Current practice of epidural analgesia during normal labour

Summary A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24‐h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivicaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top‐ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top‐up, whereas 0.25% was most often used during the first stage of labour. Midwife top‐ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top‐ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.