TENS in Obstetrics: Supporting Patient Autonomy While Relying on Evidence-Based Practice

Labour pain is recognized as one of the most intense painful experiences a person may encounter in life (Zuarez-Easton et al., 2023). Although epidural analgesia is highly effective, it is not suitable for every situation or every patient preference.

Expectations among women are changing. They now desire active involvement and minimal medical interventions during childbirth.

According to the American College of Obstetricians and Gynecologists (ACOG), non-pharmacological methods are generally safe for the mother, fetus, and labour progression (Bryant Borders, 2019). TENS therefore fits naturally within this approach.

TENS: A Simple Approach

TENS uses low-intensity electrical currents to modulate pain transmission through inhibitory mechanisms of the central nervous system. In practical terms, it acts on pain perception without the use of pharmacological agents.

In obstetrics, devices such as TENS-EVA have been developed specifically for labour pain. They are easy to use and, most importantly, allow the patient to control the intensity of stimulation according to her needs.

Clear Evidence With Measurable Effects

Recent studies provide a clearer understanding of the clinical impact of TENS. A meta-analysis published in 2025, including 51 randomized controlled trials and more than 10,000 participants, found an average reduction of approximately 2 points out of 10 on the visual analog pain scale among women using TENS compared with control groups (Hu et al., 2025).

Moreover, approximately 52% of participants experienced substantial pain relief. This aligns with a previous systematic analysis that also found notable improvements in pain alleviation with TENS use (Thuvarakan et al., 2020).

A Reassuring Safety Profile

From a safety perspective, results are highly consistent across studies. Available data do not show an increase in adverse outcomes for either the mother or the newborn (Hu et al., 2025; Michalska et al., 2025).

Additionally, research shows that using TENS does not lead to higher rates of Caesarean births, assisted vaginal deliveries, or other obstetrical interventions (Dowswell et al., 2009; Michalska et al., 2025).

These findings are important, as they indicate that TENS can be integrated into clinical practice without altering labour progression or adding clinical risk.

High Acceptability Among Patients

Another significant aspect is the patient’s perspective. Approximately 63% of women who used TENS reported that they would choose to use it again in a future birth (Dowswell et al., 2009).

This high level of acceptability is largely explained by the sense of control provided by the device. Being able to adjust the intensity independently according to one’s needs contributes to autonomy, a key component of the overall childbirth experience.

The Role of TENS in Current Recommendations

Guidelines from the American College of Obstetricians and Gynecologists acknowledge that TENS may contribute to labour pain management, although observed effects on pain scores vary across studies (Bryant Borders, 2019).

For its part, the Cochrane review places greater emphasis on patient choice, stating that women should be able to use TENS at any stage of labour, either alone or alongside other methods (Dowswell et al., 2009). This position reflects the current shift toward more individualized care tailored to patient preferences.

TENS is particularly relevant when integrated into a combined approach. It may be used alongside other interventions, whether pharmacological or non-pharmacological (Bryant Borders, 2019; Zuarez-Easton et al., 2023). This complementarity allows care to be adjusted to each patient’s needs without rigidity.

What This Means in Practice

In clinical settings, integrating TENS primarily broadens the range of available options. This is especially relevant when epidural analgesia is not possible or simply not desired.

It is also a way to support a less interventionist approach by limiting medication use while preserving mobility and active participation during labour.

Evidence also suggests that TENS is more effective when used early in labour. This highlights the importance of discussing it during the prenatal period so that patients can make informed decisions and feel comfortable using it when the time comes.

Conclusion

TENS-EVA represents a relevant non-pharmacological option supported by evidence. Its effect on pain is modest, but real and consistently observed across studies.

This is combined with an excellent safety profile and strong patient acceptability, two particularly important considerations in obstetrical care.

At a time when personalized care and respect for patient preferences are becoming increasingly central, TENS-EVA stands out as a valuable tool to integrate into practice. It broadens available options while supporting a patient-centred approach adapted to the reality of each birth.

Références:

Bernard, A., Oyler, D. R., Anglen, J. O., Burd, R. S., Khatri, V., Levy, M. J., Petersen, S. R., Sliker, C. W., Winchell, R. J. (2020). Best practices guidelines for acute pain management in trauma patients. American College of Surgeons. https://www.facs.org/quality-programs/trauma/tqp/center-programs/vrc/resources/

Bryant, A. S., Borders, A. E. (2019). Approaches to limit intervention during labor and birth. ACOG Committee Opinion No. 766. American College of Obstetricians and Gynecologists. Obstetrics Gynecology, 133(2), e164-e173.

Dowswell, T., Bedwell, C., Lavender, T., Neilson, J. P. (2009). Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database of Systematic Reviews, (2), CD007214. https://doi.org/10.1002/14651858.CD007214.pub2

Hu, Z. Y., Tang, J., Li, X. X., Zhang, Y., Wang, L., Chen, Y., Liu, Y., Wang, X. (2025). The efficacy and safety of transcutaneous electrical nerve stimulation for labor analgesia in the first stage of labor: A qualitative and quantitative analysis. Frontiers in Medicine, 13, 1730360. https://doi.org/10.3389/fmed.2026.1730360

Michalska, A., Blazuk-Fortak, A., Gladys-Jakubczyk, A., Wolder, D., Swiercz, G. (2025). The impact of transcutaneous electrical nerve stimulation (TENS) on the consecutive stages of labour and perinatal outcomes—A retrospective cohort study. Journal of Clinical Medicine, 14(10), 3445. https://doi.org/10.3390/jcm14103445

Thuvarakan, K., Zimmermann, H., Mikkelsen, M. K., Gazerani, P. (2020). Transcutaneous electrical nerve stimulation as a pain-relieving approach in labor pain: A systematic review and meta-analysis of randomized controlled trials. Neuromodulation: Journal of the International Neuromodulation Society, 23(6), 732-746. https://doi.org/10.1111/ner.13221

Zuarez-Easton, S., Erez, O., Zafran, N., Carmeli, S., Garmi, G., Salim, R. (2023). Pharmacologic and nonpharmacologic options for pain relief during labor: An expert review. American Journal of Obstetrics and Gynecology, 228(5S), S1246-S1259. https://doi.org/10.1016/j.ajog.2023.03.003