Comparative effects of rotational effleurage and connective tissue massage on labor pain, duration, and perineal outcomes in pregnant women: a randomized clinical trial

Clinical Snapshot

Key Findings

• P Value: p < 0.001 for between-group differences

• Effect Size: Mean difference of 1.74 points on VAS scale

• Primary Outcome: Pain intensity at 7-8 cm cervical dilation: effleurage 6.13 ± 0.94 vs control 7.87 ± 0.86

• Nnt Or Sensitivity: Not calculable from available data

• Confidence Interval: Not reported

Clinical Application

Requires trained personnel but uses simple, low-cost techniques suitable for most birthing environments Aligns with RANZCOG guidelines supporting non-pharmacological pain relief options; could complement existing midwifery care models Primiparous women in active labor seeking non-pharmacological pain relief

Abstract

BACKGROUND: Childbirth is a unique and significant experience in every woman's life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother's feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them. METHODS: This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist. DATA: Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10 cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4 cm, 5-6 cm, 7-8 cm, and 9-10 cm). RESULTS: Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8 cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05). CONCLUSION: Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.

References

1. 1.Sheidaee, S., Azima, S., Sayadi, M., & Yazdanpanahi, Z. (2026). Comparative effects of rotational effleurage and connective tissue massage on labor pain, duration, and perineal outcomes in pregnant women: A randomized clinical trial. BMC Pregnancy and Childbirth. https://doi.org/10.18332/ejm/132883