title: Labor pain at the time of epidural analgesia and mode of delivery in nulliparous women presenting for an induction of labor.
abstract: OBJECTIVE
  To assess whether the degree of labor pain at the initiation of neuraxial analgesia is associated with mode of delivery.
  
  
  METHODS
  Nulliparous women who presented to the labor department for an induction of labor, who were between 37 and 41 weeks of gestation, and who requested labor epidural analgesia with a pain score of 0-3 (low pain) and a cervical dilatation less than 4 cm were assessed retrospectively. Maternal and neonatal outcome including mode of delivery and duration of labor were compared with a similar group of women with pain scores of 4-6 (moderate pain), and 7-10 (severe pain). Assessing whether there was an association between pain level at the time of epidural and operative delivery rates was analyzed using a chi test for trend and by logistic regression to include potentially relevant covariates.
  
  
  RESULTS
  We found 185 nulliparous women with low pain and compared them with a randomly selected equal number of women in each of the other pain groups. There was no significant association between pain groups in terms of duration of the first or second stage of labor or mode of delivery. Women with low pain had an operative delivery rate (instrumental assisted vaginal delivery plus cesarean delivery) of 49%, compared with 45% and 45% in those with moderate and severe pain, respectively (P=.40).
  
  
  CONCLUSIONS
  We did not find an association between the degree of labor pain at initiation of epidural analgesia and mode of delivery or duration of labor.
  
  
  METHODS
  II.
authors.affiliation: From the Departments of Anesthesiology and Obstetrics, Gynecology & Reproductive Sciences, Mount Sinai School of Medicine of New York University, New York, New York.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Beilin
authors.forename: Diana
authors.initials: D
authors.lastname: Mungall
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D002585:Cesarean Section; D005113:Extraction, Obstetrical; D005260:Female; D006801:Humans; D048949:Labor Pain; D007751:Labor, Induced; D008875:Middle Aged; D010147:Pain Measurement; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult