Analgesia in labour: induction and maintenance

Since the introduction of epidurals for labour analgesia in 1946 they have become the gold standard on delivery units throughout the world. Controversy remains as to the effects of neuraxial block upon the fetus; however it is now widely accepted that there are beneficial and not just detrimental effects. With the introduction of low-dose anaesthetic solutions the major cardiovascular effects and concerns with toxicity have become much less prominent and the lack of profound motor block associated with traditional dosing has resulted in greater maternal satisfaction, although not the mobile revolution which was once anticipated. As research continues to search for the ideal form of labour analgesia, newer technologies are evolving making epidurals ever safer, individualized and tailored to the modern women on the delivery suite as they demand greater control and autonomy over their deliveries. No current method has been able to emulate these ideals, but in the meantime women can enjoy safe and effective analgesia with minimal risks to either themselves or their babies.