الفهرس 
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Abstract
Childbirth is one of the most wonderful and memorable part in every woman’s life. It does not really matter if the child is the first, second or third. Each labour experience is unique and calls for a celebration. Although the birth process is an exciting and anxiety-provoking event yet, it is a rewarding time for the woman and her family.
Pain during parturition is a physiological, complex, subjective and multidimensional response to sensory stimuli principally generated by uterine contraction. Management of labor pain is one of the main goals of maternity care. There are two models of care, namely, the medical model and the midwifery model. Each model uses fundamentally different means to achieve its end. In the former, the emphasis is largely on the elimination of the physical sensation of labor pain. Unfortunately all obstetric analgesia is invasive, and has the potential to cause side effects to both the mother and/or the fetus. Systematic analgesia or anesthesias are examples of pharmacologic methods of pain relief.
However, the latter model (the midwifery model) adopts the non pharmacological approach to deal with labor pain. It uses a wide variety of techniques to address not only the physical discomfort but also to reduce pain and suffering by enhancing the psychoemotional and spiritual components of care.
TENS is a form of electrical nerve stimulation which is used extensively in health-care settings. TENS had been proven to be useful in the treatment of various types of acute and chronic pain. It seemed to offer many advantages even in obstetrics. TENS has many benefits: it is a simple, safe, non-invasive analgesic technique, easy to apply and remove & has no side effects. Moreover, it doesn’t interfere with consciousness and it reduces exposure to drugs, which decreases the incidence of adverse effects.
The aim of this study was to determine the effect of trans-cutaneous electrical nerve stimulation (TENS) on pain intensity during the active phase of the first stage of labor.
A convenient sample of 80 laboring woman in their active phase of the first stage of labor (cervical dilatation 4-7 cm) were recruited from the labor & delivery unit affiliated to El Shatby Maternity University Hospital in Alexandria. The subjects were equally assigned to one of two groups: group 1; the study group, which consisted of 40 parturients upon whom TENS was applied. group 2; the control group, which comprised the remaining 40 parturients who received TENS placebo application
Four tools were used for data collection: Tool I; Socio-demographic & clinical characteristics structured interview schedule: this tool was developed and used by the researcher to collect the basic data. Tool II; Visual Analogue Scale (VAS): used to measure the intensity of labor pain. The scale line ranges from 0, denoting “no pain”; to 10, denoting “unbearable pain”. .
Tool III; A Modified Version of Johansson Pain-0- Meter Scale (JPOM): which was used to measure the intensity of affective and sensory components of pain (pain quality) after being translated & modified to suit the Egyptian culture. Tool IV; Present Behavioral Intensity Scale (PBIS) used for measuring the present manifestations of pain. The PBIS is a five category behavioral observation scale. Tools reliability was tested by
Alpha Cronbach test (internal consistency) and results were satisfactory (87%). A pilot study was carried out on 8 parturients who were excluded from the study sample. Purposes of the pilot study were to: ascertain clarity, the relevance and the applicability of the tools, estimate the time needed to complete the sheet and detect any problem peculiar to the tools.
group I, study group. TENS unit was placed near the woman. The two pairs of skin electrodes were placed on both sides of the vertebral column between contractions. The upper pair of electrodes was taped Para vertebra by 5 cm at the level of 10th thoracic to 1st lumbar root. The lower pair of electrodes was tapped Para vertebra by 5 cm at the level of the 2nd to 4th sacral nerves. Frequency of electrical pulse was started at 100-150 HZ. Electrical current was gradually increased till a pleasant tingling sensation was felt by the woman. The duration of TENS application was 30 minutes. Using tool II, III & IV pain intensity was assessed three times, once before TENS application and twice after the application by 30 & 60 minutes.
group II, control group, TENS placebo group, TENS unit electrodes were applied as previously mentioned while the TENS unite was off. i.e. without any current production. Using tool II, III, IV pain intensity was assessed three times, once before TENS placebo application and twice after application by 30 & 60 minutes.
Collection of data consumed four months. The collected data was categorized, coded, computerized, tabulated and analyzed by the researcher using (SPSS) version 20 program.
The main findings of the study were:
Socio-demographic characteristics:
The mean age was almost the same among the study and the control groups (27.33 ± 4.84 & 27.70 ± 4.24 years) respectively.
Secondary level of education or its equivalent was mentioned by 32.5% & 37.5 % of the control and the study groups respectively.
The majority of the study and the control groups (87.5% & 82.5%) respectively were housewives.
A sizeable proportion of the study and the control groups (62.5% & 67.5%) respectively were rural dwellers.
No statistically significant difference was found between the two groups in relation to their socio-demographic characteristics.
Clinical characteristics:
The mean number of pregnancy was almost the same (3.0 ± 1.6 and 3.0 ± 1.7) among the study and the control groups respectively.
The mean number of deliveries was 2.0 ± 1.4 and 1.8 ± 1.5 of the study and control groups respectively.
No history of abortion was reported by 65.60 % and 66.70% of the study and control groups respectively
The mean number of living children was 2.0 ± 1.0 & 2.1 ± 1.5 among the study and the control groups respectively.