Objective To systematically evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on labor pain among women undergoing vaginal trial of labor.

Methods Databases including PubMed, Embase, CINAHL, Cochrane Library, Web of Science, JB, CNKI, Wanfang, VIP and SinoMed were searched for randomized controlled trials on TENS for labor pain relief from the inception to January 2^nd, 2024. Two reviewers screened studies, extracted data, and assessed risk of bias independently. Meta-analysis was conducted through RevMan 5.4.

Results A total of 32 studies with 4 584 subjects were recruited. Met-analysis showed that TENS reduced Visual Analogue Scale (VAS) pain scores (MD = − 0.82, 95% CI: − 1.07 ~ − 0.58, P < 0.001), labor duration (SMD = − 0.50, 95% CI: − 0.64 ~ − 0.36, P < 0.001) and cesarean section rate (RR = 0.51, 95% CI: 0.40 ~ 0.66, P < 0.001) compared to control group. While no significant differences were found in instrumental delivery rates (RR = 1.3, 95% CI: 0.80 ~ 2.11, P = 0.30) and 1-minute Apgar scores (MD = − 0.02, 95% CI: − 0.09 ~ 0.06, P = 0.14) between the two groups.

Conclusion TENS can reduce labor pain in the first stage of labour, shorten labor process, and decrease intrapartum cesarean rate. But the result of this study may be biased limited by the quality of these researches. Further high-quality randomized controlled trials are needed to confirm these findings and standardize TENS implementation techniques.