EPIDURAL ANALGESIA IN LABOR USING INTERMITTENT DOSES DETERMINED BY MIDWIVES

Since 1985 midwives have been responsible for choice of drug and timin g of epidural top-up doses for women in labour at Flinders Medical Cen tre. The midwife may choose from one of three different prescribed pre parations, namely: bupivacaine 12.5 mg plus pethidine 25 mg, bupivacai ne 25 mg, and bupivacaine 50 mg each made up in a volume of 10 ml. Thi s prospective study examined the incidence of adverse effects and leve l of patient satisfaction with midwife-managed epidural analgesia. Bet ween 1987 and 1992, 6935 women received midwife-managed epidural analg esia. The pethidine/bupivacaine mixture was generally used for the fir st dose (75% of women) with a shift towards bupivacaine 25 mg or 50 mg for subsequent top-ups. Sixty-one per cent of women had normal vagina l deliveries, 25% instrumental and 14% caesarean deliveries. The most common side-effects were shivering, hypotension and itch. Shivering oc curred following 11% of bupivacaine, and 2% of bupivacaine/pethidine t op-ups. Itching was more common after bupivacaine/pethidine (3%) than after bupivacaine (1%). Women reported a high level of satisfaction wi th the overall experience of childbirth, though this was lower for ins trumental and caesarean deliveries than for vaginal deliveries. On the other hand, satisfaction with pain relief provided by the epidural wa s greater in women who had caesarean or instrumental deliveries. The m ost commonly cited benefits of epidurals were good pain relief (83%), ability to cope (74%), feeling relaxed (67%), and being aware (60%), w hile feeling numb (23%) and experiencing severe pain at delivery (17%) were the most common causes of dissatisfaction.