Some maternal complications of epidural analgesia for labour

A review of the maternal complications encountered in a consecutive series of over 27 000 lumbar epidural blocks (exclusive of epidurals administered for elective Caesarean section and complications of a relatively minor or fleeting nature) in a single obstetric unit is presented. There were nine potentially life threatening complications, of which only three caused real concern for the mother's safety. Six of these occurred with the first top-up, as given by the anaesthetist. The others were the result of three out of the approximately 100 000 top-ups administered by midwives. There were two serious, but not life-threatening complications, each of which led to the requirement of a laminectomy. In addition, there were 13 moderately serious and 17 mildly disturbing complications. All the mothers concerned made a full recovery. There was a large number of inconsequential or pseudocomplications which, although initially blamed upon the epidural, were later demonstrated to have been of a different origin. Consideration of this experience leads to the conclusion that if the rules of management are rigorously followed, epidural analgesia for labour and delivery, including topping-up by well-informed midwives, is characterised by an extremely high level of safety for the mother.