Nine ways to handle the pain

CONS: It's only a mild painkiller to help take the edge off contractions. It can make you feel very light-headed and sick and sometimes gives you a dry mouth.

IT HELPS TO KNOW: Start breathing the gas and air at the start of a contraction as it takes 30-40 seconds to take effect. If the rubber face mask makes you feel queasy, ask for a mouthpiece. You can use gas and air at a home birth or in a birthing pool.

PETHIDINE/DIAMORPHINE

Pethidine is a painkiller that also helps you to relax. It's either injected or given intravenously during the first stage of labour, before you start pushing. It's often combined with an anti-sickness drug as it can cause nausea. It takes about 20 minutes to take effect.

PROS: It has a sedative effect so helps you relax or sleep. You can get it from a midwife.

CONS: It can make you feel sick or even be sick. It can make you feel sleepy, woozy or even hallucinate. Some mums complain they were so sleepy they feel they missed out on the birth. It can make your baby very sleepy for a few days and can cause sucking, breathing and feeding problems.

IT HELPS TO KNOW: You can't have it later in labour because it could be bad for your baby. You can use pethidine during a home birth, although you may need to get a prescription from your GP beforehand. If your baby is affected by pethidine and is born sleepy, it will take four or five days to get it out of her system.

TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION)

A machine sends electrical pulses through a series of wires to pads that stick to your back. The pulses prevent the pain signals from your womb and cervix reaching your brain. They also stimulate endorphins - your body's natural painkillers.

PROS: You administer your own pain relief, so you feel in control. Twiddling the dials may help to take your mind off the contractions. If you don't like it, you can just remove it, so you're not stuck with it. It's portable, so you can use it at home and in hospital. It's a drug free option with no side-effects.

CONS: You may only find it effective if it is used in early labour. You'll have to take the TENS machine off for a water birth, or if you need to have a foetal monitoring. The pads will stop your birth partner giving you a back massage.

IT HELPS TO KNOW: It takes about an hour for TENS to take effect. You'll need to hire your own TENS machine so plan it in advance. Look for one with an ‘intensity button', which means it has a continuous current option.

EPIDURAL

This local anaesthetic is injected into your lower back through a tube which is passed through a curved, hollow needle. It works by numbing pain signals from your womb and cervix to your brain. You'll need to have a drip in your arm. This is in case the epidural causes your blood pressure to drop suddenly, which could affect the flow of oxygen to your baby.

PROS: You won't be able to feel the contractions. It provides total pain relief for more than 90% of women. You'll stay clear-headed. It can be topped up.

CONS: You probably won't be able to feel your legs and feet. You'll give birth lying down. You'll also need a catheter as you won't be able to feel when to empty your bladder. It can make you shiver. It can lengthen labour by at least an hour. You're more likely to need a forceps or ventouse delivery as epidurals can stop the baby moving into the best position to be born.

IT HELPS TO KNOW: Not all hospitals offer epidurals. You won't be able to have one in a birthing unit or at home. Some hospitals and birthing units offer mobile epidurals, a lower dose drug that can mean you're still able to feel some sensation in your legs and also will be able to feel the urge to push more easily. You're less likely to need a forceps or ventouse delivery if you have a mobile epidural than if you have an ordinary epidural, although it's still more likely than if you don't have an epidural at all.

WATER BIRTH

The water relaxes you, which helps you cope with the pain more easily.

PROS: Helps you relax and control contractions. Increases chances of a natural birth. Thought to cause a surge in the hormone oxytocin, speeding up the labour. Reduces trauma to the perineum.

CONS: There's an increased risk of the baby overheating or contracting an infection. You won't be able to use a TENS machine. Not suitable if you have complications. You won't be able to get into the pool until you're around 5cm dilated, as this could slow down the labour. Some hospitals prefer women to get out of the pool to push.

IT HELPS TO KNOW: The hospital birthing pool may not be available. Some units will allow you to take along your own. Birthing pools are available to buy at £39.95 from www.birthpoolinabox.co.uk/ or freephone 0800 035 0514 to order.

SPINAL BLOCK

You'll be given an injection of local anaesthetic in the small of your back. This will numb the nerves to your womb and cervix so you won't be able to feel the contractions.

PROS: Fast, effective pain relief.

CONS: It can't be topped up again once you've had it. You won't be able to feel your legs. You may get a headache or feel shivery, itchy or sick.

IT HELPS TO KNOW: Spinal blocks work more quickly than epidurals so they are likely to be used in an emergency, for example for an emergency caesarean section or if you need forceps or ventouse delivery because the baby is in distress and needs to be delivered quickly.

HYPNOBIRTH

You'll go to hypnobirthing classes and practise at home to learn how to achieve deep relaxation. Exercises include visualisation and self-hypnosis. The aim is to learn techniques to combat fear and anxiety of the birth, boost confidence and feel calm and in control. The theory is that by harnessing the power of the mind you can relax muscles and, in turn, ease the pain of labour.

PROS: It's empowering and will give you something to focus on in the run-up to the birth. There are no side effects.

CONS: Classes are expensive. You'll need to practise for a while beforehand.

IT HELPS TO KNOW: You need to believe that it will work. If you approach it with a sceptical attitude, chances are it won't help to relieve your pain. For more information on hypnobirthing visit the website www.hypnobirthing.me.uk/.

ACUPUNCTURE

Fine needles inserted at various points around the body stimulate energy channels to relieve pain. You'll feel a tingling but the needles shouldn't hurt. They can be left in from a few seconds to half an hour.

PROS: No side effects. Can shorten labour time and make you feel more in control.

CONS: Movement may be limited while you have the needles in place.

IT HELPS TO KNOW: Check your hospital will allow the therapist into the delivery room as not all do. Always choose an acupuncturist who is registered with the British Acupuncture Council. Tel: 020 8735 0400 or visit www.acupuncture.org.uk/.

DEEP BREATHING

Helps the muscles to relax by increasing the blood supply to them and conserves your energy to help you stay in control.

PROS: Gives you a focus. No side effects.

CONS: It may not be enough to help pain.

IT HELPS TO KNOW: It's most effective if your birth partner breathes with you.

Make the right choice:

NCT antenatal teacher and former president Gillian Fletcher says: ‘If you've done your homework before labour starts, it's a question of seeing what the contractions are like and how things go. I don't think you decide what you want until the time. Having said that, you may agree to something in labour because someone will just say, "Would you like something to take the pain away?" But what they don't say is it might come with side effects or it may make it more likely you'll have an assisted delivery. ‘I encourage women to ask about the benefits and drawbacks before they take a decision. I teach them the acronym BRAIN: consider the Benefits, Risks, Alternatives, their Instincts and what would happen if they did Nothing for a bit. Then you've made an informed choice.'

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