<![CDATA[Background: Labor pain is a physiological response caused by uterine contractions, cervical dilatation, and fetal descent during childbirth. During the active phase of the first stage of labor, pain intensity increases along with stronger and more frequent uterine contractions. Uncontrolled pain may increase maternal anxiety, stimulate catecholamine release, inhibit effective uterine contractions, prolong labor, and reduce maternal comfort. Non-pharmacological approaches such as breathing relaxation techniques and endorphin massage have been widely used to reduce labor pain. The combination of these interventions is expected to enhance endorphin release, promote muscle relaxation, decrease pain perception, and improve maternal comfort. Objective: To analyze the effect of breathing relaxation techniques and endorphin massage on reducing labor pain intensity during the active phase of the first stage of labor. Methods: A quasi-experimental pretest–posttest with control group design was conducted among 60 women in the active phase of the first stage of labor. Participants were allocated into an intervention group (n=30) and a control group (n=30). The intervention group received breathing relaxation techniques combined with endorphin massage, while the control group received standard maternity care. Pain intensity was assessed using the Numeric Rating Scale (NRS) before and after the intervention. Data were analyzed using the Shapiro–Wilk test, paired t-test, independent t-test, and ANCOVA with a 95% confidence level. Results: The mean pain intensity score in the intervention group significantly decreased from 7.63 ± 0.89 to 4.87 ± 0.93 (p<0.001), whereas no significant reduction was observed in the control group. The decrease in pain intensity was significantly greater in the intervention group than in the control group (p<0.001). ANCOVA demonstrated that the combination of breathing relaxation and endorphin massage significantly influenced pain reduction after adjustment for age, parity, and educational level. Conclusion: Breathing relaxation techniques combined with endorphin massage effectively reduce labor pain intensity during the active phase of the first stage of labor. This intervention can be integrated into comprehensive midwifery care to improve maternal comfort during childbirth.]]>
