Pain Relief and Home Births

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?

1. Drugs
2. Pain relief without drugs
3. Birth Stories with different perspectives on pain relief

Is labour easier to manage at home?

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

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

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 or Demerol

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.

But No Epidurals...

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.

Managing Labour Without Drugs

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':

• Hypnotherapy - get training before the birth or ask your practitioner to attend. Read more on the page about Hypnosis and Birth, and learn how others have used this approach.
  
  
• Birth pools - see page on Waterbirth Resources
  
  
• Warm water used in a bath or shower
  
  
• Relaxation
  
  
• Movement, eg yoga and techniques taught in Active Birth classes focus on rocking movements and sounds you can make to help manage different sorts of labour pain.
  
  
• Choosing positions that are most comfortable for you.
  
  
• A Birth Ball - this is a large ball which you can sit on in labour or beforehand, and roll your hips around on it. You can also lean over it. A helpful prop for using natural movement in labour - some women find it very helpful. A great toy for children too - can be ordered from the Active Birth Centre for around £30, or you can buy an ordinary gym ball, which does exactly the same job, eg from Argos for around £10. See Birth Balls article on the MomCare website for more ideas on the use of these before and during labour.
  
  
• Distraction - stroking your cats, watching your fishtank, listening to music, watching TV - it can help a lot in the early stages.
  
  
• Music and singing - really can help to distract and focus the mind. I would suggest music that makes you feel relaxed or happy, not stuff that makes you feel angry or full of adrenaline. Probably not the time for Nirvana or Rage Against the Machine!
  
  
• Massage from a helpful birth partner
  
  
• Heat, eg hot compresses, hot water bottles, heat packs - to be applied to your tummy, back, or wherever you want them. Make a DIY heat pack by filling a sock with rice or barley, adding a few drops of your favourite essential oils, and tying a knot in the top. Microwave on High for 2 minutes to provide an adaptable heat pack lasting at least 20 minutes.
  
  
• TENS machines - little evidence that they work in all cases, but some women swear by them. A number of the birth stories below include comments on TENS.
  
  
• Aromatherapy: read this report from the Independent newspaper on a study which found aromatherapy to be a highly effective painkiller in labour.
  
  
• Herbal remedies - but remember that herbs are drugs, just in nature's own format, and they can be dangerous. Research your options well and preferably consult a medical herbalist beforehand.
  
  
• Homoeopathy, if you believe it might help.
  
  
• Acupuncture - see a practitioner before the birth and perhaps ask her to attend. For example, Kedi used this during her home waterbirth.

Other links on drug-free pain management:

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).

Birth stories

Here are some birth stories with different perspectives on pain relief:-

• Kate S had the works with her first baby, including an epidural. Her second was a rapid homebirth, and she says "Positive thinking beats the hell out of pethidine in terms of pain relief!"
  
  
• Gina didn't want an epidural when she transferred to hospital and was put on a syntocinon drip. Gas and air didn't suit her either: "I decided to try some gas and air. It did make me feel good, but it meant that I couldn't do my yoga breath, which actually worked better for me. It also made me feel a bit woozy.."
  
  
• Charlotte H loved gas and air: "WOW that stuff is GREAT - it just took the edge off the pain and allowed me to get myself together."
  
  
• Amanda B tried gas&air, but it made her feel awful.
  
  
• Elizabeth B suffered with backache in her first labour and considered transferring to hospital for more pain relief, but she couldn't face the short journey, and her labour progressed well.
  
  
• Rebecca N gave birth to her first baby at home in Belgium, where pain-relieving drugs are not available at home. She used hypnotherapy, a birth ball and water to manage her labour.
  
  
• Nataliya had to fight to get a Pethidine prescription from her GP, but she found it helped her labour progress because she relaxed.
  
  
• Kelly R: "Compared to the strength of the contractions before, I could barely feel any pain at all with the G&A."
  
  
• Helen M liked Entonox as a supplement to the Hypnotherapy she'd practised before labour. Unfortunately only one small canister was sent and it ran out; she had to wait for another to be delivered.
  
  
• Hayley writes about Entonox: "Once up and running, I found the gas and air really helped at first, mainly because it forces you to focus on your breathing, but on the downside it sometimes made me dizzy and feel slightly out of control.", and on TENS: "I was glad to take the tens machine off as the higher settings felt like electric shocks and didn't help at all"
  
  
• Claire Thomas used TENS and Entonox (and had a faulty valve, so she had to wait for it to be fixed...). She had Diamorphine on hand, but it wasn't needed. She writes: "the experience convinced me that the level of pain is directly proportional to the feeling of control. It was quite manageable, even in the late stages, whereas with [my first baby] I felt completely unable to cope by the time I got to 6 cm. It makes sense really, but I think I had to experience that distinction to realise it."
  
  
• Donna Freemancompares her feelings during a hospital birth in which she used loads of gas and air, to those in her homebirth where she used just a " tiny bit" of gas and air, and a birth pool.
  
  
• Carolyn Hoolihan's midwife broke her waters to speed up her labour, and then found that her beloved Entonox had all run out just when she needed it most!
  
  
• Kirsty loved her Entonox, but when the canister ran out her midwives had trouble arranging for more to be delivered. Fortunately they managed to locate some, but if they had not, Kirsty might have chosen to transfer to hospital.
  
  
• Sara Gonzales's first two children were born in hospital, with the full range of pain relief from Gas and Air through Pethidine to epidurals. She wasn't sure she had the guts to give birth without an epidural, but she booked for a homebirth anyway. She did it! Sara writes "I feel very lucky, and can't quite believe I had the inner strength to give birth without drugs or intervention. I just kept thinking of lying on a beach in the sun and focusing on relaxing the muscles everywhere else in my body; in my arms and legs and neck etc. "
  
  
• Melanie Dunne found herself labouring in hospital rather than at home as she had hoped. She was keen to avoid an epidural and used Entonox and Pethidine, but says the mixture left her very light-headed and she was not keen on the effect. The pethidine left baby Alice slow to breathe and groggy, because labour progressed rapidly and Melanie's body was not able to eliminate it before her baby was born.
  
  

• 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.
  
  

• Sarah had been using a birth pool but got out to go to the loo, and "From that point the contractions were really painful and I started trying the gas and air. It did help me, but to be honest I think it made me lose the plot a bit and I felt less in control."
  
  
• Alicia had her first baby at home in Australia, where her midwife did not have access to any pain relieving drugs, including Entonox. She found a birth pool very helpful.
  
  
• Helen O'Donnell loved her Entonox so much she even took it in the bath with her.
  
  
• Rachel Hale gave birth to her first baby, Jude, at home after using TENS and then a birth pool for pain relief.
  
  
• Lorna's second labour became very intense, and before the Entonox arrived she decided to transfer to hospital for an epidural... but didn't have time. She says that "With hindsight this was obviously transition and if the midwife had told me this I would probably have coped much better.."
  
  
• Nicola had her first baby at home and managed well with TENS and Entonox, although when a midwife attempted to break her waters she found this very painful. She wrote that "The whole labour was not nearly as bad as I had psyched myself up for."
  
  
• Rebecca found TENS irritating, but a birth pool and Entonox worked very well for her.
  
  
• Vivienne got on well with Entonox, but had to put it aside to concentrate on her labour for a while.
  
  
• Rachel also found Gas and Air helpful - although after her waters were artificially ruptured, she asked for Pethidine, but was told it was too late.
  
  
• Lucy wrote that "I felt that my control of my labour had been given away in a driftcloud of Entonox"...
  
  
• Karen tried Entonox but hated it.
  
  
• Emma used two canisters of Gas and Air, and then "I was pretty out of it and ended up shouting for the midwife to "give me some drugs!"" Probably wanting a quiet life, the midwife gave her some Meptid! The Meptid worked very well and allowed Emma to feel in control again.
  
  
• Kedi didn't manage to try Entonox for the birth of her second baby - she was worried it might make her sick - but she did use acupuncture. She still fantasised about epidurals during the labour, but that's a rite of passage I think!
  
  
• Angela (that's me!) decided to try gas and air for the first time at her fourth baby's birth, but the valve could not be opened. Just as well it turned out to be the least painful birth so far.
  
  
• Shelley is the first person who has contacted me in eight years of running this site who has said that she regretted planning a homebirth. Her first labour was hard and painful, and she did not have adequate pain relief for the hardest part of it. When she tried Entonox, it worked well for her, however, but she still wishes that an epidural had been available.
  
  
• Rafeeqah writes that "I found water wonderful for pain relief but hated the feeling of being drunk on gas and air."
  
  
• Alex started on the gas and air after transferring to hospital, and found it very effective "I think it worked better because I didn't start on it till quite late on"
  
  
• Kate used massage, prayer, breathing and movement to help her manage labour, as well as Entonox when things became more intense: "Gas and Air gave me a renewed energy to cope. It also enabled me to relax, close my eyes and flake over a bean bag in between contractions to conserve energy."
  
  
• Kat found the end of her third labour very tough, and Entonox didn't help: "Having had epidurals with the other two I had no idea how excruciatingly painful labour could be. It was a real shock to me and not what I was expecting at all. I naively thought that labouring at home would be 'easy'...having a homebirth was not the experience I thought it would be. It was really unglamorous, painful and hard work and I didn't particularly feel empowered or at one with the universe or anything fluffy like that.  However, I'm quite sure that had I have been in hospital the events would have unfolded very differently probably with intervention, epidural and quite possibly c-section so I do feel incredibly proud of myself that I did stick it through at home and pleased at how it turned out. "
  
  
• Charmaine had a straightforward homebirth for her first baby, and found that Entonox and relaxation did the trick: "the entonox.. was doing a wonderful job of making me feel relaxed, slightly elated but totally in control. I felt as if I was floating and allowed my mind to journey with my breathing and the music."
• Shona had a chest infection, so couldn't breathe deeply - Entonox did not provide her with adequate pain relief and she begged to be taken to hospital. But after making very rapid progress, she had a straightforward birth and feels that the homebirth contributed to a fast recovery.

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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

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