Pain relief during childbirth is an emotive topic - from whether you have it at all to the type of pain relief you go for. It's also an area where the official advice and science around what is available to women is constantly changing. At the start of this year it was announced that some NHS trusts had taken the decision to suspend gas and air due to concerns over the long-term impact exposure was having on staff. Then, earlier this month, it was reported that the Scottish government has written to health boards suggesting that injections of sterile injections should be offered as an alternative pain relief method to established methods, including Entonox (gas and air) and epidurals, amidst concerns that use of gas and air within NHS Scotland was responsible for an admissions impact similar to 18,000 flights from Frankfurt to New York.
With so many different debates raging on this emotive topic, how the hell are you meant to know which choice is best for you - especially when you're trying to get an entire person out of a space far smaller than the average head? We've got the (non judgmental) lowdown on the most common options available.
Entonox (gas and air)
"Entonox is fifty per cent nitrous oxide, fifty per cent oxygen. Midwives will often talk about as being a bit like having a gin and tonic before breakfast," explains midwife Anna Nella from charity Tommy's.
Gas and air is administered through a valve, which you control through a single-use, antibacterial mouthpiece. "Once you're in active labour (about 4cm dilated and having regular contractions), you start taking the gas and air as each contraction starts, so that it helps you get over the most intense hump of the contraction, which is about 20 seconds," Nella explains.
"It doesn't relieve pain completely, but the woman is in control of it, and it also lessens anxiety and fear," she adds. "Its effects are rapidly reversed, it helps regulate your breathing, and it doesn't interfere with the process of labour."
On the downside though, gas and air can cause a very dry mouth, nausea, slight drowsiness, pins and needles, and even vomiting in some cases. Much like the pre-brekky G&T though, how it makes you feel may vary from woman to woman, or even from birth to birth – as Emma found.
"During my first birth, gas and air really was a lifeline. I think sucking on it gave me something to focus on, as much as pain relief. I bit down on it so hard that I left teeth marks!" she says. "With my second birth though, it just made me sick – I literally threw up after every puff – and I got no pain relief from it at all."
Opioids
If you need something stronger, opioid drugs are often the next step up from gas and air. Pethidine, which is usually injected into the muscular tissue of your bum, is the most commonly used of these, or some hospitals may use diamorphine which, Nella explains, is: "basically medical grade heroin."
"We really don't have a lot of evidence about whether pethidine is actually a very good, effective pain relief in child birth," Nella says. "It's cheap, widely used, and works in about 20-40 minutes, with effects lasting about 2-3 hours. But it will make the mum very sleepy; she may suffer from nausea and vomiting; and it can affect the baby if it's born without 2-5 hours of the injection."
For Jo, being on pethidine during labour was awful. "My husband said I was completely out of it for ages, like I was stoned! Four out of six hours of my labour are a total blank," she says.
There are however, circumstances when opioids can be useful. "If a woman had a very, very long latent phase, and she's having lots and lots of contractions, so she's absolutely exhausted, then it can be helpful to have one dose of pethidine, fall asleep, and wake up in active labour," Nella explains.
Camilla was reluctant to take pethidine during her labour, but agreed after struggling to stay on top of her contractions. "It dulled enough of the pain for me to keep going, but not so much that I couldn't go with it all," she says. "It did feel slightly like an out of body experience, but all in all it was very empowering and enabled me to have a positive birth."
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Epidural
An epidural is a regional anaesthetic injected into your lower back, and is the only form of pain relief that will take your pain away completely – as long as it works! Not all epidurals are successful, mostly thanks to the complexity of getting the needle into the right place between strong contractions.
Martha had a planned epidural with her baby. "I then went to sleep for five hours, woke up fully dilated and ready to roll, so to speak! The epidural took all the pain away, and allowed me to refocus and gather strength," she says.
"The actual horror of it being administered paled in comparison to the indescribable agony of contractions," Martha adds. "I really resent the idea that drugs in childbirth are somehow shameful or a second choice. To me it seemed like the least stressful option – not lazy, wimpy, unfeeling or unheroic; just better for me."
For other women though, epidural has its drawbacks – most notably a loss of sensation both during and even after labour. "At first the epidural was good, really good – I could feel every contraction but none of the pain. Later though I remember pushing as hard as I could but, because of the epidural, I couldn't properly feel what I was doing, so I didn't feel like I had any control," says Louise.
As a result, epidurals may prolong your labour and you may need an instrumental delivery, using forceps or a ventouse. The epidural drugs can also lower your blood pressure, causing dizziness and nausea, as well as affecting the baby's heart rate.
Natural pain relief
For women who'd prefer a drug-free labour, the options include breathing and relaxation exercises, massage techniques, and aromatherapy. Giving birth in water, such as a birthing pool, can also help to ease the pain and aid relaxation – although some mums find it a bit cold and isolating.
Hypnobirthing is another popular option, which uses self-hypnosis techniques, and expectant parents can pay for courses in advance of labour. Writer and consultant Estelle Lee, who founded parenting magazine Smallish , used this for the birth of her first child. "It's all about really enabling yourself to go into a zone," she says. "You sort of cocoon yourself away to create a biologically safe space, so you can relax into it and manage your reaction to the contractions."
Of course, this can be less effective for very long and tiring labours. "I was in labour for 54 hours," says Nilufer. "I'd done the hypnobirthing course but it was useless. There's no way you can breathe or 'calm' yourself through 54 hours of agony, especially when you are so exhausted you can't even remember your own name."
Making an informed choice about pain relief in childbirth
Basically, frustrating as it is, there's no perfect option. But it's important that all mothers-to-be are empowered to make informed choices.
"Think about how your respond to period pain or toothache and use that as a guide when writing your birth plan," advises Rebecca Schiller, author of Your No Guilt Pregnancy Plan and Director of charity Birthrights.
"Do you want to be alone or do you like hands-on help? For some women the freedom, comfort and privacy of a birth pool is ideal, and others find an epidural gives them a positive, pain-free start to motherhood," she says.
Ultimately, Schiller adds: "It's no one else's business what you choose, and don't be surprised if you change your plans in labour itself. Everyone's labours and coping mechanisms are different. There's no need for guilt and comparison when it comes to childbirth.