What is TENS?

Transcutaneous electrical nerve stimulation (TENS) is an effective, natural  method of pain control, involving the use of electrodes that adhere to your lower back (when used for management of labour pains). 

The TENS machine passes small electrical impulses to the affected area of your body. When you’re using TENS during labor, you might feel a buzzing, tingling, or prickling sensation wherever the pads are placed. It’s easy to administer, and the person who is receiving the TENS can control the intensity of the sensation using the buttons on the device. There's also a boost button you can press with your thumb when you want maximum output from the machine. This may help you to get through each contraction.

The controller part of the TENS machine is easy to hold in your hand while you're in labour. But if you don't want to hold it, you can clip it to your clothing or attach a strap and hang it around your neck.

How does a TENS machine work?

The mechanism of how exactly the TENS machine helps you to cope in labour is not exactly known, but it is believed to come down to a combination of factors. These include:

  • the electrical pulses may prevent pain signals from reaching your brain
  • the pulses may stimulate your body to release natural, feel-good substances called endorphins
  • it helps you to feel in control of your labour and be less anxious
  • it offers a distraction from your contractions

There is not a lot of evidence to show how effective using a TENS machine as a form of pain relief in labour is, but most midwives are supportive of the idea of using one.

About 1 woman in 5  plan to use the TENS at some point in labour and most mums who've tried it say that they would use it again for their next labour.

What is TENS used for?

TENS can be used to help reduce pain and muscle spasms caused by a wide range of conditions including arthritis, period pain, knee pain, neck pain, back pain, sports injuries, and of course as a method of pain relief during labour.

Is TENS safe?

If applied correctly, TENS can be used safely without any side effects to you or your baby.

How/when do I book my TENS?

Book your TENS here - hire 

You can book your TENS as far in advance as you like. We strongly advise booking at your earliest convenience, as unfortunately we don't have a machine for everyone. 

Select the date on the booking calander for when you will be 36 weeks pregnant - and then you're all booked in!

Do I have a choice of TENS machines?

We offer a range of labour TENS for hire and for sale, so you can choose the one that suits your needs and your budget. Within our hire range you can choose from the following:

  • Elle TENS Plus
  • Elle TENS 2
  • Elle TENS

What are the differences between the 3 TENS machines available for hire?

 

TENS machine comparison chart

Do I need the pelvic floor function for labour?

No. This is a function that is designed to be used 12 weeks post birth, to retrain the pelvic floor muscles. The pelvic floor probe is not included in the Elle TENS Plus TENS machine hire. We will be releasing a hire function for the pelvic floor toner soon, so watch this space!

When can I start using my TENS machine? 

Pregnancy

TENS machines have been proven to be effective at reducing lower back and pelvic girdle pains experienced during pregnancy.

If you have approval by your midwife or Doctor (or allied health professional) you can use your TENS machine for these pains prior to 37 weeks gestation.

Prior to Labour

We advise that you test your TENS machine from 37 weeks gestation to ensure the machine is functioning correctly and that you familiarise yourself with how to use the device.

You can practice using this on yourself, your birth partner or a friend. It is fine to use the electrodes that are supplied in your pack and then reuse these for labour, as they can be reused up to 20 times!

Labour

It is best to use your TENS machine at the beginning of your labour, as it is believed that the longer the device is insitu, the more effective it will be at reducing pain and creating endorphins.

TENS is most likely to be effective in early labour and you may still need other forms of pain relief as your labour progresses. You may find that the TENS works better at relieving your backache than other types of pain relief. However every woman's labour and birth is different.

TENS therapy can be stopped at any time during your labour, and does not have any residual effects. For example, you could stop it if you wanted to get into the bath or remove the electrodes to have a back massage. You can then place your electrodes and TENS back on.

Postpartum

Some mums experience horrible after birth pains, so reuse your birth electrodes and place your pads over your uterus!

Can I combine TENS with other pain relief methods for childbirth?

Yes, you can still use heat packs, massage, gas or morphine.  You can not use TENS if you are in the shower or bath.

 

What is the evidence on using TENS during labour?

We found three systematic reviews of the research; all were published in the year 2011. Because they had similar findings and looked at similar studies, we’re going to focus on the Cochrane Review from 2011.

Dowswell et al. (2011) Cochrane Review and Meta-Analysis

In this review, researchers combined 17 randomized controlled trials with about 1,500 participants total. The control groups varied between the studies. Some of them used routine care, some of them used a placebo TENS (where they applied it to the back but didn’t turn the unit on, or used an extremely low intensity), and some of them compared TENS to other methods of non-drug pain relief. Overall, 10 of the 17 trials were placebo-controlled with a TENS unit that was either not turned on or had a very low electrical current. Unfortunately, some of the participants in the studies may not have been truly blinded to what treatment they were receiving – the true treatment or the placebo – because it’s possible that they may have realized that their TENS unit was not turned on.

Overall, there was little difference in pain ratings between people who had TENS and people in the control group. However, they found that people using TENS applied to acupuncture points were less likely to rate their pain as severe compared to the control group. More people who were assigned to true TENS were likely to say that they wanted to use it in future labours compared to those in the placebo group. However, a surprising number of people in the placebo group also reported that they would like to use that treatment in future labours (not knowing that it was a placebo). This suggests that simply having the TENS unit applied to you, whether or not it’s turned on, may help by distracting you from labour and giving you a sense of control.

There were three studies that looked at using TENS in addition to an epidural. So, people had an epidural and they were also randomly assigned to have TENS during labour or not. The researchers found that it did not provide any additional benefits to reducing pain levels when you add TENS to an epidural.

There were no bad outcomes or adverse events in any study; however, there may have been some skin irritation under some of the pads. There was one case in all of the studies where the TENS did interfere with electronic fetal monitoring, but that only happened with one patient.

Since that 2011 review came out, there have been three more randomized controlled trials on this topic that were too new to be included in that review.

Shahoei et al. (2017)

In 2017, researchers from Iran reported the results of their randomized controlled trial where they assigned 90 first-time mothers to low intensity TENS, placebo TENS (where the device was turned off), or to routine care. They started the treatment on the back at about four centimetres dilation, and the treatment continued until the time of birth.

After about one hour, the average pain scores were not different between the groups; however, they saw significant differences in pain levels at two, three, and four hours after the treatment began. For example, in the second stage of labour, during the pushing phase, only 20% of the people in the TENS group reported their pain as severe compared to about 83% – 87% of people in the other two groups. When they asked people about four hours after the birth how they recalled the severity of their pain, only 7% of people in the TENS group recalled severe pain compared with 43% of people in the placebo group, and 60% of people in the standard care group.

Santana et al. (2016)

In another study, researchers in Brazil randomly assigned 46 first-time mothers to either TENS or standard care. They did not attempt to use a placebo TENS in this study. In the experimental group, once mothers reached four centimetres dilated, TENS was applied once to the back for 30 minutes. The intensity of the TENS was determined by the person who was labouring.

Before they started the intervention, about 70% of people in both groups reported that their pain was a seven or higher on the zero to ten pain scale. But after the intervention, only 34% of people in the TENS group said that their pain was a seven or higher compared with 83% in the standard care group.

On average, people who were randomly assigned to receive TENS ended up waiting about seven hours before they requested additional medication for pain relief compared to two hours in the group that did not receive TENS. So, TENS may have helped the people in the treatment group postpone their need for pain medication. This study found no differences in reports of maternal satisfaction with TENS or no TENS.

Shaban et al. (2013)

Finally, in 2013, researchers in Egypt randomly assigned 100 people in active labour to either receive low-intensity TENS applied to the back, or to receive Pethidine/Demerol, which is an injectable narcotic. TENS was used in the experimental group until the participants reached 10 centimetres dilation.

They found a decrease in pain scores in both groups, but there was no significant difference between the groups. Forty-eight hours after the birth, the people who were randomly assigned to receive TENS during labour were much more satisfied with their birth, on average, compared to the people who received the injectable pain medication. Of those who received TENS, 83% reported being satisfied compared with only 10% of those who received Demerol.

In addition to low satisfaction, the people who received Demerol also reported side effects such as drowsiness, nausea and vomiting. Babies in the Demerol group also had lower Apgar scores after birth. There were no bad side effects reported in the TENS group. The results from this study are not surprising. If you look at our video about using IV opioids, or injectable opioids during labor, Demerol is considered to be a not safe option because of its effects on babies and mothers in terms of their breathing.

Conclusion

In summary, there is a need for more high quality research on this topic. At least 11 randomized controlled trials have attempted to compare true TENS to a placebo TENS, where the device is either turned off or at a very low intensity. However, we’re not quite sure if those researchers did a good job of blinding, or making sure that people who received the placebo were blinded to the fact that they were receiving a placebo.

There is some evidence from the Cochrane Review and from the recent randomized controlled trials that using TENS during labour does decrease pain and may increase maternal satisfaction. Most people who use TENS say that they would use it again in a future labour. There was also one recent randomized controlled trial that found that the use of TENS delayed or postponed the use of medications for pain relief.

TENS applied to the lower back during labour does seem to lower pain compared to placebo or routine care. One recent study that compared TENS to injectable opioids found that TENS relieved pain just as well as the injectable opioids, but without causing side effects for the mothers and babies. So far, researchers have not reported any bad side effects on mothers or babies from using TENS during labour; however, there has been limited research in this area.

The bottom line is that the available evidence does support the use of TENS during labour as an option for pain management.

Do you deliver overseas?

No, not at this stage, but we are in the process of making our hire service available overseas.

However, we do send purchased products overseas.

What are the advantages of a TENS machine?

  • It's non-invasive and therefore allows freedom of movement including walking around.
  • It won't directly interfere with your labour.
  • You can use it for as long as you want to and take it off if you want/need to.
  • There are no lasting side-effects and its completely safe for you and your baby.
  • You don't need an anaesthetist, doctor or midwife to help you use it.
  • It can be used at home,  they are highly recommended for home birth
  • It's portable and non-invasive.
  • TENS can be used on its own or in conjunction with some other form of pain relief.
  • Easy to operate and fully controlled by mum.
  • Focuses your attention and provides you with a sense of control in managing your labour pains.

 

What are the disadvantages of a TENS machine?

  • You probably won’t be able to put the pads in place without help.
  • You may find it only gives you relief in the early stages of labour.
  • TENS can’t be used in water, though you can still use it prior to getting in a bath or birth pool.
  • If you want your birth partner to massage your back, they will have to work around the pads.

When NOT to use a TENS machine?

Never use a TENS machine under the following circumstances, without talking to a Midwife or Doctor first:

  • Prior to 37 weeks gestation unless in consultation with a midwife, doctor or other allied health professional.
  • When you are in the shower, bath, or birth pool.
  • If you have broken skin or a healing scar where you want to place the pads.
  • If you have a cardiac pacemaker or a heart rhythm problem.
  • If you have pain that you don’t think is labour pain. See your Doctor or Midwife,

Can I cancel my order?

Yes, you are more than welcome to cancel your order up until your booking date. Please allow at least one weeks notice and inform us by emailing hello@mamaanditens.com.au.

Please note that we do charge a $25.00 administration fee for cancellations.

What if I don't use the TENS in labour?

As stated in our Terms and Conditions, we cannot provide any form of refund if the TENS machine is not used in labour.

It's less than four weeks until my due date can I still book?

Yes, you can, make sure you choose express postage at checkout.

Private Health Rebate

If you have private health insurance you may be eligible for a rebate on your purchase/hire. Check with your provider and email us at hello@mamaanditens.com.au 

 

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