Objective-To examine the relation between epidural anaesthesia and long term backache after childbirth.Design-Data from postal questionnaire on morbidity after childbirth sent to women who had delivered in one maternity hospital between 1978 and 1985 were linked to maternity case notes for each woman.Setting-Maternity hospital in Birmingham. Subjects-11 701 Women who had delivered their most recent baby at the maternity hospital during the defined period and who returned their completed questionnaires.Main outcome measures and results-Of the 1634 women who reported backache, 1132 (69%) had had it for over a year. A significant association was found between backache and epidural anaesthesia (relative risk=1-8); 903 of 4766 women (18-9%) who had had epidural anaesthesia reported this symptom, compared with 731 of the 6935 women (10-5%) who had not had epidural anaesthesia. This association was consistent in both "normal" and "abnormal" deliveries, the only exception being after an elective caesarean section when no excess backache occurred after epidural anaesthesia.Conclusions-The relation between backache and epidural anaesthesia is probably causal. It seems to result from a combination of effective analgesia and stressed posture during labour. Further investigations on the mechanisms causing backache after epidural anaesthesia are required.

Summary Sixty‐six of a series of 116 patients had a postural headache resulting from an inadvertent dural puncture (despite in 64 cases the provision of an epidural drip) and 50 had headache following a spinal block. Experience suggested that it is advisable to inject 20 ml of blood unless during the course of injection the patient complains of pain or discomfort. Blood should also be taken for culture. In only one patient (who had three dural punctures) of the 98 so treated has the patch failed to relieve the headache. Arguments are presented against the use of a prophylactic patch, and against utilisation of the epidural catheter as a route for injecting the patch.

One hundred and fifty "clinically acceptable ideal cases" undergoing elective Caesarean section under a standardized regimen of general anaesthesia were studied. In 87 cases the patient was supine throughout the procedure and in 63 cases she was tilted laterally by means of a wedge. Statistical analysis of the data derived from assays of maternal and cord blood, and of the Apgar-minus-colour scores indicated that: there was among the non-tilted patients a higher incidence, and greater degree, of birth asphyxia and of low A-C scores than in the tilt series, and that this disparity was emphasized by prolongation of the I-D interval; there was a greater variance among the results obtained from the non-tilt series, suggesting that the introduction of a tilt led to a more stable situation. It is suggested that the contrasts reflect the effect of caval occlusion by the gravid uterus, and the introduction of the terms "revealed caval occlusion" and "concealed caval occlusion" is advocated. Possibly, drug-induced depression was observed among infants who were delivered within 10 minutes of induction, but no other neonatal effects referable to the drugs used could be identified.

A study of 1955 spontaneous labours is presented relating progress and outcome to the presence of a lumbar epidural block in 282 of these patients and to the need for oxytocin augmentation in 427. Graphs for cervical dilatation starting at admission to hospital were constructed for normal and dysfunctional labours of spontaneous onset. Patients requiring augmentation of labour had a lesser cervical dilatation on admission to hospital, a longer first stage, more instrumental deliveries, more Caesarean sections and a greater number of babies with a low Apgar score. An epidural block had no effect on either the duration of first stage or the rate of cervical dilatation but was associated with a 20-fold increase in rotational forceps delivery and no increase in Caesarean section rate. With an epidural block there was no increase in the number of babies with cerebral irritation or low Apgar scores and there was a statistically significant improvement in the Apgar scores of babies of mothers in augmented dysfunctional labour who had an epidural block. The incidence of rotational forceps delivery in patients with an epidural block could be reduced with safety by allowing such patients to have a longer second stage before considering interference purely for delay.

An analysis of clinical data referable to 923 lumbar epidural blocks provided during labour is presented. Points of interest include: the high incidence of completely satisfactory analgesia, the lack of serious disturbance of obstetric practice, the suggestion that application of the technique on a wide scale reduces the incidence of emergency Caesarean section, and the very low incidence of complications, with the exception of dural puncture, the frequency of which was highly correlated with the experience of the anaesthetist.