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It’s one of the big questions for birth plans: “Do you want an epidural?” But there are plenty of other ways to make those contractions more bearable. We asked two experts — Ann Schaeffer, D.N.P., C.N.M., a midwife in Harrisonburg, Virginia, and a consultant for the American College of Nurse-Midwives, and Rebecca Dekker, Ph.D., R.N., the founder of Evidence Based Birth, an organization that works to make research about birth accessible — to weigh in on three options that might be less familiar to women who are figuring out their birth plan.��

Nitrous Oxide

Nitrous oxide, aka laughing gas, is becoming more common again, Schaeffer says. (It was widespread in the ’70s and ’80s but fell out of vogue, she says.) It’s inhaled as a blend with oxygen. Mom controls the mask and holds it to her face as needed. The downside? “It has a very, very short window of effectiveness,” Schaeffer says. Breathe in for relief, breathe out, and it’s gone. Nitrous oxide promotes a feeling of calm, making it more of an anxiety easer than a pain reliever. “The intent is not so much to relieve pain but to help you cope,” Dekker says, adding that it usually isn’t the first thing moms reach for in labor — but it can help them get through the end.

Sterile Water Injections

This is exactly as it sounds: sterile water injected into points in the back. The method is “a little old-school,” Schaeffer says. It’s usually administered in four spots, and “it can be pretty painful while you get it placed,” Schaeffer warns. It offers relief through the “diffuse noxious inhibitory control” method, or “‘deliberately causing an unpleasant sensation to increase your comfort,’” Dekker says. In other words, the injections trigger the brain to release its own pain-relieving hormones (aka endorphins). Research shows the injections take effect quickly — within a minute or two, Dekker says — and can last up to two hours. Since the injections are only water, you can safely repeat them.

TENS unit

Transcutaneous electrical nerve stimulation, aka TENS, is a fancy way of saying a low voltage back treatment. The sensation is “prickly,” Schaeffer says, and moms control the intensity. It’s noninvasive and safe, but Dekker says it takes time to kick in: One study showed it took laboring moms about two to four hours to feel relief. That’s because researchers think it partly relieves pain by the “gate control” method, which means your brain can only receive so many sensations at once. So, the added sensation helps prevent moms from feeling contractions. Hospitals may have TENS units, but you can buy them for as little as $30. “It’s something you can do at home, or in the hospital, or even while driving to the hospital,” Dekker says.

Ultimately, these things are all part of what Schaeffer calls a toolbox of pain relief methods: “Ideally, when we have someone in labor, we are able to give them a few options.” And Dekker says that research shows that the best way to manage labor pain is to combine pain relief options. “You can’t just slap a TENS unit on someone and say, ‘Here you go; have a great labor!’” Dekker says. “You have to also include other comfort measures.”

A Labor Revolution

TENS units, nitrous oxide, and sterile water injections might sound foreign to many American moms-to-be who are figuring out their birth plan, but not to midwives and laboring mothers in the United Kingdom. “They’re all extremely common in England,” says Rebecca Dekker, the founder of Evidence Based Birth. Why is that? “It’s more of a reflection of the medical management model in the U.S.,” Dekker says, “whereas in the U.K., most women are cared for by midwives.”