The effectiveness of effleurage and counter-pressure massage in reducing labor pain intensity during the first stage of labor: A literature review

Abstract

Background: Labor pain during the first stage of labor is a physiological condition caused primarily by uterine contractions, cervical dilatation, and pressure on the pelvic structures. Although pharmacological methods are available, nonpharmacological interventions such as effleurage and counter-pressure massage are increasingly used because they are simple, inexpensive, and have minimal adverse effects. However, evidence regarding the comparative effectiveness of these techniques remains variable.

Purpose: To review and synthesize the available evidence regarding the effectiveness of effleurage and counter-pressure massage in reducing labor pain intensity during the first stage of labor.

Method: A literature review was conducted through searches of PubMed, ScienceDirect, and Google Scholar for articles published between January 2021 and June 2026. Articles were selected according to predefined inclusion and exclusion criteria. Eligible studies included original research articles, randomized controlled trials, quasi-experimental studies, and clinical trials involving women in the first stage of labor and evaluating effleurage, counter-pressure, or related massage interventions. Nine articles were included in the review.

Results: The reviewed studies generally demonstrated that massage-based nonpharmacological interventions reduced labor pain intensity and improved maternal comfort. Effleurage massage was associated with reduced pain through tactile stimulation, relaxation, and distraction, whereas counter-pressure appeared particularly beneficial for women experiencing lower back pain during contractions. Direct comparative evidence indicated that both techniques were effective, although some studies reported greater pain reduction with counter-pressure. Other benefits included reduced anxiety, increased comfort, and improved childbirth satisfaction.

Conclusion: Effleurage and counter-pressure massage are promising nonpharmacological interventions for managing pain during the first stage of labor. Effleurage may be particularly useful for promoting relaxation and reducing generalized pain perception, whereas counter-pressure may be more appropriate for women experiencing predominant lower back pain. The choice of technique should consider maternal preference, pain location, labor progression, and practitioner skill.