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What medical pain relief options do I have?

HypnoBirthing is a great way to cope with pain during birth, but sometimes, you might want something extra.  Asking for pain relief during birth does not mean you've failed!  It means you're listening to yourself and giving yourself what you need in that moment.  

I often hear people asking if you can still use pain relief such as an epidural when HypnoBirthing.  The answer is YES!  and guess what?  You can still use the HypnoBirthing techniques while using any other form of pain relief.  


There are many different pain relief options available to you in the hospitals and birth centres during your birth.

Hospitals and birthing centres in The Netherlands differ in the birth pain relief options they offer.  But let's look at the advantages and disadvantages, pros and cons, of all those available:


Remifentanil is a strong pain relieving medicine that belongs in the same opioid group of painkillers such as morphine and diamorphine.  It works very quickly and wears off quickly. It is administered via an intravenous drip, placed into the back your hand, with a pump so that you are in control.  Normally, you would press the pump to release some of the drug into your system during a surge/contraction.  It takes about 20 seconds to reach its full effect so you would want to press it as soon as the surge starts.  For safety, the pump is programmed to limit the dose and it is crucial that it is only you that presses the button when you need it. You can use ‘gas and air’ with Remifentanil. The use of Remifentanil does not stop you having an epidural unless there are other reasons why you can’t have one.

Benefits of Remifentanil:

  • With the use of the button, you're in control of your own pain relief

Disadvantages of Remifentanil:


  • It can make you feel sick or dizzy

  • It may make you feel itchy

  • Monitoring equipment is required during use of Remifentanil due to the risk of respiratory issues

  • It can slow down your breathing and affect your oxygen levels.  Sometimes you may forget to breathe and you'll need to be watched continuously.

  • As it can make you feel light-headed and dizzy, you will not be able to walk around, and will need to stay on the bed.  This means that you will not be able to go to the toilet and may need a urinary catheter placed to empty your bladder.

  • Does affect baby - these are the side effects:  slowed breathing after birth, may be drowsy after birth so it might affect first feed

If you would like to read recent studies:

Laughing gas

Laughing gas (also known as gas & air, Entonox and Relivopan) is a mix of oxygen and nitrous oxide.  It is tasteless and odorless.  You breathe in the gas and air through a mask or a mouthpiece, which you hold yourself.

The gas takes about 15-20 seconds to work once you inhale, so you breathe it in just as a surge/contraction begins.  It works best if you take slow, deep breaths.

Advantages of laughing gas:

  • quick to start and stop using it

  • You have control by removing the mask/mouthpiece if you do want it

  • Can be used in any stage of birth

  • If the gas is no longer inhaled, effects wear off within minutes

  • Has no side effects for the baby

  • If you're in the first line of care, your midwife can continue to support you through the birth, a gynaecologist is not required 

  • Does not affect your baby

Disadvantages of laughing gas:

  • It can make you feel nauseous and you may vomit

  • Can make you feel sleepy or unable to concentrate

  • You may feel light-headed

If you would like to see the recent studies:



Pethidine is given via an injection in the buttock or upper leg.  It is not used regularly by hospitals and only some hospitals offer it.  

It takes about 20 minutes to work after the injection. The effects last between two and four hours, so wouldn’t be recommended if you’re getting close to the second stage of labour (pushing stage).

Advantages of Pethidine:

  • Administered quickly and easily, takes 20 minutes for it to start working


Disadvantages of Pethidine:

  • Can make you feel dizzy and drowsy

  • Can make you forgetful

  • It can cause nausea and you may vomit

  • Mobility is decreased as you must remain in bed.

  • Due to the relatively short effect (2 to 4 hours), other forms of pain relief may be required.

  • Does affect baby - these are the side effects: heart tones may become less variable and if the baby is born within 4 hours of the injection, he/she may be drowsy and struggle with breathing. 

  • It may interfere with baby's first feed


An epidural is a type of local anaesthetic.  It numbs the nerves that carry the pain impulses from the birth canal to the brain.  For most women, it gives complete pain relief.  Your lower body may become numb, your legs may become weak or you may feel a tingling sensation in your abdomen and/or legs. These effects stop after the medication is discontinued.

How much you can move your legs after en epidural depends on the local anaesthetic used. Some hospitals offer “mobile” or "walking" epidurals, which means you can walk around.

How an epidural is given:

  • A drip will run fluid through a needle into a vein in your arm.

  • While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back.

  • A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting.

  • The epidural can be topped up by your care provider, or you may be able to top up the epidural yourself through a machine.

  • Your surges/contractions and the baby’s heart rate will need to be continuously monitored. This means having a belt around your abdomen.

  • Once your cervix is fully opened and dilated, and you are nearing the end of the first stage, the pain relief will be reduced. This will allow you to feel the surges/contractions in the second stage, so you can breathe and push your baby down and out.

Disadvantages of the epidural:


  • You will be connected to monitoring equipment and your mobility is decreased, and you must therefore remain in bed.

  • It is not always 100% effective.  The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief.

  • You cannot feel your lower body so are unable to stand or walk to the toilet or move around (unless you use a lesser amount called a 'walking' epidural)

  • An epidural can make the second stage (pushing phase) longer, and your baby may need to be birthed with assistance with the ventouse

  • Read on for side effects.....


Side effects and complications of an epidural

Drop in blood pressure

The analgesic liquid causes the blood vessels in the lower half of your body to expand which may cause a drop in blood pressure. To prevent this, additional fluids will be administered via your intravenous drip. Low blood pressure may cause you to feel unwell or dizzy. Lying on your side will alleviate this discomfort and prevent a further drop in blood pressure. Low blood pressure may influence your baby’s heartbeat. Your baby is therefore monitored via an ECG.


Approximately 1 in 5 women develop a fever. While this is usually in response to the epidural, an infection cannot be ruled out. You and your baby will both receive an antibiotic treatment and will remain in the hospital for at least three days until tests for infection have come back negative.

No bladder control

An epidural numbs your lower body. This makes it difficult to feel whether your bladder is full, and it may be difficult to urinate. As a precaution, you receive a catheter and you will be monitored carefully.

Itchiness and shivering

Another side effect of an epidural is mild itchiness and shivering. This is not a cause for concern and is usually over shortly.


The area around the spinal cord is punctured in 1% of cases where an epidural was applied. The leak of fluid out of this hole can cause heavy headaches. This often presents itself the following day. Headaches are treated with rest, medication, and additional fluids. If the headache does not subside, the anaesthesiologist will look for an alternate solution.

Back pain

Many women experience back pain after giving birth. This back pain is not always caused by the epidural and may have been caused by a long stretch in an uncomfortable position during delivery.

Other complications

If an epidural is administered, the mother is extensively monitored before and after inserting the needle. There is a small chance that large quantities of anaesthetic fluids will enter the bloodstream or cerebrospinal fluid. This can make it difficult for you to breathe.

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