TENS Machine in Labour

Most women don’t like the idea of using pain relief in labour and so any methods that are side-effect-free are a bonus. There are many things you can do in labour to minimise the pain and using a TENS Machine in labour is a popular choice. Here is my invaluable guide to using the TENS machine in labour, I hope you find it useful.

What is a TENS machine?

TENS stands for Transcutaneous Electrical Nerve Stimulation. It consists of a small battery-powered machine about the size of a mobile phone that produces a very small electrical current. You attach sticky pads to your skin and the electrical current is sent through your body from one set of pads to the other.

The electric current stimulates the nerves under the skin and it seems to work in two ways depending on the frequency of the current. A high current appears to confuse the nerve centres receiving pain signals and disrupt their transmission into the brain, thus “reducing” the pain. A low current is also though to help stimulate the body’s natural endorphins, again aiding the body in its own natural pain-relief system.

How do you use a TENS machine in labour?

To use a tens machine in labour you start as soon as labour starts or any time after you can also start using the TENS machine. The gel pads come in pairs and you place each pair on your back, the top pair just around your bra line, either side of the spine, and the bottom pair around your knicker line – just below the waistline on either side of the spine. The placement is quite important for effective use.

You can reuse the gel pads a number of times (so you can take it off and put it back on again – ensure it is switched off first!) but it is advisable to have fresh pads if you have hired or borrowed the machine.

Each TENS Machine is slightly different but they all have the same basic function. From the first contractions, you allow a continuous low current. This helps to boost the body’s natural endorphins.

During a contraction, you increase the frequency and switch on the pain relief part of the TENS – stimulating the nerve signal s to the brain and stopping the pain signals from getting through.

When the contraction has finished, you switch back to the low-level current.

You can set the intensity of the current at both the low and the high levels so you can build it up as labour builds in intensity.

TENS machines designed for labour also have a Boost button so once you have set the higher level, when a contraction starts you can just hit the boost button and it will go to the higher level, making it very easy to use.

What does it feel like?

Using a TENS machine feels a bit like someone is holding a couple of electric toothbrushes against your skin! It has a kind of buzzing feeling, a very fast and soft vibration. Of course, you feel it under the skin but it is not an unpleasant sensation. The main area of sensation is the pads themselves.

What are the side effects of a TENS machine?

The amazing thing about a TENS Machine in labour is that is has absolutely ZERO side effects! So this means it is completely safe for you and completely safe for your baby! Having said that, there are some situations where it is not advisable to use a TENS machine.

When can’t you use a TENS machine?

It is not advised to use a TENS machine if you have a pacemaker, a heart rhythm disorder (such as arrhythmia or epilepsy), so please seek medical advice rom your GP or consultant if this applies to you.

It is also not advisable to use a TENS machine on your abdomen during pregnancy, but it is fine to try it out on an arm or leg to figure out how it works before labour starts. You should stick to the advised placing of the gel pads during labour, but I must add you should never put the pads on your face or neck.

You can’t use a TENS machine in water – it is an electrical device remember! – so if you have a shower or bath, or get into a birth pool you will need to remove it. Once you are finished though you can put it back on.

Some people find they are mildly allergic to the gel pads that stick to your back. The TENS has to have a moist connection to your skin so will only work if the gel is against your skin. You should also avoid putting the pads onto broken skin.

 But does it actually work?

Well, the crazy thing is that the answer to this is both a resounding Yes and a resounding NO!!!

Birthzang did a (fairly unscientific) poll of mums on my Facebook network and out of 62 responses, discovered that

• 35% said it helped a bit
• 24% said it helped a lot
• 18% said it was completely brilliant
• 21% said it didn’t help at all
• 2% said it was a complete waste of money!

So clearly there is a lot of differences of opinion about whether it works, although overall 75% reported positive results. Looking at the comments mums made, however, did shed some light on the situations where TENS machines were better or worse and maybe add some guidelines to use.

1. Correct positioning of the pads made a big difference to its efficacy.
2. It helps most when used early on in labour, so don’t leave it too late to use it (this is probably because you need time to build up the endorphin levels).
3. It was more of a distraction rather than pain relief.
4. It really helped with a posterior labour (when your baby is back-to-back).
5. It doesn’t help very much for labours that come on fast and strong, or are induced (again the endorphins can’t build up).
6. You need to start at a low level and build it up slowly, rather than using a high frequency early on which is just annoying.

Here are a few comments that I feel sum up the consensus.

Briget: “It was a distracting but not unpleasant feeling in the middle of a contraction, and that’s what I needed.“

Marina: “It did take the edge off from contractions but that was about it.“

Julie: “It’s only when I took it off did I realise how much it was helping in the early stages.”

So what does science say?

This is where it gets very interesting though.

A 2009 Cochrane review of studies looking at using a TENS machine in labour concluded:

There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour.

So no real evidence that it has any great effect, but that it is good to have as an option.

A further review in 2011, reached the same conclusions and added:

Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed.

So no-one is telling women to use it and yet they are choosing to do so anyway and more studies are needed.

Then I came across this damning article from a well-respected organsiation, Birth International, who claim that using a TENS machine in labour is nothing more than a “marketing triumph” and  is scathing even of the claims that a rise in endorphin level is even occurring in labour:

What about the claim that TENS increases endorphin levels and therefore is useful in encouraging natural birth? I have not seen any research that shows TENS increasing endorphin levels in labour. There may be some evidence of increased endorphin levels when TENS is used in other situations (but I haven’t found that either), but it any case, it would be unwise to assume from any such studies, that a similar effect would occur in labour, given that birth is a completely different physiological condition.

Of course, just because there is no evidence does not always mean that is isn’t working, just perhaps the studies have not actually looked at this particular aspect and have instead focussed on the pretty subjective reporting of mums of their pain in labour (or their perception of it) often reflectively after the fact rather than at the time, so again adding even more to the subjectivity of the response.

Just a placebo effect?

So then it looks as if using a TENS machine in labour has just a placebo effect. However 75% of the mums I asked who had used a TENS machine said it helped them, even if only in a small way, so there must be something that is helping.

If it is just creating a distraction from the sensations of contractions, if it is just allowing a delay before using other pain relief options or interventions, if it is just giving you something to focus on during contractions, if it is just helping you feel in control of your labour, …

IF IT WORKS THEN WHO CARES????????

Make sure you get a product that is tested and approved by midwifes and has good reviews on Amazon can’t hurt either.

My recommendations

I personally liked the Elle TENS machine best as it was really easy to use and had quite an intuitive interface. It is good to get a TENS machine designed for labour and then you get all the boost functionality and they usually come with useful guides for labour.

 Here are the main labour TENS machines on the market.

 TENS Hire

I also hire TENS machines to people local to Frome or I am happy to arrange postage for an extra fee. You can book TENS hire via my booking system CLICK HERE but be sure to email me with your address if you want to have it posted. Cost is £20 for hire and £28 posted (that pays for postage both ways via My Hermes).

References

https://en.wikipedia.org/wiki/Transcutaneous_electrical_nerve_stimulation

https://patient.info/health/tens-machines-leaflet

https://www.which.co.uk/birth-choice/articles/coping-with-pain-in-labour?gclid=CjwKEAjwq6m3BRCP7IfMq6Oo9gESJACRc0bNFS0PBi2sL9kOEulVrRqYnpiSyJYmH4q-8a4pHefAmRoCw_bw_wcB

https://www.nhs.uk/conditions/tens/Pages/Introduction.aspx

https://www.ncbi.nlm.nih.gov/pubmed/19370680

https://www.birthinternational.com/articles/childbirth-education/136-tens-a-marketing-triumph