Inclusion Criteria:  18 - 45 years old, Physical status American society of anesthesiology (ASA) II, Singleton, Vertex fetuses at 37-41 weeks' gestation, Nulliparous and multiparous women, Immediately before epidural placement, subjects marked a VNRS score during an active contraction and parturients with VNRS ≥ 50 were included Cervical dilatation < 5 cm  Exclusion Criteria:  Contraindications to regional anesthesia Refuse to participate No pain Severe systemic disease (kidney, liver, pulmonary, endocrine, cardiac) Conditions associated with an increased risk of a cesarean delivery (i.e., history of uterine anomaly or surgery) and vaginal birth after cesarean delivery