Among my midwifery tools, I wanted to have a TENS, a labor TENS. Since it wasn’t available in Slovenia at the time, I ordered it from the UK. Why a labor TENS and how does a labor TENS differ from others? Let’s take a look…
What is TENS and How Does It Work?
TENS stands for transcutaneous electrical nerve stimulation. It is a therapy in which mild electrical impulses pass through electrodes on the skin into nerve fibers. TENS impulses help the body produce its own pain-relieving chemicals, such as endorphins. It is therefore a non-invasive and non-pharmacological method of pain relief.
Research has shown that using TENS during labor significantly reduces pain during contractions and can delay the need for pharmacological analgesia. TENS technology is based on two scientific theories of pain relief: the Gate Control Theory and Acupuncture-like Stimulation with TENS.
The degree of pain relief varies from person to person.
Gate Control Theory
When using TENS at high frequency (more than 60 pulses per second), electrical stimulation “masks” pain, as the impulses travel to the brain faster than pain signals. When your uterine muscles press on the cervix during contractions, pain travels through the spinal cord to the brain. The “Boost” function (more on functions below) on the TENS device sends electrical impulses that close the theoretical “pain gates” and prevent pain signals from passing through, thereby relieving pain during labor.
Acupuncture-like Stimulation with TENS
At low frequency (2-5 Hz), TENS encourages the body to release its own pain-relieving substances called endorphins and enkephalins, which work similarly to morphine and block pain signals. This method is effective for relieving chronic pain and is particularly useful for relief during the time between contractions.
In addition, research suggests that TENS during labor reduces anxiety, increases the sense of control over labor, and provides distraction from pain.
Research (a 2011 Cochrane review) has shown that women who used TENS on acupuncture points reported lower pain levels compared to the control group. Moreover, most of those who used TENS expressed a desire to use it again in future births. The use of TENS appears to be effective in reducing pain compared to placebo or routine care, without negative side effects.
In the following section, we will focus on the use of the most popular TENS among midwives, doulas, and women in labor: Babycare TENS / Elle TENS.
Using Babycare TENS During Labor
Babycare TENS devices are specifically designed for pain relief during labor. They have preset operating modes, which makes them easy to use. With larger pads and a unique BOOST button for stronger impulses, they provide additional relief during contractions. The device is lightweight, battery-operated, can be hung around the neck or tucked into the waistband of pants, a bra, a CTG strap… and is also designed to be comfortably held in your hand. You can use Babycare TENS on its own or combine it with other non-pharmacological (massage, acupressure comb, music…) or pharmacological pain relief methods, such as gas, pain relief injections, but the electrodes must be removed if you use epidural anesthesia or water.
When using TENS, the following precautions must be observed:
- Do not place electrode pads on damaged or inflamed skin.
- Do not place electrode pads on hands, legs below the knees, on top of shoulders, on the face, or on the neck.
- Do not apply moisturizer to the skin where you will place the electrodes before using the TENS device.
- Do not use the device while driving or operating hazardous equipment.
- Keep out of reach of children.
1. Electrode Placement
Place the adhesive electrodes 5 cm above and below an imaginary line running across your back (at belly button height). The pads should be approximately 3.5 cm away from the spine on each side. Use all four pads (those below the bra line and at the waistband of your underwear).
Insert the two wires at the top of the unit (it doesn’t matter which side). Connect the upper two electrodes with the wire on the left side of the unit (CH1) and the lower two on the right side of the unit (CH2) – each wire has a red and black connector, it doesn’t matter which side is connected, as long as the black and red connectors from the same wire are connected to the upper two electrodes and the same for the lower two.
2. Setting the Intensity
Turn on the device using the pink on/off button and select BIRTH mode. Start in BURST mode and then press the boost button at the beginning of a contraction. At the end of the contraction, return to BURST. Make sure the boost button is not pressed (on the side of the unit). TENS always starts in BURST mode.
Start by pressing the CH1 + button. Each time you press it, a small ‘crescent’ shape appears on the screen, which increases as the intensity increases. You will feel a pulsing sensation, which increases slowly until you reach a strong but comfortable level. Repeat by pressing the CH2 + button.
MODE Button
Mode 1 – can be used in burst and boost mode (mainly for early labor).
Mode 2 – can be used in burst and boost mode (for use when labor progresses and contractions become more frequent). It can be used according to preference and not necessarily in relation to the stage of labor.
3. BOOST Button
At the beginning of a contraction, press the BOOST button (on the side of the device) for extra power to help reduce pain. The sensation will be similar to tingling, which will help mask the pain (Gate Control Theory).
4. BURST Mode
When the contraction passes, press the BOOST button again to switch to BURST mode (endorphin release: Acupuncture-like Stimulation with TENS). The sensation will be similar to a heartbeat and will stimulate the release of natural pain-relieving substances.
Repeat the cycle with each contraction. The device will also help you time the intervals between contractions and the duration of each contraction.
5. Opti Max – There are five Optimax levels, indicated by dots at the bottom of the screen. The device always starts and resets to 3. The Optimax button increases or decreases the intensity of the pulses. It can be used for extra power in the final stages of labor.
Also see the visual guide in the instructions.
Difference Between Labor TENS and Other TENS
Babycare TENS or labor TENS in general are specifically designed for childbirth. They have larger electrodes than standard TENS devices, which allows for better coverage and more effective pain relief during labor.
The additional BOOST button function provides the extra power needed during contractions. During labor, the labor TENS device provides a continuous mild stimulus intended for use during breaks between contractions. The Boost button allows you to increase the stimulus during contractions and thus achieve more effective pain relief. In contrast, standard TENS devices do not have this function, which can make it difficult to manage pain during contractions.
Labor TENS devices are designed specifically for relieving labor pain, so they have higher power settings compared to standard devices. Some labor TENS devices, such as Elle TENS, also have Opti-Max technology, which provides extra power for later stages of labor. Standard TENS devices usually quickly reach their maximum power level, making them less effective for relieving labor pain.
Some labor TENS devices have a built-in contraction counter, which can be very useful for monitoring labor. When you press the Boost button, the device records the start of the contraction, and when you press it again, the end of the contraction. This function helps you track the duration and frequency of contractions, allowing better control over the progress of labor.
Babycare TENS is lightweight, battery-operated, and allows you mobility during labor, provides complete control, and you can stop it at any time if you feel it is not working.
Frequently Asked Questions
TENS is suitable for use in the maternity ward, but you may need to turn off the device occasionally if midwives or medical staff need other devices for examinations. Before use, it is good to inform the midwife that you are using Babycare TENS, as this will make it easier to adjust care. Some maternity wards have TENS devices, in others you must bring your own. Find out about this before labor. Visiting the Maternity Ward Before Labor
You can safely try the device before labor, after reaching 37 weeks of pregnancy. This will allow you to become more familiar with how it works, which is especially important so that you will be able to use it during contractions without additional stress. It is recommended that you try different pulse settings on your forearm to feel the differences in impulses.
Babycare TENS is an excellent choice for women planning a water birth as well. Although you cannot use the device directly in water, it is ideal for the early stages of labor when you are still out of the water. TENS is an effective way to gradually release endorphins, which help ease the transition through early contractions until the woman reaches the stage when she enters the water (usually when cervical dilation is between 4 and 5 cm).
Use After Childbirth
In addition to relieving pain during labor, you can use Babycare TENS after childbirth as well, for example for pain in the shoulders, lower back, and other areas where additional support is needed, for relaxation. It can also be used to relieve menstrual cramps. With different operating modes that include impulses for releasing endorphins, it also helps with postpartum recovery. In that case, use PAIN mode. 
- CONSTANT Pulsi so neprekinjeni in povzročajo občutek mravljinčenja. Ta način se običajno uporablja za kratkoročne bolečine.
Use During Pregnancy Before Week 37
A physiotherapist may recommend using TENS for your problems and give you clear instructions. But it doesn’t hurt to highlight them here as well. If TENS is used correctly, it can be a safe method without side effects for your baby. However, TENS should not be used on certain parts of the body that can stimulate labor contractions. These areas include:
- The space between the thumb and index finger
- Lower leg and ankle
- Top of shoulders
If TENS causes contractions, turn off the device immediately.
Perhaps also a comparison of all 3 BabyTENS models. All three have essential functions for relieving (labor) pain, the BOOST function, and Opti Max technology.
Other Warnings and Contraindications
- If you have undiagnosed pain, consult your doctor before using any technique from this guide.
- DO NOT use TENS if you have a demand-type pacemaker, serious or unstable heart condition, or have had a recent heart attack.
- DO NOT place electrodes on or near the eyes, in the mouth, across the front or side of the neck, across the head, heart, or on areas of cracked, inflamed, infected, or hardened skin. Electrodes should usually only be applied to skin with normal sensitivity, except under medical supervision.
- DO NOT use TENS before week 37 of pregnancy, except under medical supervision.
- DO NOT use TENS in the presence of tuberculosis, malignant tumors, very high or low blood pressure, epilepsy, high fever, or acute inflammatory diseases, except under medical supervision.
- Stop using TENS if an allergic reaction develops.
- Stimulation should not be used over or near cancerous lesions.
- DO NOT use TENS or SensaTONE units while driving or operating potentially dangerous machinery.
- DO NOT use while driving or operating potentially dangerous machinery or while using a microwave oven.
- We recommend that you only use acupuncture points and electrode placement sites as shown in this guide, and only for the specific conditions listed, and ensure that the electrodes do not come into contact with each other.
- If you have any doubts, consult your regular healthcare provider before use.
- If you are pregnant, DO NOT place electrodes on the abdomen.
- Consult your healthcare provider before use if you have heart disease, epilepsy, undiagnosed pain, have any metal implants, or have any doubts.
- DO NOT use the TENS device without first reading the instructions.
- DO NOT immerse the TENS device in liquid. Do not use it in the bath or shower.
- DO NOT place near sources of excessive heat or use in the presence of flammable gases.
- DO NOT drop this device on a hard surface.
- DO NOT attempt to disassemble the TENS device.
- Use only the specified batteries and electrodes.
- If the device is damaged, do not use it. Return it to the supplier.
- Remove batteries when not using the device.
- Keep out of reach of children.
- DO NOT place electrodes on or near the eyes, in the mouth, across the front or side of the neck, across the head, or over the heart.
- DO NOT use in the presence of tuberculosis, malignant tumors, very high or very low blood pressure, high fever, or acute inflammatory disease, except under medical supervision.
- A mild electric shock may occur if one electrode is accidentally removed. In the event of this, the device must be turned off immediately.
In Slovenia, you can purchase it from lima-medical using the code mojababica10, which is valid for the entire website. Rental is also possible at Moja Babica, if you are quick enough 🙂 ElleTENS 2 Device Rental – Moja Babica
Acupressure Comb – Moja Babica
Sources:
TENS (transcutaneous electrical nerve stimulation) – NHS
