Epidural analgesia in labour: The past, the present and the future

Abstract

Anaesthetists have a heavy responsibility to ensure that epidurals are given effectively and safely. Maintaining a high standard of service inevitably involves the constant training of changing junior medical and midwifery staff. All patients must be followed up after epidural analgesia and an enquiry made into the causes of failures and complications. Only by these means can the quantity, and even more important, the quality of the service be maintained. Where training and supervision is haphazard the results tend to discredit the method itself. Ineffective epidurals, accompanied by a high frequency of complications, deservedly attract criticism. As the attainment of consultant rank in anaesthesia does not necessarily guarantee the ability of the individual to teach the technique, there must be a wider availability of postgraduate courses for established consultants (Doughty 1979). Some may still question whether the effort is worthwhile or whether the relief of labour pain should be a high priority in the busy life of the present day anaesthetist. The beck and call of the epidural life is not to everyone's taste. There is now an indisputable case for the safe practice of epidural analgesia: while it has been shown to give positive clinical benefits to both mother and baby, its most impressive effect is to bring tranquility and humanity to the delivery suite as well as happiness and dignity to a woman on one of the most important occasions in her life.