Objective To explore midwives’ experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour. Design A qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically. Setting Two metropolitan maternity units in Queensland, Australia. Participants Eleven midwives who had administered SWI for back pain in labour in a randomised controlled trial. Findings Three major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice. Key conclusions Whilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use. Implications for practice The procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women.