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The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial

Yıl 2025, Cilt: 11 Sayı: 2, 78 - 88, 27.05.2025

Emel Tırkaz , Meltem Akbaş

https://doi.org/10.30934/kusbed.1367689

Öz

Objective: The aims was to investigate the effects of effleurage massage on pregnant women's anxiety level, the degree of their labor pain, and the duration of their labor process.
Methods: This randomized controlled study was conducted with 64 pregnant women, divided into two groups. The pregnant women in the experimental group underwent effleurage message for 30 minutes when dilatation was D1 (3-4 cm), D2 (5-6 cm) and D3 (8-9 cm), and all women received routine care. Data were collected using the Socio-demographic Form, State and Trait Anxiety Inventories, Visual Analogue Scale, Labor Process Assessment Form, and the End of Labor Assessment Form.
Results: The experimental group pain scores and anxiety scores were significantly lower than controls (p=0.001 and; p<0.05, respectively). Furthermore, the labor duration of the experimental group was significantly shorter than controls (p=0.001).
Conclusion: Effleurage massage appears to be effective in reducing labor pain and anxiety, and also shortened the duration of labor in this population.

Anahtar Kelimeler

anxiety effleurage labor pain pregnant

Proje Numarası

TYL-2017-8679

Kaynakça

  • Bolbol-Haghighi N, Masoumi SZ, Kazemi F. Effect of massage therapy on duration of labour: A randomized controlled trial. J Clin Diagn Res.2016;10(4):12-15.doi: 10.7860/JCDR/2016/17447.7688.
  • Taskın L. Obstetrics and Women's Health Nursing. 13th Ed. Ankara: Akademisyen Medical Bookstore; 2016.
  • Labor S, Maguire S. The Pain of Labour. Rev Pain. 2008;2(2) 15-19. doi: 10.1177/204946370800200205.
  • Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan. J Adv Nurs. 2002;38(1):68-73. doi: 10.1046/j.1365-2648.2002.02147.x.
  • Ipek A. The effects of the application of topical therapy methods to inferior dorsal side in labor action on labor pain perception and time of delivery. [PhD thesis]. Erzurum: Atatürk University Institute of Health Sciences, 2014.
  • Gönenç IM, Terzioğlu B. Effects of massage and acupressure on relieving labor pain, reducing labor time, and increasing delivery satisfaction. J Nurs Res. 2020;28(1):e68. doi: 10.1097/jnr.0000000000000344.
  • Mamuk R, Davas IN. Use of nonpharmacologic relaxation and tactile stimulation methods in labor pain. Sisli Etfal Hospital Medical Bulletin, 2010;44(3):137-144.
  • Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013;14(7):488-501, doi:10.1038/nrn3524.
  • Amidu N, Alhassan M, Issah H, Yakong VN, Yahaya W, Adams Y, and et al. Perceived stress and anxiety in women during labour: a case of Tamale West Hospital, Tamale, Ghana. Asian Journal of Medicine and Health. 2018;11(2):1-10. doi: 10.9734/AJMAH/2018/40373
  • Mete S, Cicek O, Uludag E. Examining the Relationship Between Labor Pain and Anxiety. Dokuz Eylul University Faculty of Nursing Electronics Journal. 2016;9(3):101-104.
  • Bhavya SV, Parvathi NK, Bhagyalakshmi HS. A study on awareness and anxiety level of primigravida mothers on labour and its outcome in a selected hospital, Mysore. Int J Nurs Educ. 2015;7(1):184-187. doi: 10.5958/0974-9357.2015.00038.0
  • Koker I. Obstetrics and Gynecology Basics. Adana: Nobel Tıp Bookstore; 2006.
  • Saydam Karaca B. The act of birth. In: Sirin A, Kavlak O, eds. Women's Health. İstanbul: Bedray Press Publishing; 2008.
  • Arslan H, Karahan N, Cam C. Nature of Midwifery and Effects of Delivery Mode. Nobel Medical Bookstores Ltd. Sti. 1; 2008: 54-59.
  • Sleutel RM. Intrapartum nursing: integrating rubin’s framework with social support theory. J Obstet Gynecol Neonatal Nurs. 2003;32(1):76-82. doi: 10.1177/0884217502239803.
  • Ozturk-Can H. Studying the affect of ice-massage applied to hands of pregnant women to reduce the perceived labor pains. [PhD thesis]. İzmir: Ege University Institute of Health Sciences; 2008.
  • Paul J, Jordan R, Duty S, Engstrom JL. Improving satisfaction with care and reducing length of stay in an obstetric triage unit using a nurse-midwife-managed model of care. J Midwifery Womens Health. 2013;58(2):175–81. doi:10.1111/J.1542-2011.2012.00239.X.
  • Komurcu N. Birth Pain and Management. 2nd ed. İstanbul: Nobel Medical Bookstores. Ltd. Ltd. Sti.; 2014.
  • Yesildag B, Golbası Z. Examination of Postgraduate Thesis Studies Assessing the Effectiveness of Non-Pharmacological Methods in the Management of Labor Pain. Duzce University Journal of Health Sciences Institute. 2018;8(3):104-111.
  • Boateng EA, Kumi LO, Diji AK. Nurses and midwives’ experiences of using non-pharmacological interventions for labour pain management: a qualitative study in Ghana. BMC Pregnancy Childbirth. 2019;19(1):168-178. doi: 10.1186/s12884-019-2311-x.
  • Harris M, Lindquist R, Snyder M, Tracy M. Massage Complementary Alternative Therapies in Nursing. 7th ed. New York: Springer Publishing Company; 2018:255-272.
  • Yuksel I. Massage Techniques. 4th ed. Ankara: Hipokrat & Bookstore Pelikan Bookstore; 2016.
  • Gholami-Motlagh F, Jouzi M, Soleymani B. Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women. Iran J Nurs Midwifery Res. 2016: 21 (4); 402-409. doi: 10.4103/1735-9066.185584.
  • Goldstein S, Casanelia L. The Techniques of Swedish Massage. Foundations of Massage. 3rd ed. Australia: 2009: Chapter 16.
  • Gale Encyclopedia of Alternative Medicine. Swedish Massage. Encyclopedia. 2020. Accessed August 24, 2020. https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-andmaps/ swedish- massage/
  • Kyle-Brown D, Saeger J. New Foundations in Therapeutic Massage and Bodywork. McGraw-Hill Eductaion; 2007
  • Benjamin PJ. Brush up on the history of the massage therapy profession. America Massage Therapy Association. 2020. Accessed August 24, 2020. https://www.amtamassage.org/articles/3/MTJ/detail/3285/brush-up-on-the-history-of-the-massagetherapy-profession/
  • Baser M, Tasci S. Complementary and Supportive Practices with Evidence-Based Guides. Ankara: Academic Bookstore; 2015.
  • Abdul-Sattar Khudhur Ali S, Mirkhan Ahmed H. Effect of change in position and back massage on pain perception during first stage of Labor. Pain Manag Nurs. 19(3); 2018: 288-294. doi: 10.1016/j.pmn.2018.01.006.
  • Türkmen H. The effect of massage and warm application to the labor pain and comfort. [PhD thesis]. İzmir: Ege University Institute of Health Sciences; 2017.
  • Sadat HS, Forugh F, Maryam H, Nosratollah MN, Hosein S. The impact of manual massage on intensity and duration of pain at first phase of labor in primigravid women. International Journal of Medicine Research. 2016: 1(4); 16-18.
  • Mortazavi SY, Khaki S, Moradi R, Heidari K, Vasegh Rahimparvar SF. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012: 286;19-23. doi: 10.1007/s00404-012-2227-4.
  • Sevil U, Ertem G. Perinatology and Care. Ankara: Nobel Medical Bookstore; 2016.
  • MedCalcs Easy to Use Statistical Software. Free statistical calculators. Medcalc. 2020. Accessed August 24, 2020. https://www.medcalc.org/calc/
  • Akin B, Kocoglu D. Randomized controlled experiments. Hacettepe University Journal of Nursing Faculty. 2017: 4 (1); 73-92.
  • Öner N, LeCompte A. Discontinuous condition/Trait Anxiety Inventory Handbook. 2nd ed. İstanbul: Bogazici University Publishing House; 1998.
  • Aydin A, Araz A, Asan A. Visual analogue scale and emotion cage: adaptation study to our culture. Turkish Psychology Articles. 2011: 14(27);1.
  • Janssen P, Shroff F, Jaspar P. Massage therapy and labor outcomes: a randomized controlled trial. Int J Ther Massage Bodywork. 2012:5(4);15-20. doi: 10.3822/ijtmb.v5i4.164.
  • Gallo RBS, Santana LS, Ferreira CHJ, Marcolin AC, PoliNeto OB, Duarte G. Massage reduced severity of pain during labour: a randomised trial. Journal of Physiotherapy. 2013: 59;109-116. doi: 10.1016/S1836-9553(13)70163-2.
  • Kamalifard M, Shahnazi M, Melli M.S, Allahverdizadeh S, Toraby S, Ghahvechi A. The efficacy of massage therapy and breathing techniques on pain intensity and physiological responses to labor pain. JCS. 1(2); 2012:73-8. doi: 10.5681/jcs.2012.011.
  • Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: a systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iran J Nurs Midwifery Res. 22(4); 2017: 257-261. doi:10.4103/ijnmr.IJNMR_109_16
  • Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between massage and music therapies to relieve the severity of labor pain. Womens Health (Lond). 2010;6(3):377-381. doi:10.2217/whe.10.15
  • Hosseini S, Asadi N, Zareei F. Investigating the effect of massage therapy on labor in the active stage of first labor. Iran J Nurs Midwifery Res. 2014:9;25-32.
  • Karami NK, Safarzadeh A. Effect of massage therapy on severity of pain and outcome of labor in primipara. . Iran J Nurs Midwifery Res. 2007: 12(1); 6-9.
  • Erenoglu R. Effect of expressive touching on labour pain and maternal satisfaction. [PhD thesis]. Kayseri: Erciyes University Institute of Health Sciences; 2013.

The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial

Yıl 2025, Cilt: 11 Sayı: 2, 78 - 88, 27.05.2025

Emel Tırkaz , Meltem Akbaş

https://doi.org/10.30934/kusbed.1367689

Öz

Objective: The aims was to investigate the effects of effleurage massage on pregnant women's anxiety level, the degree of their labor pain, and the duration of their labor process.
Methods: This randomized controlled study was conducted with 64 pregnant women, divided into two groups. The pregnant women in the experimental group underwent effleurage message for 30 minutes when dilatation was D1 (3-4 cm), D2 (5-6 cm) and D3 (8-9 cm), and all women received routine care. Data were collected using the Socio-demographic Form, State and Trait Anxiety Inventories, Visual Analogue Scale, Labor Process Assessment Form, and the End of Labor Assessment Form.
Results: The experimental group pain scores and anxiety scores were significantly lower than controls (p=0.001 and; p<0.05, respectively). Furthermore, the labor duration of the experimental group was significantly shorter than controls (p=0.001).
Conclusion: Effleurage massage appears to be effective in reducing labor pain and anxiety, and also shortened the duration of labor in this population.

Anahtar Kelimeler

Anxiety effleurage labor pain pregnant.

Proje Numarası

TYL-2017-8679

Kaynakça

  • Bolbol-Haghighi N, Masoumi SZ, Kazemi F. Effect of massage therapy on duration of labour: A randomized controlled trial. J Clin Diagn Res.2016;10(4):12-15.doi: 10.7860/JCDR/2016/17447.7688.
  • Taskın L. Obstetrics and Women's Health Nursing. 13th Ed. Ankara: Akademisyen Medical Bookstore; 2016.
  • Labor S, Maguire S. The Pain of Labour. Rev Pain. 2008;2(2) 15-19. doi: 10.1177/204946370800200205.
  • Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan. J Adv Nurs. 2002;38(1):68-73. doi: 10.1046/j.1365-2648.2002.02147.x.
  • Ipek A. The effects of the application of topical therapy methods to inferior dorsal side in labor action on labor pain perception and time of delivery. [PhD thesis]. Erzurum: Atatürk University Institute of Health Sciences, 2014.
  • Gönenç IM, Terzioğlu B. Effects of massage and acupressure on relieving labor pain, reducing labor time, and increasing delivery satisfaction. J Nurs Res. 2020;28(1):e68. doi: 10.1097/jnr.0000000000000344.
  • Mamuk R, Davas IN. Use of nonpharmacologic relaxation and tactile stimulation methods in labor pain. Sisli Etfal Hospital Medical Bulletin, 2010;44(3):137-144.
  • Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013;14(7):488-501, doi:10.1038/nrn3524.
  • Amidu N, Alhassan M, Issah H, Yakong VN, Yahaya W, Adams Y, and et al. Perceived stress and anxiety in women during labour: a case of Tamale West Hospital, Tamale, Ghana. Asian Journal of Medicine and Health. 2018;11(2):1-10. doi: 10.9734/AJMAH/2018/40373
  • Mete S, Cicek O, Uludag E. Examining the Relationship Between Labor Pain and Anxiety. Dokuz Eylul University Faculty of Nursing Electronics Journal. 2016;9(3):101-104.
  • Bhavya SV, Parvathi NK, Bhagyalakshmi HS. A study on awareness and anxiety level of primigravida mothers on labour and its outcome in a selected hospital, Mysore. Int J Nurs Educ. 2015;7(1):184-187. doi: 10.5958/0974-9357.2015.00038.0
  • Koker I. Obstetrics and Gynecology Basics. Adana: Nobel Tıp Bookstore; 2006.
  • Saydam Karaca B. The act of birth. In: Sirin A, Kavlak O, eds. Women's Health. İstanbul: Bedray Press Publishing; 2008.
  • Arslan H, Karahan N, Cam C. Nature of Midwifery and Effects of Delivery Mode. Nobel Medical Bookstores Ltd. Sti. 1; 2008: 54-59.
  • Sleutel RM. Intrapartum nursing: integrating rubin’s framework with social support theory. J Obstet Gynecol Neonatal Nurs. 2003;32(1):76-82. doi: 10.1177/0884217502239803.
  • Ozturk-Can H. Studying the affect of ice-massage applied to hands of pregnant women to reduce the perceived labor pains. [PhD thesis]. İzmir: Ege University Institute of Health Sciences; 2008.
  • Paul J, Jordan R, Duty S, Engstrom JL. Improving satisfaction with care and reducing length of stay in an obstetric triage unit using a nurse-midwife-managed model of care. J Midwifery Womens Health. 2013;58(2):175–81. doi:10.1111/J.1542-2011.2012.00239.X.
  • Komurcu N. Birth Pain and Management. 2nd ed. İstanbul: Nobel Medical Bookstores. Ltd. Ltd. Sti.; 2014.
  • Yesildag B, Golbası Z. Examination of Postgraduate Thesis Studies Assessing the Effectiveness of Non-Pharmacological Methods in the Management of Labor Pain. Duzce University Journal of Health Sciences Institute. 2018;8(3):104-111.
  • Boateng EA, Kumi LO, Diji AK. Nurses and midwives’ experiences of using non-pharmacological interventions for labour pain management: a qualitative study in Ghana. BMC Pregnancy Childbirth. 2019;19(1):168-178. doi: 10.1186/s12884-019-2311-x.
  • Harris M, Lindquist R, Snyder M, Tracy M. Massage Complementary Alternative Therapies in Nursing. 7th ed. New York: Springer Publishing Company; 2018:255-272.
  • Yuksel I. Massage Techniques. 4th ed. Ankara: Hipokrat & Bookstore Pelikan Bookstore; 2016.
  • Gholami-Motlagh F, Jouzi M, Soleymani B. Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women. Iran J Nurs Midwifery Res. 2016: 21 (4); 402-409. doi: 10.4103/1735-9066.185584.
  • Goldstein S, Casanelia L. The Techniques of Swedish Massage. Foundations of Massage. 3rd ed. Australia: 2009: Chapter 16.
  • Gale Encyclopedia of Alternative Medicine. Swedish Massage. Encyclopedia. 2020. Accessed August 24, 2020. https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-andmaps/ swedish- massage/
  • Kyle-Brown D, Saeger J. New Foundations in Therapeutic Massage and Bodywork. McGraw-Hill Eductaion; 2007
  • Benjamin PJ. Brush up on the history of the massage therapy profession. America Massage Therapy Association. 2020. Accessed August 24, 2020. https://www.amtamassage.org/articles/3/MTJ/detail/3285/brush-up-on-the-history-of-the-massagetherapy-profession/
  • Baser M, Tasci S. Complementary and Supportive Practices with Evidence-Based Guides. Ankara: Academic Bookstore; 2015.
  • Abdul-Sattar Khudhur Ali S, Mirkhan Ahmed H. Effect of change in position and back massage on pain perception during first stage of Labor. Pain Manag Nurs. 19(3); 2018: 288-294. doi: 10.1016/j.pmn.2018.01.006.
  • Türkmen H. The effect of massage and warm application to the labor pain and comfort. [PhD thesis]. İzmir: Ege University Institute of Health Sciences; 2017.
  • Sadat HS, Forugh F, Maryam H, Nosratollah MN, Hosein S. The impact of manual massage on intensity and duration of pain at first phase of labor in primigravid women. International Journal of Medicine Research. 2016: 1(4); 16-18.
  • Mortazavi SY, Khaki S, Moradi R, Heidari K, Vasegh Rahimparvar SF. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012: 286;19-23. doi: 10.1007/s00404-012-2227-4.
  • Sevil U, Ertem G. Perinatology and Care. Ankara: Nobel Medical Bookstore; 2016.
  • MedCalcs Easy to Use Statistical Software. Free statistical calculators. Medcalc. 2020. Accessed August 24, 2020. https://www.medcalc.org/calc/
  • Akin B, Kocoglu D. Randomized controlled experiments. Hacettepe University Journal of Nursing Faculty. 2017: 4 (1); 73-92.
  • Öner N, LeCompte A. Discontinuous condition/Trait Anxiety Inventory Handbook. 2nd ed. İstanbul: Bogazici University Publishing House; 1998.
  • Aydin A, Araz A, Asan A. Visual analogue scale and emotion cage: adaptation study to our culture. Turkish Psychology Articles. 2011: 14(27);1.
  • Janssen P, Shroff F, Jaspar P. Massage therapy and labor outcomes: a randomized controlled trial. Int J Ther Massage Bodywork. 2012:5(4);15-20. doi: 10.3822/ijtmb.v5i4.164.
  • Gallo RBS, Santana LS, Ferreira CHJ, Marcolin AC, PoliNeto OB, Duarte G. Massage reduced severity of pain during labour: a randomised trial. Journal of Physiotherapy. 2013: 59;109-116. doi: 10.1016/S1836-9553(13)70163-2.
  • Kamalifard M, Shahnazi M, Melli M.S, Allahverdizadeh S, Toraby S, Ghahvechi A. The efficacy of massage therapy and breathing techniques on pain intensity and physiological responses to labor pain. JCS. 1(2); 2012:73-8. doi: 10.5681/jcs.2012.011.
  • Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: a systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iran J Nurs Midwifery Res. 22(4); 2017: 257-261. doi:10.4103/ijnmr.IJNMR_109_16
  • Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between massage and music therapies to relieve the severity of labor pain. Womens Health (Lond). 2010;6(3):377-381. doi:10.2217/whe.10.15
  • Hosseini S, Asadi N, Zareei F. Investigating the effect of massage therapy on labor in the active stage of first labor. Iran J Nurs Midwifery Res. 2014:9;25-32.
  • Karami NK, Safarzadeh A. Effect of massage therapy on severity of pain and outcome of labor in primipara. . Iran J Nurs Midwifery Res. 2007: 12(1); 6-9.
  • Erenoglu R. Effect of expressive touching on labour pain and maternal satisfaction. [PhD thesis]. Kayseri: Erciyes University Institute of Health Sciences; 2013.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Özgün Araştırma
Yazarlar

Emel Tırkaz 0000-0002-6295-354X

Meltem Akbaş 0000-0002-5845-0552

Proje Numarası TYL-2017-8679
Yayımlanma Tarihi 27 Mayıs 2025
Gönderilme Tarihi 28 Eylül 2023
Kabul Tarihi 22 Aralık 2024
Yayımlandığı Sayı Yıl 2025 Cilt: 11 Sayı: 2

Kaynak Göster

APA Tırkaz, E., & Akbaş, M. (2025). The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 11(2), 78-88. https://doi.org/10.30934/kusbed.1367689
AMA Tırkaz E, Akbaş M. The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial. KOU Sag Bil Derg. Mayıs 2025;11(2):78-88. doi:10.30934/kusbed.1367689
Chicago Tırkaz, Emel, ve Meltem Akbaş. “The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11, sy. 2 (Mayıs 2025): 78-88. https://doi.org/10.30934/kusbed.1367689.
EndNote Tırkaz E, Akbaş M (01 Mayıs 2025) The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11 2 78–88.
IEEE E. Tırkaz ve M. Akbaş, “The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial”, KOU Sag Bil Derg, c. 11, sy. 2, ss. 78–88, 2025, doi: 10.30934/kusbed.1367689.
ISNAD Tırkaz, Emel - Akbaş, Meltem. “The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11/2 (Mayıs 2025), 78-88. https://doi.org/10.30934/kusbed.1367689.
JAMA Tırkaz E, Akbaş M. The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial. KOU Sag Bil Derg. 2025;11:78–88.
MLA Tırkaz, Emel ve Meltem Akbaş. “The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, c. 11, sy. 2, 2025, ss. 78-88, doi:10.30934/kusbed.1367689.
Vancouver Tırkaz E, Akbaş M. The Effect of Effleurage Massage On Labor Pain, Anxiety Level, and Duration of Labor: A Randomized Controlled Trial. KOU Sag Bil Derg. 2025;11(2):78-8.
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