Factors associated with severe pain during the active phase of pushing despite labor epidural analgesia: a secondary analysis on a prospective cohort study

In this cohort, 9.5% of women experienced severe pain during the active phase of pushing despite labor epidural analgesia (PIEB and PCEA), which was associated with rapid cervical change and fetal macrosomia. These findings suggest potential roles of incomplete sacral analgesia and enhanced somatic nociception, but require confirmation in future studies.