ELECTROTHERAPY DURING PREGNANCY

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Electrotherapeutic modality such as Transcutaneous electrical nerve stimulation (TENS) can be an additional tool for the women during antenatal period. Its non-invasive mode of action absence of side effects are very effective to the woman hoping to cope with labour by relying on her own resources.

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TENS is a method of acute, or chronic, pain relief that is used widely throughout physiotherapy.

 

Modes of stimulation

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• TENS involves the transmission of electrical energy through the skin to the nervous system. Since it first became available in the mid 1960s, it hasdeveloped as a modality in its own right and is now more than just a model for the proof of the gate theory of pain (Melzack& Wall 1965). Two of the TENS parameters described by Walsh (1997) are used for labour. These are burst train TENS and brief intense TENS.

• These two modes of stimulation are used for the specific instance of labour because they suit the specific nature of labour pain.

• The burst train mode is the type of stimulation used all the time during labour and the brief intense mode is activated by the use of a press button mechanism when the woman experiences the beginnings of a contraction. The brief intense mode is then de-activated bypressing the same boost button so that the burst train mode is resumed.

 

Placement of electrodes

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• The electrodes can be placed either over the relevant vertebral segments that receive nociceptive information from the painful areas or over the area that is giving pain.One pair covering either side of the spinous processes of T10–L1 and the other pair covering either side of the spinous processes of S2–S4.

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Practical considerations in the use of TENS

 

Ideally women should be introduced to the TENS unit during a class with a health professional, preferably a physiotherapist.

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It should be clearly stated that:

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• The unit should not be placed over the carotid sinus (the anterior

neck)

• The unit should not be placed over the area where a pacemaker has

been fitted

• The electrodes and the TENS unit should be removed before going into the bath or birthing pool

• The unit should only be used for the woman herself, and for her labour, unless she has been given instructions otherwise by a health professional.

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• The following ‘self-help’ tips may be useful:

 

• Spinal electrodes-

  • Locate the bottom of the bra strap.

  • Place three fingers of the right hand below the level of the bra strap.

  • Place the top of the electrode at this level to the right side of the spine, to roughly cover T10–L1.

  • Repeat the process, for the other electrode of that pair, to attach it to the left side of the spine.

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• Sacral electrodes-

  • Locate the level of the iliac crest.

  • Place three fingers of the right hand below this level.

  • Place the top of the electrode at this level to the right side of the sacral area.

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• Repeat the process, for the other electrode of that pair, to attach it to the left side of the sacral area.

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TENS units-There are a great variety of TENS units. The TENS unit should have a press release button (not press and hold) to enable switching to the brief intense mode. It should be described as an ‘Obstetric TENS unit.’

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​REFERENCES

1. Jill mantle et al , physiotherapy in obstetrics and gynaecology, 2nd edition.