Lumbar Epidural Analgesia in Labour. A 24-Hour Service Provided by Obstetricians

Abstract

SummaryOf 309 consecutive cases of epidural analgesia provided by obstetricians, 250 were set up by junior obstetric staff. Midwives managed the epidural analgesia and gave the top-up doses as part of their traditional role in providing pain relief in labour. This practice was thought to be influential in producing a high spontaneous delivery rate. With specialised training and clinical integration the benefits of an epidural analgesic service can safely be provided by obstetricians in a small maternity hospital. IntroductionIf properly managed extradural block provides obstetric analgesia second to none in efficiency, and the provision of an

A Review of Obstetric Epidural Anaesthesia, British Military Hospital, Rinteln 1980 – 1985

“…Acceptable analgesia was achieved in 90% of cases, which is to be expected when using bupivicaine as first choice anaesthetic (12). The incidence of hypotension and bloody taps is consistent with the findings of others ( 4,12) and the higher rate of dural taps may be a reflection of the small number inserted during those years.…”

“…This is impossible to provide in most hospitals, particularly Service hospitals where there may be less than 1000 deliveries per year. To this end, it has become accepted practice for obstetricians to provide an epidural service, and this has been shown by others to be efficient and safe ( 4,5).…”

“…Furthermore, it is logistically difficult to provide a 24-hour obstetric epidural service when there are less than 2500 deliveries per year in a maternity unit. Increasingly, obstetricians in small units have learnt the technique of lumbar epidural insertion and appear to provide a safe service (4,5). This is particularly relevant for Service hospitals, where deliveries usually number less than 1000 per year, and staffing levels do not provide sufficient anaesthetists for a 24-hour obstetric epidural service.…”

Mothers'views of Care in Labour

“…Most of the dissatisfied mothers complained about delays in the topping-up procedure and the consequent pain which they experienced ; these delays occurred because a doctor, who was the only person permitted to perform the procedure, was not always readily available. This unsatisfactory situation would be greatly improved if the midwives could give the top-up doses as is the practice in some centres (Taylor et a/, 1977).…”