Pain relief for giving birth if your baby has died

Entonox® (also known as gas and air) is a mixture of nitrous oxide and oxygen used to relieve pain.

How do you use Entonox®?

Entonox® is a gas that you breathe in via a mouthpiece or facemask when you need it. You are in control of the amount of Entonox® you use, but to get the best effect, it is important to get the timing right. You should start breathing Entonox® as soon as you feel a contraction coming on to get the full effect when the contraction is at its peak. You should then stop using Entonox® as the contraction ends, breathing normal air between your contractions.

What are the benefits of using Entonox®?

Entonox® is the most common pain relief for labour. People like it because:

• It works quickly and wears off in minutes
• It will not take the pain away completely, but it may help you feel more relaxed
• You can use it at any time during labour

Are there any side effects?

Entonox® has been used safely for pain relief during labour for many years. The common side effects are generally mild and go away quickly when you stop using it. These include:

• A dry mouth
• Feeling sick (nausea) and vomiting
• Feeling dizzy, light-headed or sleepy

Having a break from using Entonox® in between contractions helps to reduce these unwanted effects.

What are opioids?

Opioids are strong pain-relieving medicines that can be given by mouth or by injection. They are also used in pain-relieving medicines given through an epidural, or by spinal injection.

How are opioids given?

A midwife usually gives opioids during labour by injection. The pain should start to ease about half an hour after the injection and can last a few hours. Some women say the opioid injection makes them feel more relaxed and less worried about the pain.

What are the side effects of opioids?

• They can make you feel sleepy
• They can make you feel sick, but you can be given anti-sickness medicine for this
• High doses of opioids can slow down your breathing; this is very rare with the doses given in labour

What are epidurals?

An epidural is an injection in your back to stop you feeling pain in part of your body. Epidurals are the most complicated method of labour pain relief and are given by an anaesthetist. An anaesthetist is a doctor who is specially trained to give anaesthetics and pain relief. 

Facts about epidurals:

• Epidurals can be the most effective method of pain relief for labour
• When your baby has died before birth, you may be at higher risk of bleeding or an infection, so your anaesthetist will review and discuss your medical history and blood tests before inserting an epidural to ensure your risk of complications is low
• For an epidural, the anaesthetist inserts a needle into the lower part of your back and uses it to place an epidural catheter (a very thin tube) near the nerves in your spine
• The epidural catheter is left in place when the needle is taken out, so you can be given painkillers through it during your labour. The painkillers may be a local anaesthetic to numb your nerves, small doses of opioids, or a mixture of both
• An epidural may take 40 minutes to work to give pain relief (including the time it takes to put in the epidural catheter)
• An epidural should not make you feel drowsy or sick
• An epidural can usually be topped up to provide anaesthesia and pain relief if you need a ventouse, forceps or a caesarean birth

More detailed information about epidurals is available on our main epidural information page (please note this page may mention effects on the baby which are not relevant to you).

Patient-controlled intravenous analgesia (PCIA) is a method of pain relief where you can give yourself (self-administer) opioid drugs using a pump attached to a drip.

What is patient-controlled intravenous analgesia (PCIA)?

PCIA puts you in control. You hold a button in your hand. When you need pain relief, press the button and a small amount of strong painkiller is delivered into a drip in your hand.

PCIA is sometimes used instead of an epidural for pain relief during labour. This may be your preference, or there may be reasons why you can’t have an epidural. The medicines used for PCIA are called remifentanil or fentanyl. You might hear these words used. PCIA may not be available on every labour ward.

The medicines used for PCIA act quickly but only for a short time. This makes them a good choice to help with the pain of contractions.

How effective is patient-controlled intravenous analgesia?

When asking women about different types of pain relief in labour, they say that PCIA is better than other painkiller injections (pethidine, morphine or diamorphine), but not as good as an epidural. Your experience may be different. It may be possible to continue to use gas and air as well as your PCIA.

Are there any risks from patient-controlled intravenous analgesia?

Medicines used for PCIA can have some side effects:

• They can slow your breathing
• They can cause your oxygen levels to drop
• They can make you itchy
• They can make you feel sick
• They can make you feel sleepy.

These problems are usually easy to treat, but mean that you will be monitored closely and may need some oxygen. Your anaesthetic doctor will review you if any of these problems happen. If there are any concerns that it is no longer safe to use a PCIA, the anaesthetic team will explain this to you and offer alternative pain relief options.

Do all labour wards offer patient-controlled intravenous analgesia?

Not every labour ward offers PCIA pain relief. Ask your midwife what is available in your hospital. Your anaesthetic doctor will discuss pain relief with you and help you make the best choice.

Mild (or simple) painkilling medicines include paracetamol and anti-inflammatories, which can be taken by mouth or injected. These can be used alone or in combination with other medicines or therapies.

Anti-inflammatory medicines, for example, ibuprofen, diclofenac or naproxen, are not usually allowed in pregnancy, but can usually be used in the circumstance when your baby has died. Your doctor can discuss whether these are suitable for you.

TENS machine

• Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief using a mild electrical current.
• A gentle electrical current is passed through four flat pads stuck to your back. This creates a tingling feeling. You can control the strength of the current yourself. It is sometimes helpful at the beginning of labour, particularly for backache. If you hire a TENS machine, you can start to use it at home. Some hospitals will also lend you one.
• While some individuals manage their labour with only the help of TENS, it is common to need some other pain relief later on in labour.

Complementary therapies

Find more information on our complementary therapies webpage.