TENS
TENS (Transcutaneous Electrical Nerve Stimulation) is a device that you use to give yourself small electric shocks. This distracts your attention from the pain of the contractions. You operate the device yourself – which can give you a sense of control. The electric shocks enter your body via electrodes (wires that are attached to your back). This gives a prickly or tingling sensation, comparable to cold hands that start to tingle when they become warm again.

Advantages of TENS
• Some women experience less pain.
• It seems to work especially at the beginning of labor.
• TENS has no side effects or consequences for you or your baby.

Disadvantages of TENS
• You cannot take the device in the bath or shower with it.
• You have to hold the device all the time. Practical matters You have to rent the device yourself. Check with your insurer whether it is reimbursed.

Spinal tap (‘epidural’)
A spinal tap is an injection in your lower back with a combination of anaesthetic drugs. The anaesthetist inserts a needle into your lower back under local anaesthesia. You must arch your back and remain as still as possible while lying or sitting. A thin, flexible tube is inserted into your back through the needle. The needle is removed and the tube remains in place. You will be given painkillers through this tube throughout the entire delivery. You will feel the anaesthetic after 15 minutes.

The advantages of an epidural
• Most women feel little pain during contractions.
• An epidural works better than an injection with pethidine or a pump with remifentanil.
• An epidural does not make you drowsy or sleepy and you therefore experience the delivery consciously.

The disadvantages of an epidural
• Occasionally an epidural does not work or does not work sufficiently. It is not known exactly how often this occurs (probably between 5 and 10%). The epidural injection is sometimes given again.
• Some women experience itching during an epidural injection. This is related to the composition of the medication.
• You cannot get out of bed because you have less feeling in your legs. This slowly returns when the administration of medication is stopped. With a low dose, you have more feeling in your legs and you can sometimes stand and walk.
• Occasionally, women suffer from headaches after an epidural injection. This can be remedied with medication.

Remifentanil pump
Remifentanil is a morphine-like substance that is administered via a tube in the arm (infusion), which is attached to a pump. You can determine the amount of remifentanil that you receive via the infusion yourself using a push button. The pump is set so that you can never give yourself too much.

Advantages of remifentanil
• Remifentanil works quickly, often after just a few minutes.
• Remifentanil numbs the pain about as well as pethidine.
• After delivery, remifentanil disappears from your blood fairly quickly.
Disadvantages of remifentanil
• Remifentanil can affect your breathing and the amount of oxygen in your blood. That is why you and your baby must be carefully monitored continuously when using this drug.
• Remifentanil numbs the pain less well than an epidural.
• You can no longer walk around. The drowsiness can cause you to fall.
• The effect of remifentanil on breastfeeding has not yet been properly investigated.

See the leaflet ‘How to deal with pain’.