The purpose of this pilot prospective randomized control trial is to compare the initiation
of labor epidural analgesia by combined spinal epidural vs. epidural for the influence on
risk for postpartum depression symptoms. Investigators will randomize women to the receipt of
CSE or E during labor, after measuring baseline psychological, psychosocial, and
psychophysical factors related to pain and depression. The immediate research goals are to
understand whether the association between labor pain and PPD is modifiable through the use
of tailored anesthetic techniques.