Abstract Background Labor analgesia has rapidly gained popularity in obstetric practice. Low usage in developing world has raised concern. This study aimed to assess knowledge and attitude of antenatal women for pain relief methods during labor and to know the effect of presumed availability of relief pain on antenatal women's choice about the mode of delivery (vaginal vs. cesarean section). Subjects and methods: Cross sectional descriptive research design was utilized in the present study. Convenient sample was used among antenatal women in the third trimester who attended the antenatal clinic in Woman's Health Hospital in Assiut city. Two tools were utilized to collect data. Tool (one) was structured interview questionnaire included five parts (personal data, obstetrical history, data related to current pregnancy, data related to labor analgesia, data related to the attitude toward vaginal ⁄ cesarean section delivery).The second tool (Visual analog scale: was used to assess pregnant women's attitude towards pain (past experience of severe pain, previous and expected labor pain). Results: the results indicated that about 60.0 % of the participant women preferred C.S. delivery to avoid labor pain and the majority of the sample (82.9%) was unaware about labor analgesia. Furthermore, the availability of pain relief during labor may decrease CS by more than 50% in women had moderate and severe labor pain during their current pregnancy compared to non-availability of pain relief (9.6% VS 22.7% and 8.2% VS 28.1%, respectively). Conclusion: It can be concluded that there is a lack of knowledge regarding the need for pain relief during labor Recommendations: the researchers recommended that the importance to educate the antenatal women about the need for labor analgesia and the available options by the provision of information leaflets, labor pain websites and childbirth preparation classes.