T.E.N.S (Transcutaneous Electrical Nerve Stimulation) - Use in Labour - South Tees Hospitals NHS ...

T.E.N.S
(Transcutaneous Electrical
Nerve Stimulation)

Use in Labour

Physiotherapy
Patient Information

What is TENS?
T.E.N.S is a form of pain relief used in labour. It stands for
Transcutaneous (which means through the skin)
Electrical Nerve Stimulation.
It is a battery operated, electrical unit, that gives a tingling sensation
(via electrodes) by stimulating the nerves through the skin, to help
give relief from pain.
The TENS machine for use in labour has a base unit with various
settings (which will be pre-programmed) and two intensity dials,
as well as a lead with a booster button. It operates using a nine volt
square battery (which will be supplied). There are two wires that
attach to the unit and a pair of electrodes (sticky pads) that attach
to each wire. When used in labour, these pads are placed on the
mother’s back.

How does it work?
It works by increasing the body’s natural form of painkillers -
endorphins, as well as helping the brain ‘tune out’ the messages
of pain it receives. This is called ‘The Pain Gate Control Theory’
The brain registers ‘pain’ when signals are sent from the nerves in the
painful region.
In labour, the brain receives pain signals, via nerves, from the cervix,
uterus, lower back and coccyx region.
When the TENS machine is applied, it sends electrical stimulation
to the nerve roots, which sends a different (tingling) signal to the
brain, and thus the brain starts to concentrate on the new sensation
and less so on the pain.

(A simple example is when a child falls on their knee, receiving pain
signals from the nerves in the knee, a parent will instinctively rub the
painful area, which now sends a different signal to the brain and thus
lessens the pain felt).

Can it be used with other forms of pain relief?
Yes. It can be used with entonox (gas and air); meptid or pethidine.
It may even be used during the insertion of an epidural, simply
remove the lower set of pads/electrodes, but keep the top set in place.
Once the epidural takes effect, TENS may be removed as it becomes
ineffective.

Is it safe?
TENS is not addictive, non-invasive and has no known
side-effects. However, as it is an electrical unit it is not to be
used in water!
Remove during a bath or in the birthing pool (which will continue
endorphin production anyway) and then re-apply TENS pads when
skin is dry.

 As it interferes with brain signals and uses
 an electrical current:

 Do not use if you have Epilepsy
 Do not use if you have a cardiac pacemaker
 Do not use on broken/numb areas of skin
 Do not use when driving
 Do not use if you have been diagnosed with cancer

TENS in labour?
An Obstetric TENS machine used in labour is different to an
ordinary TENS machine, in that it has a unique booster button
that changes the intensity from low to high (when experiencin
a contraction) and changes the frequency from a pulsating
sensation to a continuous one.
During the low, pulsating setting, when not experiencing
a contraction, it is stimulating endorphins, similar to massage
therapy. When a contraction is felt, the booster button pressed,
it changes to the high intensity, continuous setting and this
is when it interferes with the pain signals (Pain Gate Control Theory).

 The positioning of the electrodes on the back, is therefore
 very important, to target the appropriate nerve roots, during
 labour pain.

Applying TENS
1. Ensure the skin on your back is dry and oil-free.
2. Place a new nine volt square battery into the machine
   (ensuring the rubber stopper is removed)
3. Connect the white ends of the four electrode pads to the
   black and red ends of the leads. Each pair of electrodes
   should be attached to one lead, with one red end and one
   black end. Whether the red or black end is applied to the
   left or right is irrelevant.
4. Apply the sticky electrode pads to the back:

        -                         One pair of electrodes is
		                                placed at bra strap level,

braline
                                  an inch either side of the
		                                spine (with leads hanging down).

        - The other pair of electrodes
		 is placed over the sacral
		dimples, an inch either side
sacral

dimples
          of the spine (with leads going
		upwards).

5. Make sure machine is off and intensity dials are switched
   to off, then connect the two leads to the two terminals at
   the side of the machine.

Operating TENS
(Only the lady in labour must operate the machine as only
she can feel the electrical stimulation).
1. Check booster button is in the raised position to begin with,
   for a low frequency burst/pulsating setting.
2. Check both channels are working by slowly turning one dial on
   and slowly increasing the strength until a mild tingling sensation
   is felt, then turn it off and repeat with the other dial.
3. When assured both channels are working, switch on both intensity
   dials and slowly increase the intensity until a strong tingling
   sensation is felt in both sets of pads and the pulsating/burst
   function is clearly felt, then turn the dial down a little to a
   comfortable level.
4. When a contraction starts, press the booster button down
   to change to a high frequency, continuous setting.
5. When the contraction has stopped, press the button again
   to the raised position, to return to the low frequency, burst/
   pulsating setting.
6. As the brain becomes used to the sensation and pain levels
   increase over time, the intensity dial will need to be turned
   up to increase the tingling sensation felt.
7. When TENS is no longer needed, turn both intensity dials to
   ‘off’ before removing the pads.
8. Dispose of the pads only but keep all leads/wires and return
   the whole TENS unit/pack to the rehabilitation centre at
   The James Cook University Hospital to re-claim your deposit.

 Please return the TENS unit as soon as possible
 within two weeks after your delivery date.

References
Kitchmen S., (2001) Electrotherapy:
Evidence Based Practice, Churchill Livingstone.
Clutte E., (1994) Analgesia in labour; A review
of the TENS method Professional Care of Mother
and Child Vol 4(2): 50-2
Crothers E., (1998) TENS for Labour Pain Journal of Chartered
Physiotherapists in Women’s Health 83: 6-10

Comments, compliments, concerns or complaints
South Tees Hospitals NHS Foundation Trust is concerned about the
quality of care you receive and strives to maintain high standards of
health care. However, we do appreciate that there may be an occasion
where you, or your family, feel dissatisfied with the standard of service
you receive. Please do not hesitate to tell us about your concerns as
this helps us to learn from your experience and to improve service for
future patients
If you have a concern or question regarding care of the service
received, please discuss with / contact a member of the clinical
team / matron in the first instance, who may be able to answer your
questions without delay. If you feel you cannot discuss your concern
with the clinical team, The Patient Advice and Liaison service can
advise and support patients, families and carers and help sort out
problems on your behalf. This service is available, and based, at The
James Cook University Hospital but also covers the Friarage Hospital In
Northallerton, our community hospitals and community health services.
Please ask a member of staff for further information.

The James Cook University Hospital
                                                                        STPI0135

Marton Road, Middlesbrough, TS4 3BW. Switchboard: 01642 850850
Author: Physiotherapy Issue Date: July 2019 Revision Date: March 2021