You are pregnant and have started looking into different options for pain control during labor and delivery. Or, you are hoping for an unmedicated birth but the idea of intense labor pain makes you nervous. Did you know that an over-the-counter TENS unit can help improve pain control and delay the need for an epidural? Let’s explore how this works.  

What is a TENS unit? 

TENS, which stands for Transcutaneous Electrical Nerve Stimulation, is a therapeutic modality widely used for pain management. By applying electrodes to the skin, a TENS unit sends electrical pulses that alter pain sensations. Many individuals turn to TENS units for relief from conditions such as low back pain, neck pain, and abdominal cramping. For the majority of people, TENS is a safe and effective pain management tool. However, it is important to note that there are certain contraindications, such as having a pacemaker, a history of seizures or epilepsy, and pregnancy. Despite these limitations, research has shown that TENS units are safe for use during the early or active stages of labor, helping manage pain and potentially delaying the need for pharmacological interventions.

According to Santana et al., studies have demonstrated that using a TENS unit during active labor poses no harmful effects to either the mother or fetus. Pain research can be challenging due to its subjective nature and the influence of individual background, culture, and upbringing. While today's research presents mixed findings on the effectiveness of TENS units during labor, many studies show positive results, offering an alternative method for women seeking pain relief without immediate resort to an epidural.

How does it work: 

While there are questions about how a TENS unit helps manage pain, there are two main theories: the "Gate Control" Theory and the "Endorphin Release" Theory. The Gate Control Theory suggests that the TENS unit creates interference to distract from the noxious stimulation. For example, if you hit your knee on the corner of your bed frame, rubbing your knee creates a distraction from the pain stimulus. The Endorphin Release Theory posits that the noxious stimulation from the TENS unit's electrical intensity prompts the body to release endorphins to manage the pain.

How to use:

1. Consult Your Practitioner: First, find out if the hospital where you plan to deliver offers this modality during labor. If not, you can bring your own TENS unit; don’t forget to bring extra batteries. I typically suggest the ‘TENS 7000 Digital TENS with Accessories’  from Amazon.

2. Consult a Physical Therapist: Speak with a physical therapist trained in birth preparation to guide you in using the TENS unit. You can book at Lotus Core Physical Therapy to help with your birth prep. 

Below are some general guidelines for using the TENS unit during labor and delivery:

• Electrode Placement: Place the electrodes below the bra line and above the panty line on your back. You may need assistance from your support person for correct placement.

• Cord Arrangement: Keep the red cords together in one location and the black cords together in another location.

• Suggested Mode: Use normal or modulated rate and width (MRW) with continuous ‘C’ pulsing.

• Suggested Frequency/Pulse: 100 Hz and 260µs

• Avoid Water: Do not take the TENS unit into the shower or bath.

Once the electrodes are in place and the settings are chosen, slowly turn up the dial until you feel a strong but tolerable tingling sensation. During your contractions, increase the intensity to a tolerable level, but be cautious of muscle contractions that are too strong. Once the contraction has passed, turn the intensity down. As a helpful tip, alternate between modes (normal or MRW) to avoid getting used to the sensation.  Again, don’t forget extra batteries!

Remember, TENS is typically not the only modality for pain management, but it can help delay the need for an epidural and improve pain control throughout labor. If you want to learn more about using the TENS unit during labor or its other benefits, book an in-person or telehealth appointment today!

Dr. Susan Miller PT, DPT, is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. I welcome both in-person and telehealth appointments for Colorado residents, as well as coaching calls for clients residing out of state.  

Book at www.lotuscorept.com

1. Santana LS, Gallo RB, Ferreira CH, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016 Jan;62(1):29-34. doi: 10.1016/j.jphys.2015.11.002. Epub 2015 Dec 11. PMID: 26701166.

2. Reis CCSD, Dias LDC, Carvalho LB, Junior LBA, Imoto AM. Transcutaneous Nerve Electrostimulation (TENS) in Pain Relief During Labor: A Scope Review. Eletroestimulação nervosa transcutânea (TENS) no alívio da dor durante o trabalho de parto: Uma revisão de escopo. Rev Bras Ginecol Obstet. 2022;44(2):187-193. doi:10.1055/s-0042-1742290