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When I became pregnant with my first child I was working as an anaesthetist on the delivery suite in a local district general hospital. Whereas many people think that the anaesthetist’s job is merely to “put people to sleep for operations”, our job is actually a bit more diverse than that. On the delivery suite, we perform a variety of anaesthetic services. We site epidurals in labouring women, we insert central and arterial lines when necessary and we anaesthetise patients for operations such as caesarian sections, manual removal of placenta, evacuation of retained products of conception and repair of tears sustained during childbirth. For the surgeries we can perform spinal anaesthesia, epidural anaesthesia, combined spinal and epidural anaesthesia, or general anaesthesia. Given my role on the delivery suite, you may have worked out that I only really get involved in cases where pain relief in the form of an epidural is needed or when surgery is required for one reason or another. This resulted in me getting a somewhat skewed view of what childbirth is like. I only ever really saw more complicated cases. Never would I be asked to contribute to a case where the mother laboured on paracetamol and gas and air alone and everything went swimmingly.
During a particularly busy shift on labour ward, I had just come out of theatre having anaesthetised a patient for some surgical procedure or another (I don’t remember exactly what). I went into the office to write up the case notes and the midwife in charge was there. I looked at her like a rabbit dazzled by headlights and asked nervously “when my time comes how on earth do I avoid all of this intervention?” This midwife was very approachable and rational and she herself had had two children. She gave me some very good advice. Firstly she began by saying that sometimes intervention is necessary and there isn’t a great deal that can always be done about that. There are certain aspects of the process that are out of your control and at the end of the day the most important thing for you is to take home a healthy baby. If this means you need surgery or intervention to achieve this then you need it. End of. You have to be a bit sensible and focus on the desired end result. However, then she encouraged me to think about how an animal gives birth. She said they go into a dark place (because oxytocin- the hormone responsible for causing the uterus to contract during labour- is secreted more plentifully in the dark), they eat and drink and then they give birth. We, on the other hand, bring people in here, shine bright lights on them (counterproductive where oxytocin is concerned), starve and thirst them, give them several drugs and then we sit there scratching our heads wondering why their labour does not progress. (Of course sometimes things don’t go to plan even though you don’t have any of the aforementioned- we are just saying that we can sometimes over-medicalise what is a natural process). She then went on to tell me that when she had given birth, she had tried to stay at home for as long as possible, she had endeavoured to eat and drink and, finally, she had used a TENS machine. She told me “the TENS machine got me to fully dilated in both of my labours. But we don’t really see them much these days.” She ended the conversation by safety netting and saying that staying at home is great but of course if anything happens that worries you then you must go into hospital straight away. Again, the most important thing is to take home a healthy baby. You don’t want to jeopardise anything by trying too hard to be a hero. I found this conversation very enlightening and useful. I had spent the last few months learning only about how to medicalise labour. I hadn’t really spoken to anyone about a more natural childbirth (my midwife appointments hadn’t quite got to the stage of discussing labour yet and I never did NCT classes because I was always at work and studying for some rather nasty exams at the time and so my time outside of work was somewhat limited). Additionally, because I was an anaesthetist, I think most people just assumed that I would be having an epidural. The amount of times colleagues clocked my ever-expanding bump and said “I’m guessing you’ll be going for an early epidural?!” and “you’ll be surprised when you go into labour- you have no idea how much you’ll want that epidural!” I realise I am now beginning to sound like something of an epidural hater- don’t get me wrong, if that’s what you want then there is no problem with that. Epidurals also do have their uses and their place. For example, they can be used to help lower high blood pressure in labour, they can help people to achieve a vaginal delivery in cases where their cervix has become swollen and examinations and pushing have become difficult and they can make what can be a very painful experience virtually pain free for some people. They do have a lot of benefits. However, I had started to get the feeling that epidurals weren’t really at the top of my list as far as pain relief was concerned. After all, I was spending quite a substantial proportion of my time at work warning people about the risks associated with them (there are risks involved with virtually any medical procedure) and so I think subconsciously I wasn’t particularly keen on the idea. Therefore, as soon as I got home that night I started to research TENS machines and I came to the conclusion that I would get myself one and try it when my time came. After all, if it didn’t work then I didn’t have a great deal to lose. I could always try it and then move on to something else if I wanted to.After having a look online, I purchased a MamaTENS machine . You can check this out on amazon by clicking here (for the Perfect MamaTENS) or here (for the MamaTENS) There are lots of different makes and models of TENS machines available and these can be purchased online or in some pharmacies. Different models vary in price, so it is worth shopping around before deciding on the best one for you. It may also be worth discussing with your midwife or a pharmacist as TENS machines may be available for hire from some places. Some friends of mine who did NCT classes mentioned that TENS machines were discussed with them there. Below I will explain how TENS machines work and I will also give an account of my experience with them (I have used one for both of my labours so far and thought they were excellent).
What is a TENS Machine and How Does it Work? (1,2)
TENS stands for transcutaneous electrical nerve stimulation and it involves using a small electrical current to provide pain relief. A TENS machine is a compact, battery powered device that has leads connected to electrodes. The electrodes are sticky and adhere to the skin when they are attached. The machine delivers small electrical impulses via the electrodes to the area of the body over which they are applied. These impulses are felt as a tingling sensation.
Clinical trials to investigate whether TENS is a reliable and effective method of pain relief are still ongoing. There is not yet a robust body of scientific evidence behind TENS, but healthcare professionals have seen and reported that it is beneficial for some patients. The effectiveness of TENS seems to vary widely between individuals.
It is thought that TENS works by reducing pain signals being sent to the brain and spinal cord. It is also thought that TENS stimulates the production of endorphins (these are the body’s “natural painkillers.”) Both of these actions are thought to help with relieving pain.
My Experiences with a TENS Machine
I used a TENS machine for both of my labours. As soon as I realised I was in labour with Henry (my eldest) I set up and applied the TENS machine. I had checked the components a few weeks prior to my due date and made sure that I had enough batteries. I attached the electrodes to my lower back (you will find instructions included with the TENS machine you get detailing how you should position these). I then started using the TENS on a relatively low setting to begin with. On the MamaTens you are able to use a variety of modes and you can increase or decrease the strength of the impulses to suit your needs. I played around with the settings until I found a pattern that worked for me. Generally I used a continuous impulse during each contraction and then a more sporadic one for in between. As my labour progressed and the contractions became stronger I increased the strength of the impulses and I found that this helped to relieve the worsening pain. With Henry I kept the TENS machine on until he was born. I found I was able to cope with the pain reasonably well until I arrived at the hospital and was examined. I also found that by having to constantly switch between different modes my mind was focussed on something other than the pain of the contractions and this served as a good distraction throughout the day. When they examined me I was fully dilated and taken round to delivery suite. When I got there the pain was very bad and so I opted to use gas and air in addition to the TENS. I found this combination really helped me. When I got to the pushing stage I was on all fours for a while. In this position I found the TENS machine felt slightly strange because I could feel the impulses in my abdomen a lot more (even though the electrodes were on my back). However, I was too scared to remove the TENS for fear that the pain would suddenly get worse! I gave birth to Henry after having used the TENS machine and gas and air only- I did not feel the need for any other pain relief. I required some stitches for a small second degree tear after Henry’s birth and the midwife did this with just an injection of local anaesthetic to the area.
The benefits I found from avoiding other, more potent forms of pain relief were that I was able to mobilise as soon as I had had stitches and I also avoided any potential side effects from pharmacological treatments.
When it came to my second labour with Edward I again hooked myself up to the TENS machine as soon as I realised what was going on. My experience with it was very similar to that with Henry and I used the different modes in virtually the same pattern. Again, when I arrived in hospital I was fully dilated (after a day labouring at home) and taken straight to delivery suite. This time I removed the TENS machine when I was in the birthing room and used solely gas and air for the last bits of labour. Edward’s delivery was quite a bit quicker than Henry’s. After he had been born the midwife commented on the fact that they don’t tend to see TENS machines very often anymore and she asked me where I had heard about them. I told her all about my discussion on labour ward when I was working and that it was a midwife who had recommended I try one and she thought the TENS machine seemed like a great idea. After Edward’s birth I was again lucky that I had avoided any potential side effects from other forms of pain relief and I was able to go home six hours after he was born.
Whereas TENS does not work for everyone my experiences with it during labour were very positive. I definitely feel as though the TENS machine helped with the pain of my contractions and I am sure it helped me to get to fully dilated without anything else. I know this probably won’t appeal to everyone but if you are looking at options for pain relief in labour and you think that you may want to try this before other things then I would certainly recommend it. If you don’t like it or you feel you want to move on to something else that may be more effective for you then you can do so. You don’t have much to lose by trying it and you may find it gets you to fully dilated without any other pain relief. I have recommended TENS machines to all of my friends who are expecting. They have all had different experiences with them- some have, like me, found them excellent whereas others preferred to opt for other forms of pain relief after having tried TENS. Before trying a TENS machine it is best to do a bit of research and discuss it with a medical professional so that you can ensure that it is appropriate for you. There may be some instances where TENS may not be advisable and your healthcare provider can go through this with you in more detail.
References Used in this Blog Post
- TENS (Transcutaenous Electrical nerve Stimulation) available at: https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/ accessed 24th September 2019.
- Perfect MamaTENS Maternity TENS Machine available at : https://www.tenscare.co.uk/ accessed 24th September 2019.