Epidural analgesia in labour?: Yes!: But how?

Pain management is an essential part of good obstetrical care, and obstetrical provider should discuss the options with the patient. Woman that request epidural analgesia for labor should have preprocedural evaluation by the anaesthesiologist, and informed consent should be obtained. Contraindications for neuraxial techniques are clinically significant coagulopathy, uncorrected maternal hypovolemia, infection at the needle-puncture site, increased intracranial pressure that could lead to herniation if dural puncture occurred, and inadequate training or experience on the part of those providing the anesthesia. In absence of medical contraindication, maternal request is a sufficient medical indication for pain relief in labor. To the end of last century advent of new local anesthetics, artecaines, and introduction of supplemental drugs, mainly opioids in neuraxial anesthetic techniques, resolved many controversies about epidural in obstetric practice. Today we consider it the safe and most sufficient method of labor analgesia, and while initiating the analgesia may be easy, maintaining it through labour may be challenging.