Front. Med. Frontiers in Medicine Front. Med. 2296-858X Frontiers Media S.A. 10.3389/fmed.2026.1730360 Systematic Review The efficacy and safety of transcutaneous electrical nerve stimulation for labor analgesia in the first stage of labor: a qualitative and quantitative analysis HuZhuo-Ya 1 Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing TangJuan 1 Data curation Resources Software Writing – review & editing LiXing-Xian 1 Data curation Formal analysis Software Writing – review & editing YuanDong-Ni 1 Data curation Formal analysis Software Writing – review & editing ChenZi-Yi 1 Data curation Resources Writing – review & editing LyuYang-Qian 1 Data curation Formal analysis Writing – review & editing MaWen-Bin 2 Data curation Writing – review & editing LanLei 1 * Conceptualization Methodology Supervision Writing – review & editing Acupuncture and Tuina College, Chengdu University of Traditional Chinese Medicine, Chengdu, China School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China Correspondence: Lei Lan, email@uni.edu 27 01 2026 2026 13 1730360 22 10 2025 09 12 2025 02 01 2026 Copyright © 2026 Hu, Tang, Li, Yuan, Chen, Lyu, Ma and Lan. 2026 Hu, Tang, Li, Yuan, Chen, Lyu, Ma and Lan https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Aim

Labor pain represents a significant challenge for parturients during childbirth. Transcutaneous electrical nerve stimulation (TENS) is an effective analgesic modality. However, its efficacy and safety for intrapartum analgesia remain unclear. To address this knowledge gap, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to comprehensively assess the analgesic effectiveness and safety profile of TENS during the first stage of labor.

 Methods

We searched databases from inception to October 17, 2024 and updated them to July 22, 2025. Paired researchers independently extracted data and assessed the risk of bias. All meta-analyses were performed via random effects models, and the GRADE approach was employed to evaluate the certainty of evidence.

 Results

We included 51 randomized controlled trials (10,038 participants, all females). Low evidence showed that compared with the blank control, parturients using TENS may experience more pain relief (WMD –1.98 cm, 95%CI -2.6 to −1.35 cm, the modelled RD 52, 95% CI 37 to 62%), parturients using TENS may shorten the duration of the first stage of labor (WMD –46.78 min,95% CI –61.32 to −32.25 min); compared with the epidural analgesia groups, parturients using TENS may shorten the duration of the first stage of labor (WMD-62.22 min, 95%CI -92.51 to −31.94 min).

 Conclusion

Compared with the blank control, TENS may reduce pain intensity and shorten the duration of the first stage of labor in parturients, with little to no difference in adverse events. When compared to epidural analgesia, TENS may shorten the duration of the first stage of labor, with very small differences observed in analgesic efficacy or adverse effects.

 Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251066439, identifier PROSPERO (CRD420251066439).

 childbirth labor analgesia meta-analysis systematic review TENS the first stage of labor transcutaneous electrical nerve stimulation Chengdu University of Traditional Chinese Medicine 10.13039/501100008402 The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Chengdu University of Traditional Chinese Medicine University-Institute Joint Innovation Fund (Grant No. LH202402049). section-at-acceptance Obstetrics and Gynecology Introduction

Labor pain, which is primarily induced by uterine contractions and cervical dilation, represents one of the most intense pain experiences in a woman’s lifetime (1). Characterized by progressive intensification, it initially manifests as dull lower abdominal or lumbosacral discomfort, evolving into rhythmic and excruciating sharp pain as labor advances. The intensity of labor pain and the duration of labor are two critical clinical indicators during maternal delivery. Timely and effective analgesia is crucial for ensuring maternal safety, facilitating spontaneous vaginal delivery, and optimizing neonatal outcomes (2).

The following provides a description of Transcutaneous Electrical Nerve Stimulation (TENS): Its physiological basis encompasses (1) the Gate Control Theory, where stimulation of Aβ fibers inhibits nociceptive signal transmission (via Aδ and C fibers); (2) the release of endogenous opioids, elevating cerebrospinal fluid levels of β-endorphin; and (3) central nervous system inhibition via activation of descending pain inhibitory pathways. Its indications include conditions such as labor pain, low back pain, and neuropathic pain. Contraindications involve application over implanted electronic devices, the abdomen during pregnancy, the carotid sinus region, malignant tumor sites, and areas with bleeding tendencies. The most frequently reported side effects are skin irritation, manifested as erythema, pruritus, and discomfort beneath the electrodes. Key advantages are its non-invasive nature, safety, ease of administration, provision of immediate analgesia, and compatibility with other therapies. Its disadvantages include restricted efficacy against severe or deep-seated pain, significant inter-individual variability in therapeutic outcomes, and anatomical constraints on application. Epidemiologically, as a significant pain-relief modality, its utilization demonstrates an upward trend, with potential for reducing long-term healthcare expenditures. Compared to epidural analgesia, TENS is suitable for parturients who prioritize maintaining mobility, control, and a more natural birth experience. In contrast, epidural analgesia is indicated for those experiencing severe pain or those at high obstetric risk necessitating emergency cesarean section.

Currently, TENS is employed as a non-pharmacological approach for analgesia, with its non-invasive nature offering distinct clinical advantages (3). The review article by Lowe, titled “The Nature of Labor Pain” (4), systematically delineates the stages of labor, the characteristics and physiological mechanisms of pain, as well as analgesia strategies. However, the efficacy and safety of TENS for labor analgesia remain uncertain. The first stage of labor, the cervical dilation stage, extends from the onset of regular uterine contractions to complete cervical dilatation. Its analgesic significance lies in effectively blocking the pain of contractions, for which Transcutaneous Electrical Nerve Stimulation (TENS) can be employed. In contrast, the physiological focus of the second stage is fetal expulsion, where the pain transitions to somatic pain originating from the pelvic floor and perineum. Here, the analgesic goal shifts to balancing pain relief with the preservation of the parturient’s ability to push effectively, a balance often achieved using epidural analgesia. TENS is primarily indicated for the first stage and offers limited utility in the second stage, when investigating the analgesic efficacy of Transcutaneous Electrical Nerve Stimulation (TENS), the primary research focus is typically on the first stage of labor. This study aims to quantitatively evaluate the analgesic effects of TENS compared to blank control, and assess its benefits and limitations relative to epidural analgesia. The findings are expected to provide evidence-based guidance for clinical decision-making, particularly in resource-limited settings where the non-invasive characteristics of TENS may enhance its applicability.

 Materials and methods

Our systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (5) and was prospectively registered on PROSPERO (CRD420251066439).

Literature search

Researchers have developed database-specific search strategies, without language restrictions or publication status limitations, for Pubmed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals, and Wan Fang, which were searched from inception to October 17, 2024 and updated to July 22, 2025 (Supplementary Table 1). We also reviewed previous systematic reviews and included other studies that have met the criteria. We systematically examined the reference lists of prior systematic reviews (6–8) and cross-verified all potentially eligible randomized controlled trials (RCTs), implementing individual exclusion assessments.

 Literature screen and data extraction

A pair of researchers, DNY and XXL, and ZYC and YQL, independently screened the titles and abstracts using a unified standard, and then the full texts that met the criteria were selected. Standardized pretest forms, with comprehensive instructions were used to ensure consistent application across all research sites. Any discrepancies between researchers were resolved through group discussion or, when necessary, with the assistance of an arbitrator (ZYH) to ensure consensus.

We included the following trials: (1) naturally delivered, full-term pregnancy (≥37 weeks), singleton mothers, aged more than 18 years old; (2) on the basis of usual care, TENS vs. blank treatment, or TENS vs. epidural stimulation; (3) pain intensity or duration reduction, during the first stage of labor; (4) Parallel-group randomized controlled trial.

A pair of reviewers: DNY and XXL, ZYC and YQL, independently abstracted data from each eligible trial. We have collected the relevant information of the article, including the author’s name and publication year, country of origin, sample size, characteristics of the parturient, intervention and outcome indicators, etc. We extracted the change scores from the baseline to reflect the internal changes in individuals.

 Risk of bias assessment

Reviewers (ZYH, DNY and XXL) independently assessed the risk of bias, via a modified Cochrane Risk of Bias Tool 1.0 (9, 10), including random sequence generation, allocation concealment, blinding of study participants, operators, data collectors, evaluators and analysts, incomplete outcome data (≥20% missing data was considered high risk of bias), and other potential sources of bias. The answer options for each question are “definitely or possibly” (low bias risk) or “definitely or possibly Not” (high bias risk). Disagreements among researchers are resolved through discussion, those that cannot be resolved are determined by a third party.

 Data analysis

We computed relative risk (RR) with 95% confidence intervals for dichotomous outcomes, while weighted mean differences (WMD) with 95% CIs were derived for continuous variables. We converted all continuous result data to a common scale in each domain (11): (1) pain intensity to the 10 cm visual analogue scale (VAS) for pain, the minimal clinically important difference (MID) was 1 cm (12, 13). (2) Duration of the first stage of labor. Modeled values were computed to facilitate comparative interpretation of the results.

All meta-analyses were performed via a Der Simonian-Laird random-effects model, with statistical processing executed in STATA 17 (Stata Corp, College Station, TX, USA).”

We examined publication bias through the visual assessment of funnel plot asymmetry when 10 or more studies were included in the analysis (14). All comparisons were two-tailed using a threshold of p ≤ 0.05.

 Certainty of evidence

The certainty of evidence for each outcome was evaluated via the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology (15, 16). While randomized controlled trials initially receive high certainty ratings, downgrading may occur across five domains: risk of bias, consistency, directness, precision, and publication bias, potentially yielding moderate, low, or very low certainty assessments. Treatment effects were judged to be imprecise under two distinct conditions: (1) for pain outcomes, when the 95% confidence interval encompassed half of the minimal clinically important difference (MID); (2) for adverse events, when the 95% CI included the null effect value (Table 1).

Baseline characteristics of included studies.

Study ID Intervention Control Funding Country Number of participants at baseline, n Mean duration of gestational age (SD), weeks Mean age (SD), years
Gao Y 2023(17) TENS Blank NR China 160 39.7 (0.95) 27.8 (2.22)
M. Movahedi 2022(64) TENS Blank NR Iran 100 38.9 (0.81) 29.9 (4.12)
Gao XX 2021(18) TENS Blank NR China 220 39.2 (1.42) 30.3 (4.08)
Yan J 2021(19) TENS Blank NR China 286 39.7 (0.84) 26.74 (2.79)
A. Njogu 2021(20) TENS Blank governmental China 413 39.1 (0.89) 29 (3.52)
Lei FY 2021(21) TENS Blank NR China 140 39.7 (1.65) 28.5 (4.69)
Peng LL 2021(22) TENS Blank NR China 145 39.1 (1.3) 27.8 (2.42)
Zhang XF 2020(23) TENS Blank NR China 200 NR 28.37 (4.16)
Zhang LQ 2020(24) TENS Blank NR China 86 NR 28.9 (3.44)
Li HY 2020(25) TENS Blank governmental China 100 38.7 (1.13) 29.6 (2.74)
Huang JZ 2020(26) TENS Blank NR China 160 39.4 (0.96) 28.7 (7.33)
Liu PP 2020(27) TENS Blank NR China 186 38.7 (1.18) 28 (1)
Jiang DM 2020(28) TENS EA NR China 50 39.5 (0.56) 29.6 (0.92)
Huang LY 2019(29) TENS EA NR China 480 NR 26.4 (2.25)
Zhao ZP 2018(30) TENS Blank NR China 92 38.2 (0.72) 28.3 (3.34)
A. Baez-Suarez 2018(62) TENS Blank NR Spain 63 39.5 (1.42) 28.1 (5.51)
Lu L 2018(31) TENS+EA EA governmental China 200 NR 28.2 (3.64)
Li L 2018(32) TENS Blank governmental China 80 38.5 (1.49) 29 (1.42)
A. Nyambura 2017 (33) TENS Blank NR China 326 39.1 (0.89) 29 (3.52)
Liu J 2016(34) TENS Blank NR China 100 39 (1.14) 27.4 (3.44)
TENS EA NR China 100 38.9 (1.1) 27.6 (3.61)
Xiao H 2015(35) TENS+EA EA governmental China 40 NR NR
Li J 2015(36) TENS EA government China 80 NR NR
TENS Blank governmental China 80 NR NR
Cai XL 2015(37) TENS Blank NR China 172 NR NR
TENS EA NR China 172 NR NR
Xiao H 2015(38) TENS + EA EA governmental China 40 39.3 (1.55) 26.6 (2.27)
Li HY 2012(39) TENS Blank NR China 60 38.6 (NR) 28.4 (NR)
Xu MJ 2006 (39) TENS Blank NR China 60 39.3 (0.64) 29.1 (3.58)
TENS EA NR China 60 39.3 (0.7) 28.8 (3.6)
Su XJ 2001(41) TENS Blank NR China 40 39.3 (0.5) 25.8(0.96)
Yang X 2021(42) TENS Blank NR China 60 40 (0.47) 28(4.06)
An ZZ 2015(43) TENS Blank NR China 60 NR NR
Cao JG 2025(44) TENS Blank governmental China 136 39.1 (1.12) 27.6 (5.84)
Wang L 2019(45) TENS Blank NR China 64 39.2 (0.7) 28.6 (4.3)
Xu JH 2022(46) TENS Blank governmental China 60 39.1 (1.12) 27.6 (5.84)
Song KK 2023(47) TENS Blank governmental China 90 38.7 (0.95) 30 (3.15)
He J 2020(48) TENS Blank NR China 200 39.1 (1.1) 28.5 (8)
Ma ZH 2018(49) TENS Blank NR China 60 37.5 (3.81) 27.5 (6.05)
Miao WJ 2020 (50) TENS EA NR China 151 39.6 (0.7) 27.5 (3.03)
Meng LK 2020(51) TENS Blank NR China 130 38.6 (1.26) 28.8 (4.27)
Han CP 2021(52) TENS EA governmental China 200 38.5 (1.15) 30.4 (3.3)
Zhao KL 2024(53) TENS Blank governmental China 130 39.6 (0.91) 27.1 (5.74)
Shi J 2002(54) TENS Blank NR China 60 NR NR
Niu CY 2017(65) TENS Blank NR China 400 NR 22.3 (4.63)
Liu Ye 2015(55) TENS EA NR China 60 39.2 (0.76) 27.8 (3.93)
TENS Blank NR China 60 39 (0.75) 27.1 (3.9)
QianJ 2025(56) TENS Blank governmental China 60 40.2 (1.82) 31.5 (1.62)
Miao Y 2025(57) TENS EA governmental China 92 NR NR
Xu J 2024(58) TENS Blank NR China 60 NR 30.3 (4.53)
Shi XL 2024(59) TENS Blank governmental China 80 39.6 (1.03) 26.4 (3.66)
TENS EA governmental China 80 39.6 (1.05) 26.4 (3.64)
Huang XZ 2019(66) TENS Blank NR China 94 39.3 (0.72) 28.8 (2.49)
R. Sulu 2022(61) TENS Blank governmental Turkey 42 38.27 (0.55) 22.02 (3.13)
Santana, L. S.2016(60) TENS Blank NR Brazil 46 NR 20 (4)
Zahra MEHRI 2022(67) TENS Blank NR Iran 130 39 (1.32) 24.5 (4.1)
V. Rashtchi 2022(68) TENS Blank NR Iran 80 NR 24(4.16)

NR, not reported; TENS, transcutaneous electrical nerve stimulation; EA, epidural analgesia.

 Results Literature screening

We screened 3,905 citations, and 51 RCTs (7,096 participants) were ultimately included. Workflow is shown in Supplementary Figure 1.

 Characteristics of included studies

Forty-four studies were conducted in China (17–59), three in Iran (60), one in Spain (31), one in Turkey (61), and one in Brazil (60). All participants were adult females, with a full-term (≥37 weeks) singleton delivery. The median of the mean age of participants was 26.5 years (IQR 18 to 35 years). Pain intensity were evaluated in 36 trials (19, 21, 24–29, 31–33, 36–42, 62, 63). First-stage labor duration was assessed in 33 trials (17–31, 33, 34, 36, 37, 39, 40, 43–47, 54–57, 59, 64, 65). Forty-five trials compared TENS with a blank control (17–27, 30–34, 36–49, 51, 53–56, 62–65), and eleven trials compared TENS with epidural analgesia (28, 29, 34, 36, 37, 40, 50, 54, 55, 57, 59). The TENS parameters for each article were also recorded (Table 4).

 Risk of bias

All 51 trials had at least one risk-of-bias domain: 33 trials (66%) adequately generated random sequences, 4 trials (8%) concealed allocation, 3 trials (6%) blinded participants, 1 trial (2%) blinded healthcare providers, 3 trials (6%) blinded each of the data collectors, outcome assessors, and data analysts, and 2 trials (4%) had ≥20% data missing in the trial report (Supplementary Table 2).

 TENS vs. blank control Pain intensity in the first stage of labor

Low evidence (31 RCTs, 3,227 patients) showed that compared with the blank control, parturients using TENS may experience more pain relief (WMD-1.98 cm, 95%CI -2.6 to −1.35 cm, modelled RD 52, 95%CI 37 to 62%; Table 2 and Figure 1) (19, 21, 24, 25, 27, 31–33, 36, 38, 41–43, 46–49, 51, 62, 63).

Grade evidence profile of TENS versus the blank control for first-stage labor analgesia.

No. of trials(No. of patients) Risk of bias Inconsistency Indirectness Imprecision Publication bias Treatment association (95% CI) Overall quality of evidence
Pain: 0–10 cm VAS for pain; lower is better; MID = 1 cm
31 (3,227) Serious a Not serious b Not serious Not serious Serious c Achieved at or above MID Low
TENS 79.6% Control 27.9%
Modelled RD 0.52 (0.37,0.62)
WMD –1.98 cm (−2.6, −1.35 cm)
Duration of the first labor stage(minutes): shorter is better
30(4,092) Serious a Not serious b Not serious Not serious Serious c WMD -46.78 min (−61.32, −32.25 min) Low
Adverse effects
11 (1,278) Serious a Not serious,I2 = 27.5% Not serious Not serious Serious c RR 0.51(0.38,0.69) Low

NA, not available; MID, minimal clinical important difference. a, high risk of bias in blinding; b, The observed high variance originated primarily from substantial dispersion in reported treatment effects across studies, rather than data sparsity; c, high risk in publication bias.

The pain intensity measured by the 10 cm VAS during the first stage of labor with TENS analgesia was compared to blank control.

Forest plot showing a meta-analysis of various studies comparing treatment and control groups. Results are displayed as mean differences with 95% confidence intervals, where most studies favor the "Favors TENS" treatment. Weight percentages for each study are indicated. The overall effect estimate is depicted as a diamond at the bottom, with heterogeneity statistics and model information provided beneath the plot. Duration of the first stage of labor

Low evidence (30 RCTs, 4,092 patients) reported that compared with blank control, parturients using TENS may shorten the duration of the first stage of labor (WMD-46.78 min,95%CI -61.32 to −32.25 min; Table 2 and Figure 2) (17–27, 30, 31, 33, 34, 36–40, 43–47, 55, 56, 58, 64, 65).

The duration of the first stage of labor with TENS analgesia was compared to blank control.

Forest plot depicting a meta-analysis of various studies comparing treatment and control groups. Each study is represented with a square and line indicating the mean difference with a ninety-five percent confidence interval. A diamond at the bottom shows the overall effect size. Favorable outcomes for TENS are to the left, and for the control to the right. The plot includes studies with weights expressed in percentages, and heterogeneity statistics are provided below. Adverse effects

Low evidence (11 RCTs,1,278 patients) suggests that compared with blank control, TENS may have little to no effect on reducing adverse effects in parturients during the first stage of labor (RR 0.51, 95% CI 0.38 to 0.69; Table 2 and Figure 3) (19, 21, 23, 26, 38, 41, 42, 46, 49, 51, 53).

Adverse events among parturients in the first stage of labor who received TENS versus blank control.

Forest plot showing the relative risk (RR) with 95% confidence intervals (CI) for various studies comparing two treatments. Individual studies are represented by blue squares, proportional in size to their weight. The overall effect is indicated by a diamond at 0.51 (0.38, 0.69) with an I-squared value of 27.5%, suggesting moderate heterogeneity. A red dashed line and the vertical line at one indicate the line of no effect. The plot favors the TENS treatment over EA to the left of the line. TENS vs. epidural analgesia Pain intensity in the first stage of labor

Low evidence (4 RCTs, 669 patients) showed that compared with epidural analgesia groups, parturients using TENS may have little to no difference in pain relief (WMD-0.22 cm, 95%CI-0.64 to-0.19 cm, modelled RD 0, 95%CI 0 to 0%; Table 3 and Figure 4) (28, 29, 36).

Grade evidence profile of TENS versus EA for first-stage labor analgesia.

No. of trials(No. of patients) Risk of bias Inconsistency Indirectness Imprecision Publication bias Treatment association (95% CI) Overall quality of evidence
Pain: 0 to 10 cm VAS for pain; lower is better; MID = 1 cm
4 (669) Serious a Serious, I2 = 75.33% Not serious Not serious NA Achieved at or above MID Low
TENS 99.9% Control 99.9%
Modelled RD 0.00 (0.00, 0.00)
WMD -0.22 cm (−0.64, 0.19 cm)
Duration of the first labor stage(minutes): shorter is better
8 (1,055) Serious a Serious, I2 = 65.53% Not serious Not serious Not serious WMD -62.22 min (−92.51, −31.94 min) Low
Adverse effects
3 (271) Serious a Not serious,I2 = 30.7% Not serious Serious b NA RR 0.37(0.12,1.14) Low

NA, not available. a, high risk of bias in blinding; b, small sample size.

TENS Parameters.

Study ID Frequency Stimulation site Device type Intensity Duration
Gao Y 2023(17) 2 Hz/100 Hz Bilateral Zusanli (ST36), Sanyinjiao (SP6), Hegu (LI4) Huatuo SDZ-II 15 mA Until the end of the second stage of labor
M. Movahedi 2022(64) 100 Hz Spinal nerve roots T10-L1 and S2-S4 Not specified 10–18 mA 30 min
Gao XX 2021(18) Self-adjusted Bilateral Hegu (LI4), median nerve 4 cm proximal to wrist crease; proximal to wrist crease; highest point of iliac crest to lumbar spinous process China Doule Group GT500 Series Seventh Generation Multi-functional DAOLE Doule Instrument Mild muscle tremor induced Self-adjusted usage time
Yan J 2021(19) Not specified Bilateral Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6) Not specified Gradually increased from 15 mA to obvious tremor 20 min/session, twice, 2-h interval, Stop when the cervix is fully dilated. M
A. Njogu 2021(20) Adjusted per tolerance Hegu (LI4), Neiguan (PC6), paravertebral regions T10-L1 and S2-S4 SRL998A Bio-feed TENS System Peak current: 15 mA From the onset of the active phase until the end of the second stage of labor
Lei FY 2021(21) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to slight muscle tremor and the pregnant woman’s tolerance level Until the end of the second stage of labor
Peng LL 2021(22) 2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to painless Every 2 h for 30 min, until active phase
Zhang XF 2020(23) Not specified T10-L1, S2-S4, Bilateral Hegu (LI4), Neiguan (PC6) Lebeier BTX-9800D labor analgesia instrument Start at 15 mA, increase to distinct tremor without pain Until full cervical dilation
Zhang LQ 2020(24) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) SRL998 Youbeibei A type labor monitoring analgesia instrument Start at 15 mA, increase to tolerable distinct tremor Until the end of labor
Li HY 2020(25) Not specified Bilateral Hegu (LI4), Neiguan (PC6); Qihaishu (BL24), Guanyuanshu (BL26) LABOUR-RI-Z TENS device Not specified Until entering the second stage
Huang JZ 2020(26) 40–80 Hz Bilateral Hegu (LI4), DaLing (PC8); Paravertebral region of lower back Lebeier labor analgesia instrument Frequency: 0–55 mA. Usually, during contractions it is 25–40 mA, and during the intervals between contractions it is 5–10 mA. Until full cervical dilation
Liu PP 2020(27) Not specified T10-L1, S1-S4 Fanlesheng non-invasive labor analgesia instrument 15–50 mA, to slight muscle tremor and the pregnant woman’s tolerance level Until the end of the second stage
Jiang DM 2020(28) Not specified Bilateral Hegu (LI4), Neiguan (PC6), T10–L1, L5–S4 Not specified Gradually increase to tolerance, stop at slight tremor Not specified
Huang LY 2019(29) 2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Not specified Start at 15 mA, increase to distinct tremor without pain and the pregnant woman’s tolerance level 30 min/session, 1 h interval, until active phase
Zhao ZP 2018(30) Not specified Both shoulders and lower back “Lucky Baby” low-frequency nerve and muscle stimulator It is advisable to use a mild tremor of the muscles and one that the pregnant woman can tolerate. Until the end of the second stage
A. Baez-Suarez 2018(62) 100 Hz (TENS1); 80–100 Hz (TENS2) Paravertebral regions T10–L1 and S2–S4 Cefar Rehab 2pro® TENS device Individually titrated 30 min/session, may be extended
Lu L 2018(31) 2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to distinct tremor without pain 30 min/session, 1 h interval, until active phase
Li L 2018(32) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to distinct tremor and one that the pregnant woman can tolerate. Until the end of the first stage
A. Nyambura 2017 (33) Not specified Bilateral Hegu (LI4), Neiguan (PC6); T10–L1, S2–S4 SRL998A labor monitoring analgesia instrument Initial <30 units, then adjusted to tolerance, throughout labor, intensity 30–60 units Until the end of labor
Liu J 2016(34) active phase: 100 Hz; incubation phase: 3–10–100 Hz T10–L1, S1–S4 KD-2A labor analgesia instrument Not specified 30 min/session, 2 h interval
2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6) KD-2A transcutaneous nerve stimulator Start at 15 mA, increase to distinct tremor without pain 20 min/session, 2 h interval, until full dilation
Xiao H 2015(35) 1–100 Hz adaptive Bilateral Hegu (LI4), Neiguan (PC6); T10–L1, L5–S4 Sanrui SRL998A biofeedback labor analgesia doula instrument Peak output ≤15 mA Not specified
Li J 2015(36) Not specified Bilateral Hegu (LI4), Neiguan (PC6); T10–L1, L5–S4 Not specified Increase to tolerance, slight tremor Not specified
2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6) KD-2A transcutaneous nerve stimulator Start at 15 mA, increase to distinct tremor without pain 20 min/session, 2 h interval, until full dilation
Cai XL 2015(37) Not specified Bilateral Hegu (LI4), median nerve 4 cm proximal to wrist crease; proximal to wrist crease; T10 (3 cm away from the left and right sides of the spine),5 cm vertically downward from the front side. Not specified Adjust to slight muscle tremor and tolerance Stop after the second stage of labor or before a cesarean section; stop after the second stage of labor and before switching to a cesarean section to terminate natural childbirth
2 Hz/100 Hz Jiaji points (T10–L3), Ciliao points (S2–S4) Han’s Acupoint Nerve Stimulator 15 ~ 25 mA Once per hour for 30 min
Xiao H 2015(38) 2 Hz/100 Hz Bilateral Hegu (LI4), Zhiyang (GV9, between T7-T8), Jizhong (GV6, between T11-T12) Han’s Acupoint Nerve Stimulator Hegu 8–12 mA, Back points 15–25 mA Once per hour for 30 min
Li HY 2012(39) Not specified Bilateral Hegu (LI4), Neiguan (PC6), Shangliao (BL31), Ciliao (BL32), Zhongliao (BL33), Xialiao (BL34) Not specified Adjust to tolerance every 10 min Until the end of delivery
Xu MJ 2006 (40) 2–100 Hz dense-dispersed wave Jiaji points (T10–L1, L2 3 centimeters lateral to both sides of the spine), Ciliao points (S2–S4 offset 3 cm to the side) Electronic acupuncture stimulator (Suzhou Medical Supplies Co., Ltd.) 15–30 mA, up to maximum tolerance Once per hour for 30 min, until the end of the second stage
2/100 Hz Bilateral Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6) Han’s Acupoint Nerve Stimulator 10–20 mA, to tolerance limit Once per hour for 30 min, until delivery ends
Su XJ 2001(41) Not specified Bilateral Tianzong (SI11), Shenshu (BL23), Sanjiaoshu (BL22), Jianjing (GB21) Fanke P0-9632 multifunctional electrotherapy apparatus Adjust clockwise to tolerance Until the end of delivery
Yang X 2021(42) 2 Hz Bilateral Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6) Huatuo brand electronic acupuncture stimulator Start at 15 mA, increase to distinct tremor without pain 20 min/session, 2 h interval, until placental delivery
An ZZ 2015(43) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Not specified Slowly increase to mild numbness/prickling 30 min/session, 2 h interval, until full dilation
Cao JG 2025(44) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6) Not specified 15–30 mA Once per hour for 30 min, until 3 cm dilation
Wang L 2019(45) 2 Hz Bilateral Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to distinct tremor without pain 20 min/session, 2 h interval, until the end of the second stage
Xu JH 2022(46) 2 Hz/100 Hz Bilateral Hegu (LI4), Neiguan (PC6); Jiaji (T10–L1 3 centimeters lateral to both sides of the spine), Ciliao (S2–S4) SRL998K fetal monitor/neuromuscular stimulator 15–50 mA, manual or auto adjustment Not specified
Song KK 2023(47) 2 Hz Bilateral Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6) Huatuo brand SDZ-II electronic acupuncture stimulator 15–25 mA, increase to distinct tremor 20 min/session, 2 h interval, until the end of the second stage
He J 2020(48) Hand: 10–30 Hz; Back: 20–40 Hz Bilateral Hegu (LI4), Neiguan (PC6) (hands); Bilateral Shenshu (BL23), Sanjiaoshu (BL22), Eight Liao points (back) SRL998A nerve and muscle stimulator Hand: 6–20 mA; Back: 7–26 mA Until the end of delivery
Ma ZH 2018(49) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Not specified Start at 15 mA, increase to tolerable distinct tremor Until fetal delivery
Miao WJ 2020 (50) Not specified Jiaji points (T10–L3 3 cm lateral to the spine (bilaterally).), Ciliao points (S2–S4 3 cm lateral to the spine (bilaterally).) Korean-style nerve electrical stimulation analgesic device (HA NS) Gradually increase to maximum tolerance Not specified
Meng LK 2020(51) 2 Hz/100 Hz Jiaji points (T10–L3), Ciliao (BL32) Korean-style nerve electrical stimulation analgesic device (HA NS) 15–30 mA 30 min/session
Han CP 2021(52) Not specified Back: T10–L1, L5–S4; Hands: Bilateral Hegu (LI4), Neiguan (PC6) SRL998A neuromuscular stimulator Back: 30–70, Hand: 30–50 (units not specified) From 3 cm to 10 cm cervical dilation
Zhao KL 2024(53) Hand: 6–20 mA; Back: 20–40 Hz Bilateral Hegu (LI4), Neiguan (PC6), Quchi (LI11) (hands); The horizontal line at the waist is the apex of the gluteal cleft, and the vertical axis is the spine. Not specified Hand: 6–20 mA, Back: 20–40 Hz Until the end of delivery
Shi J 2002(54) Not specified Bilateral Hegu (LI4), Neiguan (PC6) (hands); T10–L1 (spine) Lebeier labor analgesia instrument Start at 15 mA, increase to muscle tremor without pain Until full cervical dilation
Niu CY 2017(65) 2 Hz/100 Hz Bilateral Hegu (LI4), Zusanli (ST36) Not specified Start at 15 mA, increase to distinct tremor without pain 30 min/session, 1 h interval, until full dilation
Liu Ye 2015(55) 2 Hz/100 Hz Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6) Not specified Start at 15 mA, increase to tolerable distinct tremor, ≤30 mA Once per hour for 30 min, until fetal delivery
2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Not specified Start at 15 mA, increase to tolerable distinct tremor Until the end of the first stage
QianJ 2025(56) 100 Hz (TENS1); 80–100 Hz (TENS2) Paravertebral regions T10–L1 and S2–S4 Cefar Rehab 2pro® TENS device Not specified 30 min/session
Miao Y 2025(57) 100 Hz 1 cm lateral to the spine (bilaterally). T10–L1 and S2–S4 Portable TENS unit Individually titrated 30 min/session
Xu J 2024(58) 2–4 Hz (Phase 1:until 8 cm dilation.); 100 Hz (Phase 2 until delivery end) Phase 1(the cervix has dilated to 4 centimeters.): Sanyinjiao (SP6) Neiguan (PC6) (right hands); Phase 2(8 cm dilation to delivery end)Bilateral Hegu (LI4), Shenmen(HT7) Portable TENS device Gradually increase to tolerance Until the end of delivery
Shi XL 2024(59) 50 Hz (continuous); 2 Hz (burst) Paravertebral regions T10–L1 and S2–S4 Not specified Not specified Until the end of delivery
100 Hz Spinal nerve roots T10-L1 and S2-S4 Not specified 10–18 mA 30 min
Huang XZ 2019(66) Self-adjusted Bilateral Hegu (LI4), median nerve 4 cm proximal to wrist crease; proximal to wrist crease; highest point of iliac crest to lumbar spinous process China Doule Group GT500 Series Seventh Generation Multi-functional DAOLE Doule Instrument Mild muscle tremor induced Self-adjusted usage time
R. Sulu 2022(61) Not specified Bilateral Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6) Not specified Gradually increased from 15 mA to obvious tremor 20 min/session, twice, 2-h interval, Stop when the cervix is fully dilated. M
Santana, L. S.2016(60) Adjusted per tolerance Hegu (LI4), Neiguan (PC6), paravertebral regions T10-L1 and S2-S4 SRL998A Bio-feed TENS System Peak current: 15 mA From the onset of the active phase until the end of the second stage of labor
Zahra MEHRI 2022(67) 2 Hz/100 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to slight muscle tremor and the pregnant woman’s tolerance level Until the end of the second stage of labor
V. Rashtchi 2022(68) 2 Hz Bilateral Hegu (LI4), Sanyinjiao (SP6), Zusanli (ST36) Huatuo brand SDZ-II electronic acupuncture stimulator Start at 15 mA, increase to painless Every 2 h for 30 min, until active phase

The pain intensity measured by the 10 cm VAS during the first stage of labor with TENS analgesia was compared to epidural analgesia.

Forest plot displaying the results of four studies comparing treatment and control groups with mean differences and 95% confidence intervals. Studies are Jiang DM 2020, Huang LY 2019, Li J 2015, and Shi XL 2024. Squares represent individual study effects, with a diamond showing overall effect size. Statistical data includes heterogeneity and significance tests, indicating no significant difference favoring either TENS or EA. Duration of the first stage of labor

Low evidence (8 RCTs, 1,055 patients) reported that compared with epidural analgesia groups, parturients using TENS may shorten the duration of the first stage of labor (WMD-62.22 min, 95%CI –92.51 to −31.94 min; Table 3 and Figure 5) (28, 29, 34, 36, 37, 50, 54, 55, 57, 59).

The duration of the first stage of labor with TENS analgesia was compared to epidural analgesia.

Forest plot from a meta-analysis comparing two treatments, TENS and EA. The plot includes data from eight studies with mean differences favoring TENS. Studies' treatments and controls show means, standard deviations, and weights. The overall effect size is negative, indicating TENS is favored over EA. Heterogeneity metrics and statistical tests are provided below the plot. Adverse effects

Low evidence (3 RCTs, 271 patients) suggests that compared with epidural analgesia groups, parturients using TENS may be little to no difference in adverse effects (RR 0.37, 95%CI 0.12 to 1.14; Table 3 and Figure 6) (49, 50, 55).

Adverse events among parturients during the first stage of labor who received TENS versus epidural analgesia.

Forest plot showing a meta-analysis of three studies comparing TENS and EA treatments. Each study is represented by a blue square on a horizontal line indicating the risk ratio (RR) and confidence interval. Ma ZH 2018 shows RR 1.00, Miao WJ 2020 shows RR 0.14, and Liu Ye 2015 shows RR 0.50. The overall effect size, represented by a diamond, is RR 0.37. Weights and confidence intervals vary, with the total weight at 100%. The x-axis ranges from 0.0332 to 30.1, with a red dashed line at the null value of 1. Discussion Overall findings

Low-quality evidence suggests that TENS may reduce pain intensity in the first stage of labor compared with sham treatment. When compared with epidural analgesia, TENS may shorten the duration of the first stage; however, no significant differences were observed in analgesic efficacy or the incidence of adverse effects.

 Relations to other reviews

Despite four prior syntheses (75 trials total), one article was included. None of the studies exceeded 32 RCTs threshold surpassed by our 51-trial inclusion. The application of GRADE methodology in this review (absent in 75% of predecessors) provides critical evidence-level stratification.

 Strengths and limitations

The primary strength of this review lies in its comprehensive consideration of two critical concerns during childbirth: effective pain management and labor duration reduction. However, several methodological limitations should be acknowledged, particularly concerning the elevated risk of bias in allocation concealment and blinding procedures.

 Implications

This review holds significant clinical value by demonstrating that transcutaneous electrical nerve stimulation (TENS) serves as a viable alternative analgesic option for parturients who wish to avoid epidural analgesia during labor. Compared with no analgesic intervention, TENS has a pronounced pain-relieving effect. From a research perspective, our findings underscore the necessity for future clinical trials to optimize methodological rigor, particularly in allocation concealment and blinding procedures, to minimize potential bias.

 Conclusion

In this systematic review and meta-analysis of randomized controlled trials on analgesia during the first stage of labor, low-certainty evidence suggests that, Compared with the blank control, TENS may reduce pain intensity and shorten the duration of the first stage of labor in parturients, with little to no difference in adverse events. Compared with epidural analgesia, TENS may shorten the duration of the first stage of labor, with no statistically significant differences observed in analgesic efficacy or adverse effects.

In summary, the current low-certainty evidence suggests that TENS may offer potential benefits for analgesia during the first stage of labor. However, to generate high-quality evidence applicable to clinical practice, there is an urgent need for future large-scale, methodologically rigorous randomized controlled trials that employ adequate randomization and blinding, utilize standardized intervention protocols, and report core clinical outcomes.

 Data availability statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary material.

 Author contributions

Z-YH: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. JT: Data curation, Resources, Software, Writing – review & editing. X-XL: Data curation, Formal analysis, Software, Writing – review & editing. D-NY: Data curation, Formal analysis, Software, Writing – review & editing. Z-YC: Data curation, Resources, Writing – review & editing. Y-QL: Data curation, Formal analysis, Writing – review & editing. W-BM: Data curation, Writing – review & editing. LL: Conceptualization, Methodology, Supervision, Writing – review & editing.

 Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Generative AI statement

The author(s) declared that Generative AI was not used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

 Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2026.1730360/full#supplementary-material

 References ShiMCFX HouJJ MaX ZhouCX. Application progress of appropriate traditional Chinese medicine techniques in pain management during labor. J Nurs Sci. (2024) 39:20–4. doi: 10.3870/j.issn.1001-4152.2024.12.020 ZhangMZG. Research Progress on the clinical application of labor analgesia. Jiangsu Medical J. (2020) 46:956–60. doi: 10.19460/j.cnki.0253-3685.2020.09.025 GuYYXF LiZZ ZhangGY GuCY. Transcutaneous electrical nerve stimulation for reducing labor pain in women undergoing trial of labor: a Meta-analysis. Chin. J. Women Child. Health. (2024) 15:63–72. doi: 10.19757/j.cnki.issn1674-7763.2024.06.010 NancyK LoweP. The nature of labor pain. Am J Obstet Gynecol. (2002) MoherD LiberatiA TetzlaffJ AltmanDG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. (2009) 6:e1000097. doi: 10.1371/journal.pmed.1000097, 19621072 YanW KanZ YinJ MaY. Efficacy and safety of transcutaneous electrical Acupoint stimulation (TEAS) as An analgesic intervention for labor pain: a network Meta-analysis of randomized controlled trials. Pain Ther. (2023) 12:631–44. doi: 10.1007/s40122-023-00496-z, 36934401 YanSX. Impact of epidural analgesia versus transcutaneous neuromuscular electrical stimulation on pregnancy and labor outcomes: A meta-analysis. Lanzhou University. (2019) ThuvarakanK ZimmermannH MikkelsenMK GazeraniP. Transcutaneous electrical nerve stimulation as a pain-relieving approach in labor pain: a systematic review and Meta-analysis of randomized controlled trials. Neuromodulation. (2020) 23:732–46. doi: 10.1111/ner.13221, 32691942 MelilloA MaioranoP RachediS CaggianeseG GragnanoE GalloL . Labor analgesia: a systematic review and Meta-analysis of non-pharmacological complementary and alternative approaches to pain during first stage of labor. Crit Rev Eukaryot Gene Expr. (2022) 32:61–89. doi: 10.1615/CritRevEukaryotGeneExpr.2021039986, 35381132 HigginsJP AltmanDG GøtzschePC JüniP MoherD OxmanAD . The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. (2011) 343:d5928. doi: 10.1136/bmj.d5928, 22008217 AklEA SunX BusseJW JohnstonBC BrielM MullaS . Specific instructions for estimating unclearly reported blinding status in randomized trials were reliable and valid. J Clin Epidemiol. (2012) 65:262–7. doi: 10.1016/j.jclinepi.2011.04.015, 22200346 ThorlundK WalterSD JohnstonBC FurukawaTA GuyattGH. Pooling health-related quality of life outcomes in meta-analysis-a tutorial and review of methods for enhancing interpretability. Res Synth Methods. (2011) 2:188–203. doi: 10.1002/jrsm.46, 26061786 SantessoN GlentonC DahmP GarnerP AklEA AlperB . GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions. J Clin Epidemiol. (2020) 119:126–35. doi: 10.1016/j.jclinepi.2019.10.014, 31711912 WangY DevjiT Carrasco-LabraA KingMT TerluinB TerweeCB . A step-by-step approach for selecting an optimal minimal important difference. BMJ. (2023) 381:e073822. doi: 10.1136/bmj-2022-073822, 37236647 PageMJ HJ SterneJ. Chapter 13: Assessing risk of bias due to missing results in a synthesis. Cochrane Handbook for Systematic Reviews of Interventions version 64 (2023). GuyattGH OxmanAD VistGE KunzR Falck-YtterY Alonso-CoelloP . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. (2008) 336:924–6. doi: 10.1136/bmj.39489.470347.AD, 18436948 GaoY. Effect of transcutaneous low-frequency electrical stimulation combined with doula support on labor analgesia and outcomes in Primiparas. Lab Med Clin. (2023) 20:3514–7. doi: 10.3969/j.issn.1672-9455.2023.23.023 GaoXSX GuoY LinL HanJX HuangM. Impact of low-frequency electrical nerve and muscle stimulation on labor Progress, delivery mode, and maternal-neonatal outcomes: An analysis. Progress Modern Biomed. (2021) 21:248–53. doi: 10.13241/j.cnki.pmb.2021.02.011 YanJSY. Effects of combined transcutaneous electrical nerve stimulation and epidural block for labor analgesia on maternal pain neurotransmitters, inflammatory cytokines, and stress factors. Maternal Child Health Care China. (2021) 36:955–8. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.04.071 NjoguA QinS ChenY HuL LuoY. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth. (2021) 21:164. doi: 10.1186/s12884-021-03625-8, 33627077 LeiFYSJ BiSJ WangDM HanHJ ZhengDY YuMJ. Efficacy and safety of transcutaneous electrical nerve stimulation combined with a birthing ball for labor analgesia: An investigation. Sichuan. J Tradit Chin Med. (2021) 39 PengLLLH CaiMY WangY ZhaoY QiDM LuoCR. Effects of combined transcutaneous electrical nerve stimulation and epidural block on pain neurotransmitters, inflammatory factors, and stress response in Parturients undergoing labor analgesia. J Clin Experiment Med. (2021) 20:1760–3. doi: 10.3969/j.issn.1671–4695.2021.16.022 ZhangXF. Efficacy of transcutaneous electrical nerve stimulation combined with intradermal sterile water injections for labor analgesia in Parturients: a study. Contemp Med Symp. (2020) 18:92–93. ZhangLQ. Application of transcutaneous electrical nerve stimulation in labor analgesia: a study. China Continu Med Educ. (2020) 12:120–2. doi: 10.3969/j.issn.1674-9308.2020.19.051 LiHYCP ChenH XuJ. Evaluation of two analgesic interventions in doula-assisted delivery. Prev Med. (2020) 32:778–81. doi: 10.19485/j.cnki.issn2096-5087.2020.08.005 HuangJZSLLiJS WangZH. Impact and safety analysis of combined electrical stimulation and doula analgesia on labor outcomes. J Binzhou Med Univers. (2020) 43:420–2. doi: 10.19739/j.cnki.issn1001-9510.2020.06.006 LiuPPLJ ZhaoYQ ZhangS WangL. Effects of transcutaneous electrical nerve stimulation combined with birthing ball on labor Progress, labor pain, and analgesic drug utilization. Shanghai J Acupunct Moxibust. (2020) 39:47–52. doi: 10.13460/j.issn.1005-0957.2020.01.0047 JiangDMSH LaiXT WangL LiuJH. Clinical application of doula support combined with transcutaneous electrical nerve stimulation in labor. Med Innov China. (2020) 17. doi: 10.3969/j.issn.1674-4985.2020.29.031 HuangLYSP. Impact of full-course multimodal labor analgesia on maternal and neonatal safety. Maternal Child Health Care China. (2019) 34:5134–5137. doi: 10.7620/zgfybj.j.issn.1001-4411.2019.22.19 ZhaoZPQL LeiZW. Efficacy of Lamaze breathing combined with transcutaneous low-frequency electrical stimulation for labor analgesia and its impact on maternal-infant safety. Nurs Res. (2018) 32:3801–4. doi: 10.12102/j.issn.1009-6493.2018.23.041 LyuNLY LiL. Safety and efficacy of transcutaneous electrical nerve stimulation combined with epidural block for full-course labor analgesia. China Medical Herald. (2018) 15:94–97. LiLLY ZhaiXJ WangB CuiHY. Clinical study of transcutaneous electrical nerve stimulation for labor analgesia. Int J Obstetrics Gynecol. (2018) 45:37–40. NyamburaA. Application of transcutaneous electrical nerve stimulation therapy for pain relief during the first stage of labor. Hunan Normal University. (2020) LiuJQD TanX ZuoL QinJJ LiRM. Efficacy observation of transcutaneous electrical nerve stimulation for labor analgesia. J Jinan Univ. (2016) 37:416–9. doi: 10.11778/j.jdxb.2016.05012 XiaoHWJ WuMX. Adverse reactions assessment of combined electrical stimulation and epidural labor analgesia. (Natural Science & Medicine Edition). J Jinan Univ. (2015) 28:26. doi: 10.3969/j.issn.1006-1959.2015.11.032 LiJYY. Study on biofeedback-based transcutaneous electrical stimulation for analgesia in natural childbirth. Shanxi Med J. (2015) 44:2113–5. CaiXLLD YaoJY YuanYQ FengM JiangM. Impact of two analgesic modalities (transcutaneous electrical nerve stimulation and epidural anesthesia) under doula assistance on maternal delivery outcomes. Chin Foreign Med Res. (2015) 13:23–5. doi: 10.14033/j.cnki.cfmr.2015.24.013 XiaoHWJ KongJQ LiYQ. Clinical study of transcutaneous electrical nerve stimulation combined with epidural labor analgesia. J Clin Anesthesiol. (2014) 30:745–7. LiHYWZ WangF XuXF. Efficacy observation of transcutaneous electrical nerve stimulation for labor analgesia. Nurs Rehabil. (2012) 11:1140–1. XuMJZG ChenL ZhangJY. Clinical study of HANS-assisted PCEA for Labor Analgesia. In: Peking University-Harvard Anesthesia and Pain Therapy Symposium (2006) 3 Beijing, China SuXJAJ. Clinical observation and evaluation of Han's Acupoint nerve stimulator (HANS) for labor analgesia. Chin J Pain Med. (2001) 2:89–93. YangXCJ HuLH. Effects of electrical stimulation at Hegu, Neiguan, and lumbosacral Acupoints on labor pain and duration in Parturients. Guangming J Chin Med. (2021) 36:2592–4. doi: 10.3969/j.issn.1003-8914.2021.15.043 AnZZYZ TongB ZhangYQ. Study on transcutaneous Acupoint electrical stimulation (TEAS) combined with Dexmedetomidine for labor analgesia. Shaanxi J Trad Chin Med. (2015) 36:1410–1. CaoJGZL WangYF LiSH LuoW WangCS. Effect of transcutaneous Acupoint electrical stimulation on intrapartum fever in Parturients receiving epidural labor analgesia. J Clin Anesthesiol. (2025) 41:36–39. doi: 10.12089/jca.2025.01.007 WangLLP. Effect of transcutaneous Acupoint electrical stimulation on labor pain perception in Primiparas undergoing natural childbirth. Electron J Pract Clin Nurs Sci. (2019) 4:30–1. XuJH XiongDD. Impact of transcutaneous Acupoint electrical stimulation-assisted remifentanil full-course intravenous labor analgesia on mother and infant. Pract Clin J Integrated Trad Chin Western Med. (2022) 22:6–9+13. doi: 10.13638/j.issn.1671-4040.2022.14.002 SongKKYT YangL KongZD WangQ GaoW. Clinical efficacy of transcutaneous Acupoint electrical stimulation combined with epidural anesthesia for labor analgesia. Chongqing Med. (2023) 52:3133–6+41. HeJWH ZhangRH. Application of transcutaneous Acupoint electrical stimulation combined with epidural block in painless labor and its impact on delivery outcomes. Shanghai J Acupunct Moxibust. (2020) 39:1269–73. doi: 10.13460/j.issn.1005-0957.2020.10.1269 MaZHYF ZhaoYY JiaoBJ QuM MaoSH. Clinical study of transcutaneous Acupoint electrical stimulation combined with remifentanil for labor analgesia. Shanghai J Acupunct Moxibust. (2018) 37:526–30. doi: 10.13460/j.issn.1005-0957.2018.05.0526 MiaoWJ QiWH LiuH. Role of Transcutaneous Acupoint Electrical Stimulation in Labor Analgesia. Chinese acupuncture and moxibustion. (2020) 40:615–618, 628. doi: 10.13703/j.0255-2930.20190824-0001 MengLKWM. Analgesic efficacy of Acupoint electrical stimulation combined with remifentanil PCIA for labor analgesia and its effect on peripheral blood β-endorphin levels. Psychol Monthly. (2020) 15:41+3. doi: 10.19738/j.cnki.psy.2020.01.028 HanCPXW XieQY. Comparison of analgesic efficacy between Acupoint electrical stimulation and Neuraxial anesthesia in multiparous women during labor. J Minimal Invasive Med. (2021) 16:51–3+62. doi: 10.11864/j.issn.1673.2021.01.11 ZhaoKLML LiY CuiC YangR ZhangL LiXY . Efficacy of combined epidural labor analgesia and transcutaneous Acupoint electrical stimulation in Primiparous women undergoing vaginal delivery. J Women and Children's Health Guide. (2024) 3 ShiJWZ. Efficacy observation of analgesia device combined with tramadol and psychological nursing for labor analgesia. Nurs Res. (2002) 4:210–2. doi: 10.3969/j.issn.1009-6493.2002.04.014 LiuY XuM CheX HeJ GuoD ZhaoG . Effect of direct current pulse stimulating acupoints of JiaJi (T10-13) and Ciliao (BL 32) with Han's Acupoint nerve stimulator on labour pain in women: a randomized controlled clinical study. J Tradit Chin Med. (2015) 35:620–5. doi: 10.1016/s0254-6272(15)30149-7, 26742304 QianJCF WangYX YinMQ ZhuXQ. Application of transcutaneous electrical nerve stimulation in labor analgesia and its impact on maternal pain scores. Chin Sci J Database Med Health. (2025):57–60. MiaoYLX ZhangX LiGL. Efficacy observation of epidural block anesthesia versus transcutaneous electrical nerve stimulation for painless delivery. J Bengbu Med Univ. (2025) 50:630–633. doi: 10.13898/j.cnki.issn.2097-5252.2025.05.015 XuJXM LyuF ZhangN. Clinical observation of transcutaneous electrical nerve stimulation combined with epidural labor analgesia. China Med Herald. (2024) 21. doi: 10.2004/j.issn.1673-7210.2024.28.26 ShiXLLL ShenT GaoY. Efficacy of transcutaneous Acupoint electrical stimulation combined with continuous epidural anesthesia for labor analgesia in Primiparas. Pract Clin Med. (2024) 25:68–72. doi: 10.13764/j.cnki.lcsy.2024.04.018 SantanaLS GalloRBS FerreiraCHJ DuarteG QuintanaSM MarcolinAC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. (2016) 62:29–34. doi: 10.1016/j.jphys.2015.11.002, 26701166 SuluR AkbasM CetinerS. Effects of transcutaneous electrical nerve stimulation applied at different frequencies during labor on hormone levels, labor pain perception, and anxiety: a randomized placebo-controlled single-blind clinical trial. Eur J Integr Med. (2022) 52:102–124. doi: 10.1016/j.eujim.2022.102124 Báez-SuárezA Martín-CastilloE García-AndújarJ García-HernándezJ Quintana-MontesdeocaMP Loro-FerrerJF. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials. (2018) 19:652. doi: 10.1186/s13063-018-3036-2, 30477529 MehriZ MoafiF AlizadehA HabibiM RanjkeshF. Effect of acupuncture-like transcutaneous electrical nerve stimulation on labor pain in nulliparous women: a randomized controlled trial [J]. J Acu Tuina Sci. (2022) 20:376–382. doi: 10.1007/s11726-022-1298-4 MovahediM EbrahimianM SaeedyM TavoosiN. Comparative study of transcutaneous electrical nerve stimulation, the aromatherapy of Lavandula and physiologic delivery without medication on the neonatal and maternal outcome of patients. Int J Physiol Pathophysiol Pharmacol. (2022) 14:206–10. doi: 10.1007/s11726-022-1298-4 35891935 NiuCYTF KongXL YangHH. Application of low-frequency pulse electrical stimulation combined with traditional Chinese medicine Meridian theory in labor analgesia: a study. Chin J Mater Child Health Res. (2017) 28:43–4. HXZ. Clinical study of transcutaneous electrical nerve stimulation for labor analgesia. J Pract Med Techniq. (2019) 26:328–30. doi: 10.19522/j.cnki.1671-5098.2019.03.032 RanjkeshZMA. Effect of acupuncture-like transcutaneous electrical nerve stimulation on labor pain in nulliparous women:a randomized controlled trial. J Acupunct Tuina Sci. (2022) 20:376–82. doi: 10.1007/s11726-022-1298-4 RashtchiV MaryamiN MolaeiB. Comparison of entonox and transcutaneous electrical nerve stimulation (TENS) in labor pain: a randomized clinical trial study. J Maternal-Fetal Neonatal Med. (2022) 35:3124–8. doi: 10.1080/14767058.2020.1813706, 32862743

Edited by: Mattia Dominoni, San Matteo Hospital Foundation (IRCCS), Italy

Reviewed by: John Mitchell, CHU UCL Namur Site Godinne, Belgium

Cansu Kılınç Berktaş, University of Health Sciences, Türkiye