Background The evolving nature of patient concerns during pregnancy and delivery, including labor pain, plays a key role in guiding antenatal counseling about labor and delivery, but the timing of these concerns has not been well characterized. Understanding when labor pain becomes a prominent concern for pregnant patients can inform the timing of antenatal education about labor analgesia.

Objective This study aimed to determine how labor pain ranks among pregnancy-related concerns identified by nulliparous pregnant patients and how the relative prominence of these concerns changes across gestation.

Method We conducted a prospective, single-center longitudinal cohort study of 53 English-speaking, nulliparous patients. Participants ranked their top seven concerns from a list of 13 pregnancy-related concerns, including labor pain, at 20, 24-, 28-, 32-, and 36-weeks’ gestation. Rankings were scored from 1 (lowest-ranked concern) to 7 (highest-ranked concern), with the six unranked concerns assigned a score of zero. Changes in labor pain concern scores over time were assessed using linear mixed-effects models, adjusting for maternal characteristics and pregnancy- and fetal-related complications.

Results The score for concern about labor pain management increased with advancing gestational age, with mean adjusted rank scores increasing from 1.4 at 20 weeks to 3.8 at 36 weeks (P < 0.001). No demographic or clinical covariates were significantly associated with labor pain score. Peak scores were most commonly reported at 28- and 36-weeks’ gestation.

Discussion While labor pain became a greater salient concern along pregnancy, for some nulliparous patients, concern about labor pain arose as early as 20th week gestation, with significant individual variation in the timing of these concerns.

Conflicts of Interest/Competing Interest: Dr. Alexander Butwick received honorarium from Edwards Lifesciences for consulting work.

This study did not receive any funding

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Ethics committee/IRB of University of California San Francisco gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors