Tentative about TENS?

By Amy Peterson CD(DONA), CLC

In my initial doula training I was first introduced to the gate theory of pain. Gate theory says that you can block the perception of pain by stimulating receptors in another fashion - causing a sort of neural traffic jam. This is a lesson that most birth doulas learn very quickly as we support laboring moms with massage, counter pressure, cool cloths, heat packs, running water and even somewhat more surprising techniques like hair pulling and comb squeezing. All of these techniques attempt to produce some of the sensory overload, or distraction if you will, that closes that neural gate in the spinal chord and changes mom’s perception of labor pain. TENS (Transcutaneous Electronic Nerve Stimulation) is a great way to do the same thing, plus: bonus - it causes the body to release endorphins too! - another pain coping mechanism.

TENS is a drug free way to reduce pain in childbirth. Electrical Nerve Stimulation is commonly used during labor by women in Great Britain and Sweden. In the US, TENS units have been used for years by physical therapists and chiropractors in their rehabilitation of injured patients. As a DONA certified doula, TENS is considered out of scope unless you carry the DONA TENS certification. It is a short one day class that teaches you the basics of operating the unit and when it is contraindicated. DONA also makes the labor TENS units and supplies available for purchase, as they can be difficult to find in the US.

The unit is about the size of a small harmonica and runs on a 9 volt battery. It has a setting that lets you select the intensity of feeling, and a “boost” button on top that moms can press during contractions to increase the sensations. Wires run from the unit to gel pads that are applied to the skin. There are 4 pads (which need to be replaced for each client); two are positive and two are negative. The current will run from the positive to the negative. You apply the pads in such a way that the current will run through the area of discomfort. This is usually in an X configuration across the lower back.

DONA requires doulas to get approval from the client's practitioner to use TENS with them. I checked with the local hospitals that I work at and was surprised to find that most already had standing orders for TENS and that some would even let you use a unit from their rehab department if you didn’t have your own. This is certainly not something that is routinely mentioned in the hospital tour, and nurses I spoke with had not ever seen it used.

I tuck the unit in my bag and tell my clients that it is a new option that they may choose for pain management. I do not spend a lot of time preparing them for it’s use, as it is very simple and they can learn everything they need to know between contractions. I usually just show them what it looks like and explain the theory of how it works and let them know that I will have it with me if they want to use it a the time.

Here is the testimony of the first client who used my unit...
“I was able to achieve a NUCB (natural unmedicated child birth) thanks to my doula's TENS unit! During my labor I used the tub to help with the pain but it slowed down my contractions significantly. When I got out of the tub it was excruciating and I told my support team that I needed something. They suggested sterile water injections or TENS and I decided on TENS after the nurse told me the injections burn going in. I felt immediate relief. It is a buzzing feeling that hurts really good. It's the type of hurt you get with a good deep massage. Where you say "ow" and are asked if it is too much and you say no that it is perfect. I didn't notice the pads at all or the cords. I actually forgot the pads were on until after delivery and my doula said I needed to take them off. I still felt the contractions, and they still hurt, but I never asked for anything else for pain once I had the TENS. It made labor manageable. I used TENS from 8cm until I was crowning and I think it is a wonderful tool for labor!”

Obstetric TENS has been found to be an effective technique for over 80% of births. Many studies have been done in Europe with marked success, especially for back pain in labor. There are no known harmful effects to mother or baby. Most reports of success with TENS state that it is best for early labor and should be started as early as possible. My experience has been otherwise. I tend to use it as an ace up my sleeve when moms ask for medication during late first stage after planning an unmedicated birth. I find it often buys them enough time to reach complete, or at least helps them get into, or back into, “the zone” where they can cope. I am a huge proponent of water for labor coping, and although the TENS can be removed and reapplied (because you certainly don’t want to wear it in the water YIKES!) , it is not a great fit if laboring in water a lot. TENS can be hugely helpful to moms who are experiencing back labor whether it is due to a posterior presentation or a previous back issue. In these moms I often recommend it over water.

I have been very impressed with the success of the TENS. I would say that about 20% of my clients choose to use the unit. It has earned a place in my doula bag by being a realistic alternative to pharmaceuticals. I don’t pull it out unless a mom is unable to manage with the usual supports I offer, but I’m glad to have one more alternative available to my clients that is low risk and safer for her and baby than other interventions.

Amy Peterson CD(DONA), CLC

With experience in Emergency Medical Service, infant group daycare direction, and specialized foster care for NHDCYF, Amy has been working with infants and families all of her adult life. In 2009 she became a doula, and is certified in labor support with DONA International, in lactation counseling with Healthy Children’s Center For Breastfeeding, as well as DONA certified for TENS for Birth. Amy strives to help women trust their instincts and their body’s ability to birth; instilling confidence and a joyful appreciation of the journey toward parenting.