The use of Transcutaneous Electrical Nerve Stimulation (TENS) in labouring women as a form of non-pharmaceutical pain relief

NHS Borders clinical guidelines
NHS Borders

Objectives

The Transcutaneous Electrical Nerve Stimulation (TENS) hand held device, is a non-pharmaceutical option for pain relief in labouring women.  

Ideally, this should be offered to women in early labour preferably before any opioids to promote an upright mobile labour. It is important that all midwives are familiar with the correct positioning of the electronic pads, the ability to offer advice in the functionality of the various button on the handset, the limitations if using a TENS from home and the contraindications of usage. 

The TENS, is a battery-powered device controlled by the labouring woman. It stimulates the nerves leading from the uterus to the brain to increase the body’s natural painkillers called endorphins. It also helps distract the brain from the pain of contractions with the ‘tingling’ sensation and therefore triggering ‘the pain gate control theory’ 

 

Scope

It is important that midwives are given the knowledge to recommend the use of TENS in appropriate situations and that everyone be able to offer the same advice. 

 

Audience

  • Community midwives
  • Hospital midwives
  • Obstetric staff

 

 

How to apply TENS in Labouring women and use of handset

  1. Ensure skin on back is free from oils/creams and no areas of broken skin 
  2. Make sure battery is working  
  3. Make sure TENS is turned off and two sets of electronic pads are available 
  4. Have the woman sitting upright or lying in a lateral position with the back of the bed completely flat to place pads in optimal position. The most ideal position is an upright position. 
  5. First set applied just under the bra line level approximately 5cm apart (see diagram). Ensure the set applied comprises of one red and one black cable inserted into one side of the handset 

 

Second set applied over sacral dimples approximately 5cm apart (see diagram).                                     

Again, ensure the set applied comprises of one red and one black cable into the other side of handset.

  • Turn machine on. The digital screen should display in BURST mode. Show woman how to increase the intensity on the handset by pressing the CH1 + button and subsequently with the CH2 + button. You should advise that a pulsing sensation will become apparent and to press until a desirable level achieved – it should be strong, but comfortable.
  • Advise woman to press the button at side of the handset to activate the BOOST when experiencing a contraction and then to press again once contraction has subsided and settle on the BURST when no contraction present.

 

Mode Button  

Mode 1 – can be used in burst and boost (primarily for early labour) 

Mode 2 – can be used in burst and boost (to use when labour advances and contractions become more frequent). It can be used according to preference and not necessarily the stage of labour 

 

Optimax button 

  • There are five optimax levels indicated by dots on the bottom of the digital screen. 
  • The machine always starts and resets at three dots. The Optimax (+OM-) button 
  • Increases or reduces the intensity of the pulses. It can be used to give an extra surge of power in the final stages of labour.         

When woman wishing TENS to be taken off press the off button and carefully peel off sticky electronic pads from skin. These can be reused in the same patient – so can be placed back onto original clear plastic sheets. To disconnect TENS from pads, hold hard plastic at end of each of the cables in turn and the hard plastic end of electronic pads and pull. Do not pull by the cables themselves 

If using own TENS from home/hired

Direct woman and birthing partners to guidelines on own device initially but can advise re placement of pads as per previous instructions.

TENS must be a maternity TENS with two sets of pads and a boost button.

Contraindications for using TENS

  1. Avoid usage on broken skin 
  2. Do not use if you have Epilepsy 
  3. Do not use if a cardiac pacemaker is in situ or any other electrical or metal implant 
  4. Do not use in water 
  5. Do not use if there is a history of Deep Vein Thrombosis or other similar blood disorder 
  6. Do not use in Preterm early labour in Antenatal Ward or home as this can mask advancing labour 

TENS is not addictive, non-invasive and has no known side effects.

It can be used alongside other forms of pain relief, including mobilisation in labour, massage, reflexology, aromatherapy, hypnotherapy, Entonox, Dihydrocodeine and Diamorphine. 

Supporting Evidence/References/Related Guidelines & Resources

Santana LS. et al (2016) Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial Journal of Physiotherapy 62:1 January 2016 pg 29-34 

Dowswell T. et al (2009) Transcutaneous electrical stimulation (TENS) for pain management in labour Cochrane Database 15 April 2009 

Bedwell LLB et al (2011) The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence Midwifery 27:5 October 2011 

Baez-Suarez A et al (2018) Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial Department of Medical and Surgical Sciences 19:652 

Birthzang’s Guide to Using a TENS Machine in Labour (2016) http://www.birthzang.co.uk 

Editorial Information

Next review date: 01/10/2028

Author(s): Bell C.

Version: 1.0

Approved By: Women & Child Health CMT

Reviewer name(s): Grieve C.