Chances are you've never heard of TENS, which stands for transcutaneous electrical nerve stimulation, since its use in labor is exceedingly rare here in the US. If you're interested in non-pharmaceutical comfort in labor, it could be the option for you.
Portable, non-invasive, labor pain relief that you can control yourself sounds almost too good to be true, right? Not so for women in Canada and the U.K., who often have access to TENS units during childbirth (about 1 in 5 women in the UK try one for their labor. For example, you can clearly see the wires of the mom's TENS unit in this British birth story that went viral on Buzzfeed.) But chances are you've never heard of TENS, which stands for transcutaneous electrical nerve stimulation, since its use in labor is exceedingly rare here in the U.S. But if you're interested in non-pharmaceutical comfort in labor, TENS can be a terrific, low-risk option for you and your birth.
How it works
Introduced into maternity care in Scandinavia in the 1970s, a TENS unit is a handheld machine, connected by wires to electrodes that stick to the skin on your back. TENS works by sending electrical nerve stimulation through these electrodes; it doesn't take away the sensation of contractions, but essentially interrupts the pain signals your brain is receiving, possibly reducing your awareness of them or producing endorphins that allow you to cope better. It's a common comfort measure used in physical and occupational therapy, especially by people who suffer from chronic pain.
Why it's great
TENS units are great because they allow you, as a laboring mother, to remain active and upright—you can labor with a TENS in any position you want. The feeling that comes through the electrodes is kind of like a light buzzing or prickling, but the unit has buttons you can use to turn the intensity up or down, depending on your pain level, tolerance, and where you are in your labor. TENS usually does not interfere with electronic fetal monitoring, so it's fine to use when laboring in a hospital setting. Other benefits to TENS include the fact that it does not require a medical professional to administer (so it's good for pain relief at home, too), there are no side effects for your baby, and that it can be put on or taken off at any point during your labor. Thought to be especially good for back labor, research shows that TENS is most effective when it is used in early labor and then continued throughout the labor process.
Why you need it
The TENS appeals to people who are planning unmedicated birth as well as those who just want multiple options of pain relief during their labors. Jessica Fuqua, a family nurse practitioner in Albuquerque, N.M., who used the TENS as she labored with her second baby, says, "I am so glad I was able to use the TENS. I used it once my contractions got to a 6-7 on the pain scale for me and it was comforting to know I could turn on the unit at the start of my contraction as another 'coping mechanism' to deal with the pain."
So why is this alternative pain relief option so uncommon here in the United States? Eileen Ehudin Beard, a certified nurse midwife and senior practice adviser at the American College of Nurse Midwives, says: "Complementary and alternative ways to provide comfort are not thought of as first line here in the U.S." Anthony Scialli, clinical professor of obstetrics and gynecology at George Washington University School of Medicine, adds that, "obstetrical traditions here are centered around the use of epidural for pain relief in labor." In other words, Americans aren't used to relying on non-pharmaceutical methods for comfort in childbirth; not because they aren't effective, but because the system doesn't support it. TENS units for obstetrical use are difficult to find in the U.S. and many medical professionals are not aware of TENS and/or have never seen one used by a birthing person.
There aren't many downsides to using the TENS during birth, other than the fact that its effects can vary widely from person to person. Studies are inconclusive regarding exactly how and why it works, and why it might work very well for some people and not at all for others. Still, in a Cochrane review of evidence regarding TENS, the majority of women who used it said they would use it again in a future labor. Use of TENS is not recommended for people who have pacemakers and it can't be used while you are in a shower or a bath (or once you get an epidural).
Stephanie Bieniarz was already familiar with TENS during her studies as an occupational therapist, so she was open to using it when her labor was longer than expected. She says, of her experience: "During hour 12 of what ended up being 50 total hours of labor, my doula encouraged me to try using TENS to assist with back pain. I agreed, as I was eager to try pain management treatments that were non-invasive. The TENS allowed me to rest a bit as labor progressed; I even slept in between contractions when I had it on! It gave me enough of a mental edge over the pain that I felt I could manage to birth without pain medicine."
TENS can be a powerful means to avoid pharmaceutical pain relief, if that's your goal, or it can just be a tool to lessen discomfort during early labor or while you are waiting for an epidural. Many people find it beneficial mentally, as another sensation to concentrate on during contractions. TENS can also help women to feel more in control of their labor. Eileen Ehudin Beard comments that, "The women who seemed to have the most success with pain relief in my practice were women who used TENS during their pregnancy and were familiar with it. They were then very comfortable using it during labor."
Where to get one
If you want to use the TENS unit during your birth, you'll likely have to seek one out yourself or find a doula who offers one as part of her care. If you do buy or rent one, make sure it's a TENS that's specifically for pregnancy and birth—TENS units designed for other uses aren't appropriate for pregnancy. You should also discuss your intention to use TENS with your provider and the people who will be present at your birth, too—making sure everyone is on the same page about pain relief options will make for an easier communication process once you're actually in labor. Whether you end up trying this little-known choice, becoming informed about TENS and your other options for pain relief will help you feel knowledgable and empowered during your birth experience.