Coping with Pain
in Labour
Our “Window of Tolerance” is what we are able to cope with before becoming dysregulated (stressed, numb, fight/flight/freeze). By working out what tools help us come back to a calm, regulated state (within our “Window of Tolerance”), we can also expand our window of tolerance.
Basically, it’s about finding your tools to help yourself cope when things are intense or difficult, such as during labour and birth, and using them in a way that works for you!
This page contains information on:
The Window of Tolerance & Your Personal Coping Toolkit
Non-Medical Coping Tools
Medical Coping Tools
Your Personal Coping Toolkit
There are many different options to consider to help you cope in labour and birth. When thinking about how you can cope in labour, you’re thinking of how you can keep your body and nervous system in a regulated, calm, and coping state.
It’s not about creating a beautiful, Instagram-ready birth space (though of course that can be fun!). It’s about unpicking what matters to you, and learning what choices you can make that align with that, even in a less-than-ideal scenario.
I’ve created a list below of non-medical and medical coping tools that you can use as a starting point to form the basis of your birth preferences regarding which coping tools you’d like to use for labour and birth. You may also wish to explore, for example, alternative therapies such as homeopathy.
Your chosen coping tools should be things to bring your stressed nervous system (after all, even the “best” births are intense experiences) back into calm equilibrium; into your window of tolerance, where you are coping, able to access both your rational mind and emotional being.
Always plan for multiple scenarios. Start with your Ideal Scenario A and get those birth positivity juices flowing! Then, unpack your fears and worries. What could go wrong? How would you cope with that? What would be your second choice option, or your third? Work out how you’d turn those situations into ones where you feel good about the choices you’re making (and familiarise yourself with the BRAIN acronym!).
The idea is that by the time you birth, no matter what happens, you’ll be making informed choices and feeling positive and empowered in your experience.
Non-Medical Coping Tools
Creating Your Birth Environment
Take some time to think about what makes you feel comfortable, safe, happy, and calm. Humans are mammals, and mammals birth best in dark, warm, cosy environments where they feel safe. This can be easy to create at home, but requires some forethought in a hospital setting - and what makes you feel most safe and calm will be unique to you!
Download the “Finding Your Calming Tools” Printable Worksheet to start creating your ideal birth environment, and delve into what will keep you in your window of tolerance, coping well with labour and birth. These are the same tools that will promote oxytocin, supporting your body to birth! Use the worksheet to write down everything you can think of in the categories that help you feel good, calm, and emotionally regulated. These don’t just have to be things you use when you’re outside your window of tolerance, they can just be things you like, too!*
When thinking about what coping tools you plan to use in labour, these tools already in your personal toolkit should form the foundation of your coping strategies.
You may include things like:
Fairy lights of a salt lamp for low, cosy lighting
A portable or Bluetooth speaker to play your chosen music (a playlist for feeling good and moving, a playlist for relaxing etc)
Strong tasting snacks - a strong taste can bring us back into our bodies when we are feeling overheard and disconnected!
Earplugs or noise-cancelling headphones
Literally anything that works for you! Your choices will be unique to you.
*Some people may not want to bring all their favourite coping mechanisms with them into birth, in case they then become linked with birth in their mind. You may want to pick something you feel neutral-to-pleasant about, such as a lavender essential oil, and spend some time deliberately associating it with calm and pleasant feelings during pregnancy. This will allow you to use this to support yourself during birth, as an additional tool, if there are some calming rituals you do not want to associate with your birth for whatever reason.
Warm Water (Bath or Birthing Pool)
Many women and birthing people find being in a birth pool (or a warm bath in early labour) extremely helpful in labour and birth. It reduces pressure and perceived pain, allows supported freedom of movement, and is just generally found to be excellent at helping you relax and cope!
If you plan to use a birth pool in a hospital setting, do make sure you have backup plans (as with any birth preferences) in case there isn’t one available on the day, as not all rooms will have a pool. For birthing at home, make sure you rent or buy your pool well in advance of your estimated due date so you’re ready to go, and have a trial run so you know how to set it up and that all your attachments work before you actually need them!
Birthing in a bath is not recommended due to reasons like it being harder to control the water temperature, there not being a safe depth of water to keep all of baby submerged while birthing (if baby hits air they may be stimulated to breathe, which is obviously risky if they’re then re-submerged), and lack of space for you to move around. That being said, many women do choose to birth in their bath regardless (or do so accidentally if labour progresses quickly!).
Birth Pool Hire: The Water Stork
Birth Pool Hire & Purchase: Birth Pool in a Box
All links to external suppliers are just suggestions based on word-of-mouth recommendations, and are non-affiliate links.
The Comb (Gate Control Theory)
The humble comb is a simple yet effective birthing tool that’s growing in popularity (and Birth Magic antenatal class clients all get one as a free gift!). Essentially, it works through what it known as the “Gate Control Theory”. Essentially, your nerve receptors can only handle so much input at once. By holding the comb and pressing its teeth into the palm of your hand, your brain registers this input above the input of your surges/contractions, reducing your perception of pain from them. Pretty cool science!
If you’re into acupressure, The Comb also works through applying pressure to acupressure points that run along the creases of the hands where the fingers join the palm, reducing pain perception and releasing positive endorphins.
I’d recommend using a wooden comb over a plastic one where possible, as the plastic ones can be a bit too pointy and cause skin damage if used over a long period of time. You don’t need to buy an expensive one!
TENS Machines (Gate Control Theory)
This is another one that works using Gate Control Theory. A TENS machine is a machine where you attached sticky pads to your lower back which emit an electrical pulse, blocking/distracting your pain receptors from noticing the sensations of your surges/contractions.
You can often find them second hand on online marketplaces after people have bought them for birth, or you can rent them from Boots.
The only real con of these is of course you can’t use them in a water birth! As ever, I’d recommend having a go and seeing how you find it before you’re actually in labour.
Video: Evidence-Based Birth: TENS for Pain Relief During Labour
Movement
Following your instincts is so important when it comes to birthing in a position that feels right for you. Often, our bodies will “tell” us when we need to change positions to help baby descend through the birth canal; being able to listen and move to accommodate this is so important.
I recommend my clients look into ideas for birthing positions as part of their labour & birth preparations. It may look bonkers right now, but in the moment it may be exactly what you need! These videos show some fantastic options you may not have considered.
You can use all sorts of tools to help you move in a way that feels right and comfortable during labour, including rebozos and other fabrics to pull against, door frames, birth balls, and birthing stools - and many women swear by straddling a toilet!
Though we live in a culture where birthing on your back is seen as the norm, and it’s all we usually see in media, it’s actually one of the least comfortable and most difficult positions to birth in. When you’re considering other pain management options, try to keep in mind their effect on your movement as one of the potential pros or cons. One clear example is an epidural; some techniques can allow you to keep movement, so if it’s something you’re considering bear than in mind, as well as weighing up the risks and benefits - more on that further down the page.
Instagram Reel: Partner-Supported Labour Birth Positions
Instagram Reel: Movement and Positioning in Labour
Video: What Positions are best for Labour and Birth? (NHS)
Massage & Counter-Pressure (& Rebozo!)
Often used in conjunction with movement, massage and counter-pressure work in various ways to reduce pain perception during labour. For example, massage can help you to relax tense muscles and release any stress or tension you may be holding in your body - great for more oxytocin and allowing your body to do what it needs to do!
Counter-pressure is particularly good for pain relief during “back labour”, but it’s important to think about longer-term solutions to this is it’s being caused by baby being in a less-than-ideal position for birth. The below IG reel on movement shows a rebozo-shake - the one where her hips are being held in the rebozo like a hammock - which can be helpful for this, as can other rebozo techniques. Think about changing positions (listen to your body as to what feels right) and stay mobile; your body’s contractions may feel really intense, but they’re trying to move baby into a better position if you let them. Counter-pressure can be a great coping tool to help, used alongside other methods in your personal coping toolkit.
Instagram Reel: Movement and Positioning in Labour
Video: Counter-Pressure for Pain Relief During Labour
Hypnobirthing
Many women and birthing people find the techniques taught in hypnobirthing to be extremely helpful and keeping them regulated, coping, and inside their window of tolerance during labour and birth.
Doulas!
There’s a lot of evidence that having a Doula with you when you birth reduces the pain experienced by birthing people - or rather, reduces their perception of pain! Having the support of a doula is shown to make you feel more confident, and relaxed as your use your coping toolkit, resulting in feeling less pain during labour and coping better.
Doulas - or, more specifically, someone who continuously cares for you during labour and birth - result in increased oxytocin and positive endorphins, and a reduction in stress hormones. The more relaxed and happy you and your body are in labour and birth, the less painful the intense sensations will be for you.
Medical Pain Management
Paracetamol
In early labour, you may be advised to take paracetamol to ease the pain you may be feeling with your contractions. However, new research shows that paracetamol actually inhibits prostaglandins - the hormones needed for your cervix to soften and dilate to birth your baby! - so many now consider it to be counter-productive. That being said, if you’re struggling to cope and it will bring you back within your window of tolerance, it may make you more relaxed and cope better having a positive effect in the long haul. Every person will feel differently about this balance. You may want to use other coping tools at your disposal first, but find paracetamol helpful in avoiding more medical pain management further down the road. As always, you know what’s right for you!
“Gas & Air” (Entonox/Nitrous Oxide)
The archetypal birth drug! Breathed in through a mouth piece, the effect is similar to being a bit drunk. Your body and mind may relax, helping you to cope and your body to do what it needs to do.
Pros:
Wears off quickly, so if you don’t like it, it’s easy to stop!
Easy to use (and you control how much you use)
Does not effect baby
Does not affect freedom of movement
Cons:
Some women find they hate it and feel “out of control” on it
Can make you feel/be sick
Can make you feel dizzy
Water Injections
This is not commonly offered in most trusts, so if it’s something you’d like to try/have in your birth preferences you’ll need to talk to your care provider about it during pregnancy.
There has been some discussion in recent years around whether sub- or intra-cutaneous (under on in the middle of the skin layers) injections of sterile water across 4 sites in the lower back is an effective method of back pain relief during labour. This is also known as a “water block” as it works on the pain gate theory; that by irritating more surface-level pain receptors, deeper pain receptors in the back are blocked. Water injections seem to work in a similar way to a TENS machine, without the wires, and allow free movement and use of a birthing pool after the injections are done. The initial injection is experienced as a painful stinging sensation (NICE, 2023), with pain relieving effects lasting from 30-90 minutes on average where felt (ibid). However, the majority of evidence for the efficacy of sterile water injections comes from studies with inconsistent reporting of other influencing factors so is not generally of particularly high quality (ibid).
It is mainly proposed as a useful pain management technique for women experiencing back pain in labour, but not recommended for general labour pain (“front labour”) as it does not show effectiveness for this (the research is focused on its prevention of back pain in labour only). As back pain in labour tends to be caused by sub-optimal fetal positioning, this could potentially be better combated by taking steps to address this issue in labour, such as Spinning Babies techniques, rebozo shakes, movement and positioning adjustments.
However, where appropriate, and should you desire a less medicalised form of pain relief, sterile water injections could form a part of your birthing toolkit to support pain relief from back pain whilst exploring other adjustments to help this during labour.
Pethidine
This is given as an injection into the muscle of your thigh or buttock. “It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so would not be recommended if you're getting close to the pushing (second) stage of labour” (NHS). This because pethidine - in the opiate family, along with codeine and heroin - acts a sedative, and can cross the placenta into baby’s bloodstream, making them sleepy too. This is a particular problem if baby is still sleepy and woozy once born, as they may struggle to adjust to being earth-side and need some help or resuscitation.
As with all medical opiates, it’s a pain medication for when you needs something extra strong!
Pros:
Strong pain relief
Can help you rest (make you sleepy/able to sleep through contractions) if you’ve had a long labour
Cons:
It can make you feel “out of it”/woozy
You may feel sick or be sick
You may feel forgetful
“If pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing – if this happens, another medicine to reverse the effect will [need to] be given” (NHS)
Baby may be sleepy and this may interfere with initiating breastfeeding
Diamorphine
Diamorphine is medical-grade heroin, a super strong opiate painkiller. It’s similar to pethidine, and administered the same way, but less commonly used. The side effects are the same as for pethidine.
Remifentanil
Less common than pethidine and diamorphine but in the same wheelhouse (it may not be on offer at your NHS Trust, so if you’re interested ask in advance). Sited in a vein in your arm, it’s much shorter acting than other options, working quickly and wearing off after just a few minutes - and you control the flow!
Pros:
Fast acting & short-lived; can be used for each contraction, and if you don’t like it it wears off quickly
Cons:
Can make you feel dizzy/woozy, itchy, and/or sick (but this, like the medicine, wears off quickly)
If you decide you don’t like it actually, you’ve already had a cannula sited in your arm
You’ll need a clip on your finger to monitor your oxygen levels, “as remifentanil can make you feel breathless or need oxygen” (NHS)
“Remifentanil can affect the baby’s breathing but this usually wears off quickly” (NHS)
Epidural
Considered by many to be the holy grail of pain relief in childbirth, it’s important as ever to consider the pros and cons of the procedure.
In essence, and anaesthetist will inject a local anaesthetic into your spine to block the nerves carrying pain signals to the brain. Some hospitals can offer “mobile” epidurals, where you can retain some (if not all) movement in labour, which is great when it’s available. More commonly, you’ll be lying down in bed from the administration of the epidural onwards. You can read more about them in detail on the NHS website, but here’s a summary for quick reading.
Pros:
Most effective pain relief (usually complete, and can be extremely welcome in a long or difficult labour)
Cons:
Lack of mobility has a knock on effect on labour progression, which can impact other outcomes such as baby coping, perineal tearing, increased risk of instrumental or assisted deliveries, and increased risk of c-section.
Coached pushing may be needed if you can’t feel your contractions, which can come with an increased risk of perineal tearing
Hospital policies say they’ll need to do continuous fetal monitoring after an epidural is administered; even if you have a mobile epidural this may impede your freedom of movement. They may use a fetal scalp electrode to monitor baby’s heart rate (look out for the phrase “we’re just going to pop a clip on baby’s head”; what this means is that a “fetal electrode will then be placed by screwing a tiny wire into the top layers of the baby's scalp” (Weiss, 2021). This means you can move more freely if you’ve got a mobile epidural, but does cause tissue damage to baby’s head and has its own risks, as does everything!
Longer labour and pushing stage
1 in 100 people get an “epidural headache” (decribed by many as the worst pain they’ve ever felt). Easy to remedy, but unpleasant to experience.
Difficulty urinating
Other, rarer risks are listed on the NHS website.
Additional References
Diamorphine: Medical Heroin for severe pain management
NCT (2022) Labour pain relief: sterile water injections, https://www.nct.org.uk/labour-birth/your-pain-relief-options/labour-pain-relief-sterile-water-injections
NHS (2023) Pain Relief in Labour
NHS (2023) Inducing Labour, https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/inducing-labour/
NHS Maidstone and Tunbridge Wells (2021) Sterile water injections for low back pain in labour, https://www.mtw.nhs.uk/wp-content/uploads/2021/05/sterile-water-injections-leaflet.pdf
Wendt, T (2022) What Are Sterile Water Injections for Labor Pain?, WedMD, https://www.webmd.com/baby/what-are-sterile-water-injections-for-labor-pain