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I am delighted to announce the latest TIPS Awards in the TENS (Transcutaneous Electrical Nerve Stimulator) Machine category.
24 machines (four brands) were sent to six of my pregnant parent testers. They had the chance to try out and use these pain relief machines in the comfort of their own home, before deciding on which machine they would use during their labour.
All machines worked well and all are worthy of an award. However, as with all awards, there must be an overall winner. I am proud to announce that the Bodyclock Elle TENS machine was a clear winner and I am happy to award it the TIPS ‘Best of the best’.
As with all TIPS awards it is important to explain the methodology behind the testing process and how this relates to current evidence. You can find out more by clicking on the following links:
Final review of winning machine
Elle TENS by Babycare TENS:
This machine is a clear winner. It has all the necessary features to make your TENS experience seamless. The excellent ergonomic design ensures that the machine is easy to use. Instructions are concise and testers especially liked the quick reference guide. Testers loved the easy-grip finish which is ideal to hold during labour. The large digital screen is simple to navigate. Extra features such as the Opti-max, boost button and dual control pads make this machine a firm favourite with parent testers.
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The following advice was given as part of the guidelines for testers during the TIPS testing of TENS Machines
Why is pain an important part of labour and childbirth
It is not the pain that will be remembered following childbirth, but the perception of that pain. This is an important point because if the experience of childbirth was perceived as traumatic, then the memory would also be traumatic.
Fear, loss of control and lack of support throughout labour cause more pain than labour itself. The physiological process of birth should be embraced, with women becoming the focus. A good midwife will empathise, touch, support, nurture, encourage, watch, wait, understand and educate (Leap 1993).
Much more has been written about the pharmacological methods of pain relief than about the individual power within every woman to help herself.
Technology and obstetricians have moved childbirth towards its present position as a ‘complication waiting to happen’. Midwives have the opportunity to regain control as lead carer and subsequently: ‘Rescue birth from technology and restore it to its rightful place in the family. This will benefit the mother and her child and, in the long run, all of us. (Verney & Kelly 1993).’
What causes the pain in labour and childbirth?
During the first stage of labour, pain is due to the dilatation of the cervix alongside stretching of the lower uterine segment. Nerve fibres from these structures pass through the posterior roots of spinal nerves T10, T11, T12 & L1. They synapse at the interneurones in the posterior horn of the spinal cord, also known as the Substantia Gelatinosa (SG) and proceed to the higher centres of the brain in the Sensory Cortex via the Thalamus.
During the second and third stages, pain originates in the Sacral nerve roots of S2, S3 and S4, which is due to stimulation of nerve fibres in the pelvic and perineal structures. This is why pain, at full dilatation or where there is a poor presenting part, is felt in the lower-back area.
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The Gate-Control Theory
Pain is transmitted along nerve fibres together with the neurotransmitter Substance P, which enhances transmission. The intensity of these impulses depends on the size or number of the nerve fibres rather than the intensity of the stimulus.
Melzack and Wall (1988) introduced the Gate-Control-Theory in 1965, which remains a relevant explanation of how physiological pain relief can be achieved. They proposed that a Gate exists at the site of the SG. The passage of sensory signals through this depends on whether it is ‘Open’ or ‘Closed’. The Gate is opened by the release of neurotransmitters, which excite the postsynaptic membrane, causing pain signals to follow ascending tracts towards the higher centres of the brain. The Gate is closed by the release of endogenous opioids and inhibitory neurotransmitters via descending pathways, which inhibit the conduction of pain any further, therefore avoiding transmission to the thalamus.
A holistic approach to pain relief
The holistic approach to care involves an inter-relationship between mind, body and spirit (Koehn 2000) and does not involve the loss of control of any party. By working within this framework we learn and are guided by each other. This is by no means a new concept, being evident since the time of Florence Nightingale and continues to be a common theme today (Fuller 1978).
The environment of birth
This is not just a matter of where to ‘birth’ but also refers to how the environment will assist in the outcome of the birth. In an attempt to be more ‘homely’, many maternity units have introduced less clinical surroundings. This is a step in the right direction, but we need to be creative in order to create an atmosphere of safety that will truly encourage normal birth. One of the questions has to be: do we need a bed at all?
Bianca Lepori, (2000) an architect, studied women in labour and concluded that they spontaneously choose to move when unrestricted. As a result, she designed birthing rooms where there is space to move, pools to relax in, platforms to lean on and suspended towels to stretch, hang and squat from. Bianca says of her rooms: ‘This puts the mother physically and emotionally in control and places the staff in a supportive role’.
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Continuity of care
The ‘doula’ (meaning slave or handmaiden) is a woman who gives continuous support to another woman during labour and birth (McGinnis 2001). Research has shown that the presence of a trusted supporter (this could be your partner, your mother, your friend or your midwife):
- reduces the need for pharmacological pain relief
- reduces the length of labour
- reduces the number of instrumental deliveries
- increases breastfeeding rates
- increases positive birth experiences (Hodnett 2003)
Transcutaneous Electrical Nerve Stimulation (TENS)
The most natural and non-invasive methods of pain relief available to women at present are the use of water (preferably by complete immersion in a deep bath or birthing pool) and the TENS machine. TENS stands for Transcutaneous Electrical Nerve Stimulation. This works by stimulating your body’s own natural defences against pain. In the final weeks of pregnancy, a woman’s pain threshold is much higher than normal. This is nature’s way of preparing her to cope with the pain of childbirth. A TENS machine transmits gentle electrical impulses through the skin via four self-adhesive electrode pads positioned on the back. These impulses act on pain by flooding the ‘gate’ with natural endorphins, which in turn stop the pain messages from getting to the brain.
Used properly, a TENS machine can take a woman from the first contraction to the birth of your baby without the need for any other methods of pain relief.
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Results
Best of the best - Elle TENS by Babycare TENS
www.bodyclock.co.uk
RRP: £69.95 to buy (£27 pm to hire)
This machine is a clear winner. It has all the necessary features to make your TENS experience seamless. The excellent ergonomic design ensures that the machine is easy to use. Instructions are concise and testers especially liked the quick reference guide. Testers loved the easy-grip finish which is ideal to hold during labour. The large digital screen is simple to navigate. Extra features such as the Opti-max, boost button and dual control pads make this machine a firm favourite with parent testers.
Best budget - Obstetric TENS by Natures Gate
www.naturesgate-uk.com
RRP: £28 for 6 weeks hire
Although the digital version of this device was not available at the time of testing, the obstetric TENS scored highly with testers. It was easy to set up, worked well and provided effective pain relief. Testers liked its simplicity and overwhelmingly voted for this machine to be awarded ‘Best budget’. Natures Gate has just launched a new digital device (see picture). This version incorporates a boost button, dual control pads and a large digital display. This new device will cost £28 to hire and £54.99 +VAT to buy for an introductory period (RRP £79.99 +VAT).
Highly commended - Mama TENS
www.mama-tens.info
RRP: £69.50 to buy (£27.50 for 6 weeks hire)
Testers loved the neat carry case which is both colourful and compact. The Mama TENS is well designed, light and easy to use with good supporting information and a useful ‘trouble shooting guide’. Photographs and ‘checkpoint’ advice further explained how to use this device. Testers found this machine the easiest one to set up. The digital display is a good size with easy to follow graphics. The best features include an integrated boost, button lock and extremely secure pads that stay in place whatever the setting.
Commended - Boots TENS
www.boots.com
RRP £45.95 to buy (£29.99 for 30 days hire)
Testers found the Boots TENS machine simple, compact and straightforward to use. It is easy to set up and provides effective and controllable pain relief.
It would benefit from a bigger screen and a more ergonomic shape would be easier to hold during labour. The cost for hire is high in comparison to the other machines on test but it is the cheapest machine to buy.
Without exception I would like to applaud the response from each Company who kindly sent me samples to test. Such efficient communication made my job easy and I would like to thank all parties involved.
Sharon Trotter © 2007
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