How to Use a TENS Machine in Labour: Pad Placement, Settings and Timing

A labour TENS machine is beautifully simple to use, but a little know-how beforehand makes all the difference on the day. This is a practical guide to the three things that matter: where to place the pads, when to start, and how to work the settings and boost button. It's general information, not medical advice, so always follow the instructions that come with your machine and the guidance of your midwife.

Get familiar before the day

The single best tip is to have a practice run before labour begins, ideally from around 36 weeks. You don't want to be reading the manual mid-contraction. Pop the pads on, feel the sensation, and find the settings you like. It's also worth knowing that your support person will be the one applying and adjusting the pads, since they sit on your lower back where you can't easily reach, so practise together.

Where to place the pads

A maternity TENS machine comes with four pads, used as two pairs, placed vertically on your lower back either side of your spine. They never go across the spine itself, and never over your pregnant belly. As a general guide:

• The top pair sits at about bra-strap level, roughly a finger-width either side of your spine, with the leads hanging downwards.
• The bottom pair sits lower, over the small dimples above your buttocks (just above the underwear line), either side of the spine, with the leads pointing upwards.

Make sure your skin is clean and dry, and that the machine is switched off before you apply the pads. Every machine includes a placement diagram, so follow the one for your specific unit. If in doubt, your midwife can help you get the position right.

When to start using it

Start early. A TENS machine can be used as soon as labour begins, and most women pop it on in early labour while they're still at home. Starting at the first regular contractions gives your body the longest time to build up its own natural pain-relieving endorphins, which is why women who start early often find they cope better later. TENS tends to be most helpful in early labour and for that low, aching back pain, rather than in the intense final stretch.

Getting the settings right

With the pads on and the machine still off, slowly turn up the intensity until you feel a strong but comfortable tingling across both sets of pads. You're aiming for a sensation that's noticeable and distracting, but never uncomfortable. As your contractions build over the hours, you can gradually turn the intensity up to stay on top of them. It's all about finding the level that feels right for you.

Using the boost button

The boost button is the feature that makes a maternity TENS machine so useful, and it's simple to use. As a contraction builds, press and hold the boost to switch to a stronger, continuous pulse that helps you through the peak. As soon as the contraction passes, release it to drop back to the gentle background setting and rest. In other words, you ride each wave with the boost, then relax in between. Your support person can press it for you if your hands are busy.

A few do's and don'ts

• Place the pads on your lower back only, never over your belly.
• Keep the machine dry. It isn't waterproof, so take the pads off before a bath, shower or birth pool, and pop them back on afterwards.
• Remove the pads if you move on to continuous monitoring or an epidural, as you'll usually be asked to.
• TENS is generally not suitable if you have a pacemaker, spinal rods, or epilepsy, so check with your midwife or doctor first.
• Always read your machine's manual, as it has the exact placement diagram and settings for your unit.

If it doesn't seem to be doing much

Remember that a TENS machine takes the edge off rather than switching pain off completely, and it works best when you start it early. If it feels underwhelming, check that the pads are pressed on firmly and placed correctly, turn the intensity up gradually, and make sure you're using the boost with each contraction. It also works beautifully alongside movement, warm water and breathing. And if you'd like more relief, you can always move on to other options. There's no right or wrong.

What comes in a hired kit

When you hire a labour TENS machine from Coastal Birth Co., it arrives cleaned, tested and ready to go, with fresh electrode pads, new batteries and the instruction manual included, so you can have that practice run before your due date. We hire the Elle TENS across South-East Queensland, from Tweed Heads through the Gold Coast to Brisbane, prepared with care by a midwife and mum.

References and further reading

• Pregnancy, Birth and Baby (TENS)
• healthdirect (TENS)
• NHS (pain relief in labour)
• Royal Berkshire NHS Foundation Trust (TENS machine use in labour)

Frequently asked questions