Once we say that now you are in labor or in active phase of labor, you continue with your pain relief management like during a lot of deep breathing exercise, doing mediation, yoga, walking around but yet if you feel that you cannot cope, them this is the best time to discuss your pain relief options. We have three main pain relief options. We have sleeping injections. It is a mixture of pethidine and injection phenadone. The whole idea with this is to keep you relaxed. It may make you a little drowsy. It may make you sleepy and it works for 4 hours. The drawback of this injection is if the labor progresses for 12 to 14 hours, that means every 4 hours you need to repeat this injection. So what happens in the end is you become very drowsy and when you are ready to deliver, you are not able to listen to us and follow those orders. Another thing about this sleeping injection is sometimes some amount of this drug may go to the baby and the baby may become drowsy. That is also not a big deal. We just tell the pediatrician that I have given you so many injections at some many intervals. so he watches the baby to see if there is any of those effect reaching the baby, in case the baby to see if there is an of thee effects reaching the baby. In case the baby is drowsy they have an antidote injection to reverse the effect on the baby, that is the sleeping injection. The other option is commonly we call as entonox or we also use these words called as gasinair. It is a combination of oxygen and nitrous oxide or oxygen and laughing gas mixture. It comes in a mask. So every time when there is pain, you hold that mask close to your face and take 2 to 3 deep puffs. After 2 to 3 puffs you might feel like a gas balloon oral light headedness or a floating feeling. So we say that you are feeling the pain but you are in control of the pain. The drawback of the mask or entonox is in case your labor takes 12 to 14 hours for you to deliver, breathing this mask for 12 to 14 hours will exhaust you., make you very drowsy and when you are ready to deliver , you are not able to perform it. So we say the sleeping injection or entonox is good for people who do it very fast. Usually I see the ladies in their second or the third pregnancy are the ladies who do it fast or of the lady in the first pregnancy is the one who does his two options. Then we have the third option as the epidural or commonly caused as the painless labor. In this the anesthetist comes and they des this. First they will give a local anesthetic to numb the skin at the lower part of the back. In the spinal cord there is an outer space called as epidural. The anesthetist will identify that spot where the nerves are coming from the spot. So they pass a fine catheter which is when connected to a drip just like an intravenous drip. It is a bottle or a syringe containing few cocktail of the pain relief injection. Once the drip starts flowing in the epidural space, in the lower part of the back, it will start noticing all the pain nerves in the uterus. So what happens is you are numb from your waist onwards or from your belly button lower down you are not feeling all the pain. nowadays we control the drip in such a way that some amount, maybe 20% of this pains you may continue to feel so that it is bearable and why we let you feel is that you can move your legs, you an bent your knees and you can pass urine on your own and also when the baby’s head is coming out, you are able to feel and you are ready to push, actively participate and help us in pushing the baby. So these are the pain relief options. The small drawback of the epidural is lot of patience is needed. Any injections if you are taking, take it at an early stage when you are calm. So even an epidural, if you are taking, take it at an early stage when you are relaxed, when you are clam, and the anesthetist can also do his job calmly. Another job about the epidural is lot of patience is needed. At the end is we wait for the baby’s head to come down before we ask you to push and when we tell you to push, you need to be physically strong to tell you to push. So your physical exercise, mental strength has to be there when option for an epidural.