1. Gas and air (entonox)

You breathe in entonox through a mouthpiece or mask at the start of each
contraction. Many women find that it reduces the sharpness of the pain.

Whats good about it?

• It doesnt affect your baby.
• You can control how much you use.
• It gives you something to focus on. Many women find that concentrating on
  breathing in the gas and air at the right time can distract from the
  contractions.
• You can use it at home and with other pain-relief options, such as TENS (see
  below) or water.
• You can use it throughout labour.

Whats not so good?

• It can make you feel sick and light-headed.
• Its a mild painkiller, so it might not be strong enough.

2. Use a TENS machine

TENS is transcutaneous electrical nerve stimulation. A TENS machine is a
small battery-powered box with wires attached to four pads that stick to your
lower back. It sends small electrical pulses that block the pain messages to
your brain. Some women find that it helps them to cope with contractions or back
pain in early labour.

Whats good about it?

• You can move around while using it.
• You can use it with other forms of pain relief.
• You control it, so you can increase or decrease the level of pain relief
  according to your needs.
• Its drug-free and doesnt have any known side effects.

Whats not so good?

• You cant use it in the bath or in a birthing pool.
  

3. Water

Soaking in a deep, warm bath can be very soothing. Many hospitals now have
birthing pools, and you can either give birth in the water or just use it for
pain relief.

If you're giving birth at home, you can hire or buy a birthing pool.

Whats good about it?

• It helps with pain relief and can make you feel relaxed.
• You can move around more easily and be upright when you give birth.
• It's drug-free.

Whats not so good?

• It may not give you enough pain relief.
• If you're giving birth in hospital or at a birth centre, someone else might
  be using the pool when you need it.
• If youre having a home birth, you'll need to hire your own pool.
  

• It offers total pain relief for most women.
• It works quickly.
• It can be topped up when needed.

• An anaesthetist has to give you the epidural, so it's not available at a
  home birth, and you may have to wait to get one in hospital.
• It can't be given in a midwife-led maternity unit if the unit is completely
  separate from a hospital.
• Some women still feel pain in one spot or down one side.
• It may make your legs heavy, depending on the type of epidural that you
  have.
• Your blood pressure may drop. This is rare, as the drip in your arm will
  help to maintain good blood pressure.
• Your baby's heartbeat needs constant monitoring.
• You're more likely to need an assisted delivery with forceps or ventouse (a
  suction cap to help the baby out) as you may not be able to feel when to push.
  You probably won't be able to move around for an hour or two after the
  birth.
• You may need a catheter (a tube in your bladder to help you pee) until the
  epidural wears off.
• About one in 100 women get a headache after an epidural. If this happens to
  you, it can be treated.
• Your back might be a bit sore for a day or two, but epidurals don't cause
  long-term backache.

5. Pain relief injections

These are injections of drugs, such as pethidine or diamorphine, directly
into the muscle in your thigh or bottom. An intramuscular injection takes about
20 minutes to work, and lasts for between two and four hours.

Whats good about them?

• They can help you to relax, which can lessen the pain.
• They're usually available in all birth settings, i.e. in hospital, at
  home, and at a midwife-led unit.

Whats not so good?

• They can make you feel sick, 'woozy' and forgetful.
• If the drugs haven't worn off towards the end of labour, pushing can be
  difficult. You might prefer to ask for half a dose initially to see how it works
  for you.
• If pethidine or diamorphine are given too close to delivery, it may affect
  the baby's breathing. If this happens, an antidote will be given.
• The drugs can interfere with breastfeeding.