A three-year survey of an obstetric epidural service with top-up doses administered by midwives

A three-year survey following the introduction of an epidural service to a maternity unit is presented. 1,438 epidural blocks were attempted (a rate of 30%). Provision of pain relief was the principal indication. There were no serious complications or sequelae although minor complications or difficulties of insertion were noted in 21%. The procedure was abandoned in 1.5% and accidental dural tap occurred in 1.7%. Satisfactory pain relief was achieved in 90% during the first stage of labour and 71% during delivery. Of those who delivered, 47% retained an urge to bear down and spontaneous delivery occurred in 43%. 89% of patients interviewed were fully satisfied with, or considerably helped by, the epidural block. Incremental epidural doses were managed by midwives and it is argued that the midwife is ideally suited to this role providing she is trained and experienced and can call for immediate anaesthetic assistance.