1. GENERAL

1.1 Epidural analgesia will be performed on request from the patient's obstetrician or a person delegated by him. As with all inter disciplinary referrals provision of relevant clinical information is important.

1.2 The patient's consent should have been obtained and the procedure explained.

1.3 The response to a request for epidural analgesia will be as rapid as possible but it should be noted that adequate notice of impending need will greatly reduce the necessity for urgency.

1.4 Absolute contra-indications to epidural analgesia in labour include :-

1.4.1 Current anticoagulant therapy

1.4.2 Bleeding diathesis or defibrination process

1.4.3 Uncorrected haemorrhage and hypovolemia

1.4.4. Local sepsis where the epidural catheter is to be inserted.

1.5 Special situations such as spinal column deformity, obesity, history of low back pain or central neurological disease, require special consideration and consultation to determine whether epidural analgesia is indicated under these circumstances.

1.6 A midwife must be present during the performance of the epidural block.

1.7 The continued presence of the husband during the performance of the block is entirely at the discretion of the anaesthetist.

1.8 Prior to the performance of the block, an intravenous infusion, via a wide bore cannula must be established. A fluid load of 500 ml of crystalloid solution should be given.

1.9 A vasopressor, preferably with pure beta activity such as ephedrine, must be available.