Although many women over 35 end up having an epidural, there are multiple other options, and it's good to be informed about these and ask about them when you talk with your care provider. Types of pain relief range from complementary techniques like acupuncture to powerful narcotic drugs.

Tens

Transcutaneous electrical nerve stimulation (TENS) works by passing a tiny electric current through the skin. This current is believed to block pain messages from reaching your brain. It may also stimulate your brain to produce natural pain inhibitors, called endorphins. Tens devices are about the size of a small radio and are connected to electrodes placed on the skin, usually on your lower back. Electrical impulses result in a tingling sensation, which some women find annoying. The side effects of tens are usually no more than some skin irritation where the pads are stuck to the back. The electrical impulses do not affect the baby. Most studies of tens in labor have found it to be only mildly effective in reducing labor pain.

Acupuncture

Some women find acupuncture helpful in reducing labor pain. There are different theories as to how acupuncture works. In Western medicine, the hair fine needles placed in the skin are believed to stimulate larger nerve fibers, which then block nerve activity in the smaller fibers that transmit pain sensations. It may also release endorphins, the body's natural painkillers. There is conflicting evidence on just how effective acupuncture is in reducing labor pain. However, it does seem to reduce the chance that you will request epidural analgesia. If you feel strongly about avoiding an epidural, acupuncture may be helpful for you. However, you'll need to find a licensed practitioner who will be able to be with you during labor, and to check the regulations at your hospital.

Hypnosis

There is some evidence that women who are susceptible to hypnosis may be able to reduce the sensation of pain through hypnosis. Hypnosis is a state of deep relaxation and concentration and is something that you can learn to do yourself (in which case it is called autohypnosis). While hypnosis is not harmful. it is expensive and only effective in women who are most susceptible to hypnosis. It may also only have mild effects on labor pain. If you want to try hypnosis, you should start inquiring about classes early in pregnancy.

Subcutaneous Water Injections

In this technique a small amount of sterile water is injected under the skin in two to four spots in the lower back. The procedure seems to be helpful for women who experience labor pain in their backs, especially if it is given in the early stages of labor. In two studies, treatments were found to provide a small to moderate reduction in pain intensity for up to 45 minutes after the injections. This therapy is safe and can be given by your care provider and may provide some pain relief in early labor. However, there is no evidence so far that water injections decrease the use of epidural analgesia.

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