Table 1.

Non-pharmacological pain management in labor: An in-depth analysis of physical modalities concerning the mechanism of action, perceived benefit, and the supporting references.

Methods	Methods Sub-Types	Proposed Mechanism of Action	Perceived Benefit	Authors’ Name; Publication Year
Massage	▪Vibrating ▪Stroking ▪Effleurage	▪Gentle massage or counter-pressure to specific areas is effective in reducing discomfort and triggering endorphin releases, an endogenous hormone with analgesic properties. ▪Additionally, it promotes a subjective sense of psychological relief.	▪It proved effective in reducing lab pain, yet the character of pain and lab duration was unchanged. ▪Combining oil with massage decreased lab pain and duration and improved satisfaction.	Pawale et al. [30]; 2020 Silva Gallo et al. [31]: 2013 Eskandari F et al. [32]; 2022
Pressure on precise anatomical locations	▪Acupressure ▪Acupuncture: ▪traditional acupuncture ▪sham acupuncture	▪The application of pressure on precise anatomical locations potentially induces Relaxation and reduces Stress. ▪Triggering non-painful stimuli closes spinal cord “gates,” thus blocking pain signals. ▪Triggering acupuncture spots sends signals to the brain to release endorphins. ▪Regulation of oxytocin hormones ▪For more details, see Figure 2.	▪Acupressure may improve women’s satisfaction and reduce labor pain and duration. ▪There is insufficient evidence of Acupuncture’s effects on labor; it seems that it decreases pain intensity but not duration and has better satisfaction rates.	Smith et al. [33]; 2020 Schlaeger et al. [34]; 2017 Eshraghi et al. [35]; 2021
Transcutaneous Electrical Nerve Stimulation (TENS)	▪Conventional TENS: reduces labor pain. ▪Acupuncture TENS ▪Intense TENS ▪Burst mode TENS ▪Modulated TENS	▪Applying low-intensity electrical pulses to targeted regions of the body via electrodes affixed to the skin. ▪It inhibits the pain signals’ transmission to the nervous system.	▪It significantly reduces pain intensity; however, the evidence was low. ▪A significant reduction in pain score and improved women’s satisfaction.	Thuvarakan et al. [36]; 2020 Gibson et al. [37]; 2019 Daniel et al. [38]; 2021
Water immersion	▪Cold water ▪Hot water ▪Alternating hot/cold water bathing	▪Immersing in a bath or utilizing a birthing pool can induce relaxation, diminish pain perception, and facilitate smoother movement during childbirth.	▪There was low evidence that immersion reduces the need for PPM. ▪Significant improvement in physical and psychological comfort, and the need for pain relief.	Cluett et al. [39]; 2018 Carlsson et al. [40]; 2020 Cooper et al. [41]; 2022
Heat therapy	▪Warm pack and towels ▪Hot water bags ▪Warm shower ▪Thermal and infra-red belt	▪Administration of heat to a specific region experiencing pain enhances blood circulation, induces muscle relaxation, and alleviates pain perception.	▪Evidence confirmed an effective reduction in labor pain intensity and labor duration. ▪Significant reduction in post-labor pain	Goswami et al. [42]; 2022 Akbarzadeh et al. [43]; 2018 Akbarzadeh et al. [44]; 2016 Dastjerd et al. [45]; 2023
Cold therapy	▪Ice packs ▪Ice massage	Utilization of cold packs or ice to induce numbness in a specific area, thereby mitigating inflammation and offering temporary pain alleviation.	▪Significant reduction in pain intensity and duration.	Shirvani et al. [46]; 2014 Emine et al. [47]; 2022 Serap et al. [48]; 2022
Breathing techniques	▪Deep, slow, and patterned breathing.	▪Effective in diverting attention from pain and facilitating a state of relaxation.	▪Effective reduction in labor pain added to a shorter labor duration. ▪Ineffective in reducing pain in the 1st stage.	Baljon et al. [49]; 2022 Issac et al. [50]; 2023 Yuksel H et al. [51]; 2017 Boaviagem et al. [52]; 2017
Positioning and Movement	▪Changing positions frequently, such as walking, squatting position, ▪Birthing ball rocking	▪Helps manage pain by utilizing gravity and promoting optimal fetal positioning.	▪Effective in reducing pain and duration of labor. ▪Upright positions and free mobility reduce labor duration and pain and improve women’s satisfaction.	Huang et al. [53]; 2019 Ondeck et al. [54]; 2019 Borges et al. [55]; 2021 Ali SA et al. [56]; 2018