Thursday, January 4, 2018

The Sensations of Labor: TENS Units and Sterile Water Injections

Happy New Year! I hope you enjoyed your holiday season, and are ready to bounce into the new year with new goals, and new optimism about pursuing those long-term goals you're carrying forward. Yay!!! I'm jumping back into my Sensations of Labor blogpost series, and today we're talking about: sterile water injections, and TENS units! These are two basically unrelated techniques, but what ties them together is that they're both best suited for addressing back labor, and they're both applied to the back of the body.

Back labor is simply when the sensations of labor are felt primarily in the back, or in addition to the sensations felt in the abdomen. In my experience, people tend to struggle more to cope with back labor than with 'front' labor, and back labor also tends to persist more between contractions, giving the birthing person less of a break. In some cases, back labor is caused by the position the baby is in in the pelvis, so when I encounter it in my doula practice, I take steps via the miles circuit, and rebozo techniques to help shift the baby to a better position. Sometimes this works like magic! Other times, malposition isn't the problem; back labor is just the way this person's body processes the sensations of labor. Fortunately, there are specific ways to address those symptoms. In keeping with my pattern so far of working from the most invasive pain-management interventions to the least, we'll be talking about these two methods now, and circling back to position changes, rebozo techniques, and other tricks like counter pressure and the double-hip squeeze, later on. Here we go!

Sterile Water Injections:

Sterile water injections aren't used often in America, but they are a wonderful option when a birthing person needs relief, but is still hoping to avoid the side effects of an epidural. Small amounts of sterile water are injected into four specific spots on the lower back, resulting in a temporary, but intense stinging sensation, sometimes compared to a wasp sting. The stinging subsides in about 30 seconds, and the relief of the back pain immediately follows in about 85% of birthing people. Wow! That's a very high success rate for a completely drug and side-effect free pain relief option! Some doctors and midwives opt to give the injections during a contraction, so the contraction itself serves as a distraction from the stinging sensation, and as the contraction subsides, so does your back pain! The relief generally last for two hours, and more sterile water injections can be given as needed. Let's talk pros and cons!

Pros:

Drug free: no effect on mother or baby outside of the short term stinging sensation

Effective!: 85% effective at relieving back labor (even if you've been feeling labor primarily in the back, you'll usually find that the lesser discomfort in the abdomen does get more intense as your brain begins to focus more on it, but most people still find it much easier to cope)

Easy to administer: it's great when two people can give two injections each, to get it, and the stinging that comes along with it, over with as quickly as possible, but even one person can place the four injections very quickly if everything is prepped in advance.


Can be readministered as often as needed: no side effects, no concern of over-dosing!

Cons:

Sting!: The stinging sensation may be intense enough, and relief slight enough for some people to be a net loss of comfort, and there's no telling before giving it a shot (no pun intended) whether that will be the case for a particular person.

Front labor need not apply: this method won't help if abdominal labor sensations are the ones that are getting overwhelming.

TENS Unit:

TENS stands for Transcutaneous Electrical Nerve Stimulation. The unit consists of a little electronic device attached via wires to four pads that stick to your skin. You place them on the back, turn on the device, and adjust the intensity until you feel a vibrating, prickling, or tingling sensation. You may feel discomfort or pain if the machine is set too high, but it is easily turned down. This sensation diminishes your awareness of the pain of back labor, and the stimulation helps to keep the muscles from tensing up in response to the discomfort, which might be enough to make back labor bearable on its own. Like all pain management options, the effectiveness of the TENS unit varies person to person. For many people, it works best when started earlier on in labor, as it won't provide adequate distraction from intense, active labor contractions. It can't be worn in the bath, or shower, but other than that, it doesn't interfere with freedom of movement. It's a very common tool for labor in the UK, but less common in the U.S. While I'm hearing more and more about it, and even know of one hospital that has one for patient use, theirs was broken the last few times I was there, and the nurses weren't very encouraging of its use.

Pros:

Safe, and non-invasive!: As long as you start very low, and turn the machine up slowly, you should have very minimal or none at all discomfort as you experiment with where you like the machine set. You may find you want it pretty high during contractions, and much lower in between.

Accessible for home use!: All of the pain management options we've discussed thus far, including sterile water injections, must be administered by a medical professional. You can use a TENS unit wherever, and whenever you'd like!

Adjustable for individual's needs, and variations of labor: You may turn up the machine higher as contractions progress, or vary the pattern of the stimulation, to provide more effective relief as needed. You're in control.

Cons:

Unlikely to provide significant relief in active labor: You'll likely find that at a certain point, the TENS just isn't doing it anymore! This can be an excellent time to pull off those pads, and put yourself in a warm bath or shower.

Can be tough to find!: These aren't widely available yet, though they're getting easier to come by thanks to retail giants like Amazon. Your doula may have one as well. It's helpful to get one in advance and spend some time getting to know the controls, and levels of sensations it produces, and you'll want it with you when labor starts, so you can start using it before labor gets too intense for it to be very helpful.

There's no predicting who will experience back labor, and for those who do, having these low-intervention options up their sleeves can make the difference between getting an epidural and not. Even if you planned to get an epidural at some point in your labor, back labor is a good reason to hold off on that decision long enough to try some of the movements, positions, and techniques that can help a baby shift into a better position since back labor is sometimes caused by a malpositioned baby, and a TENS unit or sterile water injections may provide adequate relief for you to take those steps, and then get the epidural later on.

Have you heard of these techniques and tools before? Ever tried them in your labor?

Live Omily,
~em

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