Using TENS in Labor: Pain Coping
I’m so pleased to announce that I am certified to support the use of TENS in labor. I frequently answer questions about what TENS is and how it’s used in labor, so I thought I’d take his opportunity to share it with the masses. Consider this an ode to TENS. TENS stands for transcutaneous electrical nerve stimulation and in labor, we can use a TENS unit for comfort and pain coping.
Before I get into the science of it, I’d like to note that TENS has been used frequently for labor support in many parts of the world, and has been used for many, many years — since the 1970s — for this purpose. According to my doula trainer, Penny, TENS units are handed out like birthing balls at hospitals in the UK! TENS has been found to be a very effective tool for labor coping… so why hasn’t it taken off in the United States? Let’s look at the science and then maybe you can reach your own conclusion.
TENS IN LABOR
The TENS unit consists of a handset, lead wires, and 4 stimulating pads that we place strategically on the back of the laboring person. The area where the pads are placed are around nerve clusters that are linked to the cervix and perineum. I use an obstetric TENS which was created for the purpose of labor coping. From the intensity of the sensations to the simple design, the unit I use was made for labor!
What is the sensation like? It feels like a buzzing, vibration, or tingling for most people. Some people describe the feeling as “a shower massage without the water”, meaning it feels like water hitting your back in the shower, but there is no water present (see WHEN NOT TO USE TENS section below). The birthing parent is in complete control over the intensity and pattern of the sensation.
WHY TENS WORKS FOR LABOR PAIN
There are a few main reasons why TENS may work so well for labor pain coping:
The Gate Control Theory of Pain (GCTP), and
Endorphin Production
Distraction
The GCTP (in very watered down terms) is a theory we frequently tap into when it comes to supporting labors. It basically states that there is only so much “room” in our nervous system for our brains to recognize stimuli, so if we can flood that system with positive stimuli, the body copes with pain more easily.
Pain is said to travel slowly, and pleasure or other non-painful sensations, travel quickly over nerves (this has to do with myelin which is a substance that controls the speed in which a stimulus travels over nerves, but I won’t bore you with all the particulars right now). If we can “flood” the system with positive stimulus, we’re better able to cope with the painful stimulus from contractions because our brain recognizes less of the painful stimuli.
So what about endorphins? Every millennial knows that “Exercise gives you endorphins. Endorphins make you happy. Happy people just don't shoot their husbands, they just don’t.”… Oh, sorry. I got sidetracked by the large quantity of Legally Blonde trivia that lives permanently in my brain. But yeah, that’s basically the jest of it. Endorphins are known to increase pain tolerance and TENS has been shown to increase endorphin production. If we can help our bodies produce more endorphins, we might be able to handle a higher amount of painful stimuli comfortably.
As for distraction, the TENS can provide distraction through sensation, but also through ritual. A recent client said this about using the TENS in labor: “Using the TENS was a diversion for me. It gave me a job — to control the TENS — that was my focus. When I was having a contraction, it shifted my mind to the task of turning it on/off rather than the contraction.”
Ok, so you’re intrigued, but if you’re like me, you appreciate the numbers. Let’s talk about the DATA, baby!
DATA SUPPORTING THE USE OF TENS IN LABOR
Let’s first take a look at this results from the 1998 study that was done in Israel by Kaplan, et al.
There were two control groups: one for first time parents (nulliparous, or nullips) and one for parents who have previously given birth (multiparous, or multips). The study looked at the use of TENS in both of these groups.
For first time birthers, the TENS groups, in both nullips and multips, used pain medication less frequently (67% and 60%, respectively). When the TENS groups used pain medication, they were much farther progressed in their labor, as evident by the average dilation at first pain medication.
In addition, the two TENS groups had shorter labors when compared to the control group that did not use TENS.
Now let’s look at the 1997 study by Carroll et al. This study concluded that although the TENS wasn’t found to have analgesic properties (pain relieving), pain medication was used less often when the TENS was used, which supports the idea that using the TENS may increase pain tolerance.
A 1981 study found that not only was TENS found to have a beneficial effect on pain localized in the back (goodbye back labor), but when TENS was used there were less NICU transfers.
Other studies to consider:
A 2013 study from Egypt concluding that “TENS is effective for labor pain relief, but with greater satisfaction reported by women and no side effects.”
A 2016 study from Brazil concluding that “The results of this study have demonstrated that the use of TENS at the beginning of the active phase of labour produces a significant decrease in pain.”
WHEN NOT TO USE TENS
You shouldn’t use TENS in the water, ever. The pads are easy to put on and take off and you should remove them before seeking any sort of water therapy. You can always reapply the pads!
You also should refrain from using TENS if you have a pacemaker, or a seizure disorder. Apart from that, it’s completely safe to use for birthing parent and baby.
TENS does not numb you, so it is not provide an equal alternative to analgesia provided by an epidural. However, the data shows that less medications are requested when TENS is used.
TENS does not interfere with external fetal monitoring (EFM), but may interfere with Internal Fetal Monitoring (IFM). Since IFM isn’t standard practice for most people, using a TENS should not be discouraged for typical monitoring purposes.
TENS is not a medical device, which means this is something you can purchase (or borrow/rent) and use yourself without a prescription. I would encourage you to chat with your healthcare provider and share the data and safety with them prenatally so that they aren’t taken by surprise at the use of the TENS during your labor.
ALBUQUERQUE TENS FOR LABOR
If you’re local to Albuquerque, New Mexico and are interested in using the TENS in your labor, I would be happy to chat with you. I am pleased to offer TENS to parents who are interested as a part of my doula services at no additional cost. If you’re local, but don’t plan to use a doula, I am happy to refer you to New Life Birth Services for a TENS Instruction and Rental program.
TENS HAS A PLACE IN BIRTH
It’s my sincere hope that more people come to know the power of the TENS for use in labor. The data clearly supports it! There is no scientific reason why TENS should not be used more frequently in labor and delivery rooms in the United States. It’s safe, effective, and cheap in comparison to other means of pain coping or pain management. It can be argued that there are better outcomes when parents choose TENS. TENS absolutely has a seat at the labor pain coping table… and it’s not going anywhere any time soon!