Massage is the oldest tactile stimulation method which implements systematic hand techniques on soft tissue, muscles, tendons, ligaments and fascia with the application of oil to reduce friction on the skin. The aim of the study was to investigate the effect of low back massage in the first stage of labor on pain severity, anxiety, labor duration and satisfaction among nulliparous women. Study design: Intervention study. Setting: labor ward of labor and preterm infants' hospital, Zagazig university hospitals. Study subjects: A purposive sample of 200 parturient women equally divided into two groups: massage group and control group. Tools of data collection: two main tools: general characteristics record and labor record which entailed four parts; Visual analogue scale, Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL),Duration of the first stage of labor and Six simple questions (SSQ) questionnaire of satisfaction with care during childbirth. Results: The mean pain score at cervical dilatation 4cm, 8cm & 10 cm was significantly lower in the massage group compared to the control group, P = 0.001, 0.001, 0.021 respectively. Significantly lower mean of anxiety score in the massage group than the control group 19.48±2.54 VS. 28.94±2.91 respectively, P= 0.031. A significantly higher percentage of women in the massage group was highly satisfied (61.0%) with a mean score of satisfaction 29.67±5.44 compared to 9.0% in the control group with a mean score of satisfaction 23.96±5.18, P = 0.001. Conclusion: low back massage performed to nulliparous women in the first stage of labor, significantly reduced the score of visual analogue scale of pain severity all over the three phases of the first stage of labor, also significantly reduced anxiety throughout labor and significantly increased nulliparous satisfaction with the process of labor. However, it didn't affect the duration of the first stage of labor. Recommendations: Nurses working in labor wards should be encouraged to perform back massage for laboring women as a routine care during first stage of labor as it would change the delivery process into a desirable experience with no harmful effects on mother or fetus. Key words: low back massage, pain severity, anxiety, labor duration, satisfaction