Wednesday, July 17, 2013

TENS Unit for Labor Pain Relief

There are a variety of ways women can achieve relief from labor pain. Many women choose narcotics, epidural analgesia, or other pharmacological options. There are growing numbers of women who seek chemical free options and use a variety of non-pharmacological comfort measures for labor.

Pursuing childbirth education in birthing methods such as The Bradley Method of Natural Childbirth, Hypnobirthing, Birth Boot Camp, Birthing from Within and others can be one way women gain knowledge about their bodies and the birth process. This can empower them to achieve the natural childbirth experience they desire.

To aid them in their goal for a non-medical, chemical free birth, there are several options available to help ease the intensity of labor so birthing mothers can decline unnecessary or harmful interventions and medications and attain a natural childbirth experience. One of these chemical free pain relief options is the Femme TENS Unit.

What is TENS?

TENS stands for Transcutaneous Electrical Nerve Stimulation. Through the device, mild electrical impulses are transmitted through the skin, where they stimulate nerve fibers. The woman controls the stimulation through a handheld, battery-operated device which generates the electrical impulses and transmits them via electrodes (stimulating pads).

Four electrodes are placed on the lower back (picture below). For placement, find the "points of Venus" or the two dimples on the lower back. Place two electrodes above these dimples on either side of the spine, and two below the dimples also on either side of the spine. The two lower electrodes should be on the upper part of the buttocks. These electrodes are connected to the battery operated, handheld device where the laboring mother can adjust the strength and duration of the electrical pulses to accommodate her needs.

History of TENS:

Electrical stimulation has been used since 46 A.D. when a Roman doctor recorded using the electrical powers of a fish to treat headache and gout. In the 19th and 20th centuries, electrostimulation with static electricity was used for many purposes. Presently, TENS is used for many acute and chronic painful conditions, including pain in labor, post-surgical discomfort, chiropractic treatments and chronic pain associated with other disorders.

In 1965 Melzack and Wall introduced the Gate Control Theory of Pain. This theory suggests that the severity of pain one feels depends on the balance between the painful and non-painful or pleasant stimuli that reach one's consciousnesses. Pain awareness can be reduced by closing the "gate" to pain, which can be accomplished by increasing non-painful or pleasant stimuli. The low frequency "acupuncture-like" TENS stiumulates the release of endorphins, which are opiate like hormones released by the pituitary gland during intense physical activity, sexual activity and childbirth.

Scientific Support for TENS:

TENS in labor can help tremendously with pain relief, back pain and a woman's overall satisfaction during childbirth by distracting and refocusing the mother with a competition of stimuli and an increase of endorphin production. In 1997, a study of 8 randomized controlled trials including 712 women showed that though there was "no compelling evidence for TENS having any analgesic effect," additional analgesics were used less by the women who used TENS during labor, and 54% of them went on to use it in a future labor [i].

Studies of the use of TENS for back pain in labor show that although few women reported reduction in abdominal labor pain, it had a spedific beneficial effect on pain localized to the back. In another study, by Budsen in 1981, it results showed "TENS has a specific beneficial effect on pain localized to the back" [ii]. In this study, the TENS group used less nitrous oxide and fewer TENS babies went to the NICU.

Advantages of TENS in Labor:
  • There is no reported harm to mother or baby.
  • TENS can be used with other palliative measures.
  • TENS Allows ambulation and movement.
  • The laboring mother remains clear-headed while utilizing TENS.
  • No extra safety interventions are required with TENS use.
  • TENS may help a mother postpone or avoid the use of epidural analgesia.
  • The woman is in control of the frequency and intensity of the TENS.
  • Many women consider TENS as effective as pharmacological options.
Disadvantages of TENS in Labor:
  • TENS is less effective than epidural analgesia.
  • Not all women find it helpful.
  • TENS must be initiated early in labor for maximum benefit.
Access to TENS for Labor Pain Relief:

It is highly recommended that you seek out a professional who has certification and experience in the use of TENS for labor pain relief. I recently received training and certification to offer TENS to my clients as a part of my various doula packages.

You can also purchase your own Femme TENS unit online or rent one from a qualified professional.

Precautions with TENS:
  • TENS should not be stored or used in water or near high heat or near flammable gas.
  • TENS should only be used with specified electrodes placed on body only as and where directed.
  • Women should not use TENS before full term (38-40 weeks)
  • TENS should not be used with a demand-typ cardiac pacemaker or if a woman has a seizure disorder. 
More pregnancy info!

Sources and References:
  • [1] British Journal of Obstetrics and Gynocology, February 1997,
  • [ii] Acta Obstectrica et Gynocologica Scandinavia, 1981,


Denise said...

ARe you sure this works? it jsut seems like more wires and tubes coming out of your body. Do laboring mothers really need this?

Missy Rose said...

Hi Denise. TENS is very effective pain relief for some women, especially those experiencing back pain during labor. Research shows that it is not effective for all women. Not all of my clients choose to use TENS, but those who do feel it is a valuable tool, in conjunction with other comfort measures for labor. No, women do not "really need" TENS any more than they need any other tried and true comfort measures like massage, visualization, position changes, movement, nourishment, and continuous emotional and physical support, but I see it as one more tool for my bag that may help my clients achieve their best birth! It's like certain massage tools I have, certain positions or the birth ball. Some women don't ever want to get off of the birth ball during labor because they are comfortable there while others hate it. Some people want to be touched and massaged the entire labor, while others don't even want to be touched. That said, the research does show, and my experience tells me that TENS can be effective for some women and is a valuable tool to have available! Thanks for reading and thanks for your comment!

Missy Rose said...

As far as "more wires" coming from the mom's body goes - my question would be do laboring mothers really need all of the OTHER wires coming from their body. These wires can be removed by the laboring mother at any time, and even reapplied if she wishes. I feel the better question would be do laboring mothers really need the monitors and the iv's and the blood preassure cuffs and the pulse ox on their finger and the medications and the epidurals. Since the TENS is battery operated, mother can move around freely without the wires getting in the way, and the small unit can clip right onto their shirt or gown. I find it far less constricting in labor than the IV's and other things that are much more likely to confine the mother to the hospital bed and cause a multitude of problems for her birth experience.

Denise said...

I was with you until you starting talking about cables for monitoring. Yes you are right. Once there were no monitors, but hen again the expectancy of a laboring mother to live was a lot less than today.

But besides that point I understand what you are getting at. :)

Missy Rose said...

As far as eletronic fetal monitoring goes, I encourage you to read an excellent article about evidence based fetal monitoring here: I am not against hospitals or interventions, and all of the "wires and tubes" can and do have their place when mothers need them. Since you had mentioned "it just seems like more wires and tubes coming out of your body," I simply wanted to point out that there really is no need for most moms to have multiple wires and tubes connected to them during the duration of labor. So, in the case that all other interventions are being used judiciously instead of routinely, these wouldn't just be more wires coming out of the mom's body or attached to her; they would be the only wires attached to her. And honestly, they are not very noticeable, and not long enough to get tangled in or hindered by, whereas the IV tubes, fetal monitors, pulse ox monitors, blood preassure cuffs and other mechanisms can greatly hinder comfort and mobility for a laboring mother. Having read the research and evidence to support TENS units for labor pain relief, I feel there is good scientific research to show it can be effective for many women. On the other hand, there is not good evidence to support the routine use of many of the other interventions outside of medical indications to do so. I hope that makes sense. Electronic Fetal Monitors can be effective in alerting us to babies in distress, but it has not been shown in its history to improve maternal or fetal outcomes and instead has been shown to contribute to our ever growing cesarean rate.

Anonymous said...

Speaking as an Occupational Therapist, the TENS pads in the picture are placed too close to each other. There should be at least a 1-inch space between the pads.


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