Epidural, Combined Spinal-Epidural, and more recently dural puncture epidural are forms of neuraxial anesthesia used to provide pain relief in laboring women . The investigators want to assess the onset of pain relief with 2 different neuraxial techniques performed at our center, but which have not yet been compared in the literature: (1) Modified CSE, with only local anesthetic injected into the spinal fluid to reduce side effects of opioids that are seen with the traditional CSE and (2) Dural Puncture Epidural (DPE), involving puncture of the spinal membrane, but without injection of medication into the spinal space. The investigators hypothesize that the onset of labor analgesia will be faster with modified CSE compared to DPE.

Purpose of the research:

• To determine the onset of effective analgesia (Numerical Rating Scale (NRS) for pain \

Inclusion Criteria:

• ASA II healthy adult parturients, at 37-40 weeks gestation with singleton pregnancy and vertex presentation.
• Parturients in early labor with cervical dilatation less than 6 cm requesting epidural analgesia
• Parturients able to provide written informed consent.

Exclusion Criteria:

• Patient refusal to participate in the study.
• Presence of clinically significant disease
• Contraindications to neuraxial analgesia.
• Presence of conditions associated with an increased risk of a cesarean delivery like history of uterine anomaly or surgery, morbid obesity and known fetal anomalies or non-reassuring fetal heart rate.

Pregnant patients