This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion
f the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies,
the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines,
if they exist, are presented. The article ends with the author’s clinical recommendations.
Epidural Analgesia for Labor and Delivery
Joy L. Hawkins, M.D.
30-year-old nulliparous woman at 39 weeks’ gestation is undergoing induction of
abor because of premature rupture of membranes. She is currently receiving an oxy-
ocin infusion, and her cervical dilatation is 1 cm. Her obstetrician has ordered inter-
mittent intravenous administration of fentanyl for pain relief, but she feels nauseated,
as been unable to rest, and describes her pain as 9 on a scale of 10. The patient
trongly prefers a vaginal delivery to cesarean delivery and is concerned that epidural
nalgesia may alter the progress of labor. The anesthesiologist is consulted to discuss
he use of epidural analgesia during labor and delivery.