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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

TENS - Transcutaneous Electrical Nerve Stimulation

It is a set of electrodes which are placed on the skin on your back and it emits an electrical signal which stimulate your neurons through the skin. (Thus the name.) The sensation is more like the tingling and numbness of your jaw after dental work than like pain. They let all of us try it out during the class.

You (or a coach) control the amount of signal that you need for the numbness to overpower the pain during a contraction by using a dial on the control box. They say it works for some people but doesn't work at all for others. The nice thing is that you can try it during labor and if it doesn't work at all, you can just take it off and there's no harm done at all. (unlike medications) You can also turn it off in between contractions.

I found TENS an absolute God-send and would use it again like a shot. It got me through most of my labour until transition without much else and I found it pleasant to use. I want one for period pain but they cost too much! :-( My friend used hers for post-Caesarean pain to great effect, and it's also good for coping with after-pains. Most of the women I've spoken to, who used it first time, say they would absolutely use it again.

Incidentally, the orthopaedic ones are great for back-pain during pregnancy, but you must get fitted by a proper physiotherapist.

The only notes of warning I would make are make sure you hire one from a reputable company; make sure it's a proper obstetric one complete with booster button; and put it on way before the contractions get painful - the effect builds up over several hours and works better the longer you keep it on; and make sure you have a new battery in case you have a long labour. Oh, and don't get in the bath with it on! :-)

I was using a TENS unit for back pain while I was pregnant and decided to try it during labor. I had an unmedicated labor that lasted about 29 hours. Most of it wasn't so bad. I went into labor Saturday afternoon, put on the TENS until Sunday morning and wore it until I got to transition. At one point I figured it wasn't helping because I was still feeling the contractions and they were pretty tough but when I turned it off I *KNEW* it had been helping! The contractions were much stronger feeling and hurt more in my back when I turned it off. I turned it back on and left it until the tingling started to annoy me. At that point I was very near pushing and I don't think it would have helped much then. The pushing contractions were much stronger and were in a totally different place that the labor contractions.

Anyway, I loved mine and I plan to use it again!

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6) Question of the Week Responses

Question: I would like more information about TENS (Transcutaneous Electrical Nerve Stimulation) for use in labor. The instructions on the units say "PREGNANCY: The safety of [TENS] for use during pregnancy or delivery has not been established." But I know it has been used for this purpose. Is there evidence that TENS works and is it safe? -Jeanne Batacan, CMA, ICCE, CLE

We use an Obstetric TENS machine in our practice. A lot of women don't want to try it, but those who do generally feel they get some relief from it. The instructions suggest that you should put the pads only on the back and not pass the current through the foetus, but there are no other "warnings" in relation to its use in pregnancy.

I cared for someone only this week who used it throughout her labour (her first) and had 30 mg pethidine IV at about 8 cm dilated. She claimed, at one stage, that the TENS was not working, so her partner and I moved the pads farther down her back so that two of them ended up on her buttocks and the other two were around waist level, and she felt relief again. She said afterward that she had noticed the difference when we moved the pads. -Jane, Australia ====

I used a TENS machine during my labor. I borrowed it from a British friend who used it for all her labors. She benefited greatly from it. I found it very helpful up to a certain point. You hold a little device that you push if you want another "shot" of tensing. When I was at the last point of active labor it started annoying me, so I pulled it off.

But until that point it really helped (this was my third baby so I had done two before without any TENS). It especially helps with posterior birth because it really relieves backache. You have to take it off if you want to take a bath or shower, however, and you have to make sure you stick the little pads on exactly the right places on the back.

TENS has been used in England for a pretty long time now, so maybe there is some literature available there. -Karen van Loon ====

The warning that you mention appears to be a legal requirement in the United States, as the same wording appears on instructions for TENS machines apparently made by a number of manufacturers. I have no medical qualifications, but am aware that TENS is commonly used during labour here in the United Kingdom, and is as far as I am aware uncontroversial.

There's quite a bit of information at http: including a list of indications (which include labour pain) and contraindications (including pregnancy). All are supported by references, which I have not been able to follow up, but which may well include the information you are seeking. -Dave Seymour

I've used TENS during labor for back pain. It is not recommended that it be applied to the abdomen, because the electrical current could interfere with the electrical conductivity of the uterine contractions. So it can't be used for contraction pain. It can be helpful for back pain with contractions, but it is problematic.

The electrodes are applied to the back, and the electrical current is turned up as a contraction starts, and turned down at the end of a contraction. It's very difficult for the laboring woman to do this for herself, because concentrating on turning up the flow at the beginning of a contraction throws her off, so she can't really catch the contraction and go with it--by the time she's turned up the TENS unit, she's at the peak and overwhelmed. We've tried having her signal to someone else when the contraction starts so that person can turn up the unit for her. But then she doesn't have control over how high it's turned up, which needs to be higher for some contractions than for others. So I've found it to be less than satisfactory for that purpose.

TENS is very effective for relieving incision pain after a cesarean section. We used them in a hospital I worked in years ago as a nurse. The woman could control it herself, and could turn it up just before moving or getting out of bed. The amount of pain medication women needed was remarkably reduced. Some women didn't need any at all. I don't know why they aren't used today for that purpose. -Carla Reinke, CNM, Virginia Mason Midwifery

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