Mar 19 2008

Labour TENS is essential for VBAC

Published by at 9:12 am under Birthing articles

Experts agree that women wanting a vaginal birth after cesarean (VBAC) would be more successful if using a Labour TENS in the early stages of childbirth. Often women going for VBAC are fearful due to previous experiences of birth. Labour TENS expert Heather Greer explains that labour TENS helps stop the cycle of pain and fear by blocking out pain signals to the brain and releasing endorphins; the body’s own pain relief and feel good hormones. Heather adds “When pain control is literally in the hands of the women they feel empowered and more able to cope with labour.”

In Australia one in four births are born via caesarean section every year. This is higher than average according to the World Health Organisation (WHO) who recommend a caesarean section rate of 10-15%. The research suggests that women should have around an 80% chance of success of vaginal delivery even after more than one caesarean. Yet the figures for vaginal birth after caesarean (VBAC) in Australia are usually much lower than this, even in hospitals where VBAC is encouraged. Heather Greer suggests that this figure can be improved upon. In Australia labour TENS is still relatively new compared to Europe. Heather says “as more women use labour TENS successfully for VBAC the word is spreading and health care professionals are encouraging women to use labour TENS.”
Dr Chris Vose who has a PhD in midwifery and specialises in home-birthing agrees “I believe Labour TENS are essential to women who are having a VBAC”. Dr Vose explains that women wanting a VBAC are usually monitored continually which increases pain due to an inability to move freely. When using a labour TENS from the word go women are less frightened, more relaxed and more able to cope with discomfort. Dr Vose adds “I strongly believe a birth using Labour TENS is safer because, when women feel more comfortable, they are less fearful and this reduces the likelihood of adrenalin being released. When adrenalin is released in the first stage of labour it causes a preferential redistribution of blood supply away from the uterus and other visceral organs and this deprives the uterus and the foetus of oxygen’.

Lisa’s experience of a successful VBAC using labour TENS reflects this. The birth of her first child was long and difficult and ended in a caesarean. Second time around Lisa did lots of research, hired a labour TENS from and prepared her birth plan hoping for a vaginal delivery.

Labour started in the early hours, so she tried to sleep through the contractions. By 7am in the morning Lisa put on her labour TENS and timed each contraction which by now were only 3 minutes apart. After a quick call to arrange care for her toddler she informed the hospital of her progress. They told Lisa to come in whenever she felt ready or if she wasn’t coping. Lisa remembers coping well at home “as each surge came, I leant against a bench or wall, and pressed the ‘boost’ button on my labour TENS to relieve the pain. My husband held a cold flannel to my forehead and heat pack on my belly.

“After about 3 hours of this, the surges were closer to 2 minutes apart and lasting longer so we decided to make the 10min trip to the hospital. When we arrived at the hospital I was informed I’d have to be on the bed attached to the CTG monitor for at least 20min to get a good trace of the baby heart rate. I wasn’t too happy about this as I’d been coping well in upright positions but figured if it wasn’t for too long I’d be OK. I was also asked if I’d like to be internally examined at this point and was told I was 3cm dilated but my waters hadn’t broken yet. I was given the option of having them artificially ruptured but declined that since I felt there was no need to rush things only having been in labour for about 4 or so hours. About 1 hour after being strapped to the foetal monitor I was struggling to relax with the surges in this position. By this stage my husband was using the labour TENS boost button for me as I needed to solely focus within using the breathing techniques I’d learnt. During one surge he accidentally put it to ‘rest’ mode instead of ‘boost’ and I wasn’t too calm after that one ended, let me tell you.”

The seated position on the bed wasn’t helping things and I started to get cranky and demanded to know when I could get off this monitor and the bed. The midwife patiently explained that the baby’s position and movement was making it difficult to get a good trace and admitted I’d probably need to stay on the monitor for the entire labour. At this point I just about lost it and said “well if I’m forced to labour this way, I may as well have the caesarean!” She offered me an alternative of using a wireless monitor that needed to be inserted in the babies scalp and would allow me to walk around but this would mean breaking my waters to get it in. At this point I gladly agreed – anything to get off the bed. After breaking my waters, I felt a warm gush and then a strengthening of the surges as the babies head put pressure on my cervix. Having a surge while the midwife was inserting the monitor is something I’d never want to repeat but once it was in and I was given the all clear I just about cart wheeled off the bed with glee. I was told I was about 5cm dilated when she broke my waters.

The bed was raised so I could stand and lean over it. My husband continued to boost the labour TENS and reassure me that I was doing well, and that the baby was coming. After what seemed like only 3 or 4 surges in this position I started to get transition ‘shakes’ in my legs and feelings of wanting to push. At first the midwife didn’t believe me but after a quick check she said sure enough I had dilated remarkably quickly in this position with my waters broken.

I was told I’d have to get back on the bed to deliver which I wasn’t too keen about but managed to find a comfortable all fours position with my upper body resting on pillows. When the doctor arrived he wanted me in a side lying position. I wasn’t too keen to move but by this point I was feeling so positive that I could do this, I didn’t let it put me off. It only took a few surges to push the baby out and I don’t even remember at what point the head and shoulders came out, it just all seemed to happen in one surge. Before I knew it a baby was passed to my belly and my husband was telling me it was a little girl.

It was barely 6 hours since I had been breakfasting with my toddler and felt the first signs of labour. There was a bit of commotion at the other end as the doctor was worried about how short the cord was, but I was just happy she was out and I was looking into her big dark eyes. The placenta was delivered without problem and I required some stitches, which wasn’t too pleasant but at least I got to hold my little girl throughout. When all was said and done…and cleaned up we were left to feed and get to know our little girl. My husband opened the curtains to let in the warm sunlight and we were full of amazement and happiness at how alert and eagerly she fed. My husband and I joke this was a very ‘civilized’ birth. Given the choice I would definitely choose a VBAC over the repeat caesarean. I was so glad I’d hired the labour TENS -it was an amazing birth experience.”

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