This is the most effective way of relieving the pain of contractions, with complete relief of pain in 95% of labouring women. The procedure may be instituted at any time and does not interfere with uterine contractility. It may reduce the desire to bear down in the second stage of labour.

A fine catheter is introduced into the lumbar epidural space and a local anaesthetic agent such as bupivacaine is injected (Figure 1.). The addition of an opioid to the local anaesthetic greatly reduces the dose requirement of bupivacaine, thus sparing the motor fibres to the lower limbs and reducing the classic complications of hypotension and abnormal fetal heart rate. The procedure involves:

Insertion of an intravenous cannula and preloading with no more than 500 ml of saline or Hartmann?s solution

Insertion of the epidural cannula at the L3?L4 interspace and injection of the local anaesthetic agent at the minimum dose required for effective pain relief.

Figure 1. Epidural Anaesthesia.