Evidence Library · Pain relief

The other options

Nitrous oxide, opioids, water, movement, and nothing.

Nitrous oxide. A review of 58 publications found it relieves less pain than an epidural, with nausea, dizziness and drowsiness as the main side effects. It has the advantage that you hold the mask yourself and can stop at any moment.

Intravenous opioids. Reduce dissatisfaction with pain relief compared with placebo, but were outperformed by epidurals in every trial that compared them directly. They cross to the baby and can cause drowsiness at delivery.

Movement, water and support. Being upright in the second stage reduces assisted deliveries (relative risk 0.75) and episiotomy (relative risk 0.75). Continuous one-to-one support reduces use of pain medication and the chance of a negative memory of the birth.

You can change your mindWanting an unmedicated birth and then asking for an epidural is not a failure, and nobody is keeping score. Say this to your support person in advance so they know not to talk you out of it.

Where this comes from:

6. Likis FE, Andrews JC, Collins MR, et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg. 2014;118(1):153-167.

7. Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010;(9):CD007396.

8. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7:CD003766.

9. Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017;(5):CD002006.

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