have Entonox available, perhaps your birth partner could ask the midwife to test her stash when she first arrives. See Rebecca's story for one example of faulty Entonox supplies, and my own fourth baby, Lachlan's, story for another, and Doris's for yet another. The National Birthday Trust study found that Entonox was used at 50% of home births surveyed, and 73% of the hospital births. I'm not sure what proportion of these it actually worked at, though!
Pethidine/Demerol is a Class A drug and an opium derivative, which a midwife can give by intra-muscular injection. It can have serious side-effects for the baby such as breathing difficulties at birth and problems in establishing breastfeeding. An antidote (Narcan, Naloxone) should be available whenever Pethidine/Demerol is used in case the baby is born in trouble, but it may not solve all problems caused by the drug. For these reasons, many midwives and mothers do not want Pethidine/Demerol used at their home births. Nonetheless, it is available at many home births in the UK and elsewhere, and in certain situations can be very useful. The National Birthday Trust study found that it was used at 4% of home births surveyed, and 31% of the hospital births.
Epidurals are not available at home. They must be administered by a skilled anaesthetist - and an anaesthetist is a fully qualified doctor who has specialised in the area. There is a risk of side-effects for the mother, and of fever or low blood pressure in the mother which could be harmful for the baby, and so epidurals are only used in hospitals where mother and baby can be carefully monitored.
There are many non-drug options to help manage labour at home births (sometimes called 'non-pharmacological pain relief'). For birth stories where no drugs were used, and a variety of alternative forms of pain relief explained, see the Natural Birth Stories webring.
Equipment and 'props' mentioned here and elsewhere are noted in 'shopping list' format on the Home Birth Equipment page.
Here are some examples of drug-free options for your 'toolkit':
Waterbirth Resources - a page on this site with things to consider, links to birth stories where water was used, and other sources of information.
Hypnosis and Birth - introduction to the subject, an article from hypnobirthing practitioner Deborah Henley, and links to websites owned by practitioners specialising in hypnotherapy and self-hypnosis for birth.
Managing Labor Without Drugs, by Gayle Peterson, Ph.D. MSSW
Pulsar Tens - obstetric TENS machine hire in the UK (www.pulsar-tens.com).
Here are some birth stories with different perspectives on pain relief:-
Rosie Taylor emptied her midwife's supply of Entonox in 20 minutes, so the second midwife went to get new canisters. She also found TENS and a birthpool helpful.
You might also find the pages on Practical Preparation for Home Birth, Home Birth Plans and Antenatal Preparation for Home Birth interesting.
This page updated 12 February 2010
Home Birth Reference Page