SELECTIVE EPIDURAL ANALGESIA AND THE FORCEPS RATE

Abstract
Epidural block for the relief of pain in normal labour still remains a relatively uncommon practice in this country. One of the reasons for its lukewarm acceptance may be the belief that its use commits the mother almost invariably to a forceps delivery. Records of over 800 deliveries attended by the writer from 1957 to 1969 show that, while the use of selective epidural analgesia has increased over the years, the frequency of forceps delivery has decreased. It is suggested that epidural block need be less of a cause of a high forceps rate than hitherto believed provided that: (1) the technique is employed in normal as well as in abnormal labours; (2) the strength of uterine contraction is augmented if necessary by an oxytocin infusion; (3) a selective technique is used involving minimal dosses of local anaesthetic directed at the nerve pathways by which the mother is feeling pain at the time of injection; (4) the attending obstetrician is willing to allow the mother time ans opportunity to deliver herself without unduly hasty intervention.