Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Management in Labour: A Systematic Review

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Abstract Background: Pain management plays a crucial role during labour, as it contributes to maternal and foetus physical and psychological health and reduces the physiological consequences of pain, such as respiratory alkalosis and increased oxygen consumption. Since the 1970s, transcutaneous electrical nerve stimulation (TENS) devices have been used to relief a range of pain disorders, including labour pain. TENS is currently a popular choice in clinical practice to reduce pain during the early stages of labour and potentially delay the need for pharmacological methods. This reduction in drug exposure, in turn has the potential to reduce any unwanted side effects on both mother and foetus, such as disrupting the birth process and foetal distress. Aims: The aim of this review is to assess whether TENS is effective in reducing labour pain. Methods: The review was developed using the standard systematic review (SR) methodology. This review considered studies that assessed the effects of utilising TENS on labour pain in either primigravida or multigravida and included comparisons with a placebo and/or usual care. The search strategy and questions were developed using the population, intervention, comparison, and outcome (PICO) and limited to English language studies conducted from 2009 to 2020. Whilst randomised controlled trials (RCTs) are the preferred inclusion study design for assessing the efficiency of healthcare interventions, due to the paucity of available evidence, other designs were included. Studies were excluded if participants received any pain management combined with TENS, such as an epidural and/or opioids. The systematic search yielded a total of ninety possible studies, but only eight studies met the inclusion criteria. The visual analogue scale (VAS) was used for the assessment of pain in all the included studies. Narrative synthesis was conducted to demonstrate the findings of this review. Results: Whilst labour pain is influenced by the strength and duration of contractions, woman’s physical condition, previous labour experiences, and culture, and the mode of TENS administration, TENS was found to be an effective relief for labour pains. During labour, electro-acupuncture on the different acupoints effectively relieves labour pain. There was a significant reduction in pain among participants in the TENS groups comparing with placebo. TENS was found to delay the need for pharmaceutical therapies during the early stages of labour. Women who received TENS at the acupuncture points reporting less pain and stating that they would ask for it in future deliveries. TENS considered as a safe pain management therapy because it has no negative effects on the process of childbirth or on maternal or foetal outcomes. Conclusion: TENS has been found to have an acceptable effect in heling women coping with labour pain and can be utilised by both primigravida and multigravida women during the first and second stages of labour. It does not necessitate the support of anybody other than an acupuncture-trained midwife if TENS is applied on acupuncture points, nor does it necessitate additional monitoring of the unborn baby or the mother in labour. The use of TENS in conjunction with acupuncture points is safe during labour and follows WHO recommendations. Complementary therapy is a good alternative for accelerating the labour process and inducing effective and sufficient labour experience.

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