The following information should be covered in clear and simple language:
1. A brief description of the anatomy.
2. A simple explanation of what will happen:
- intravenous infusion
- posture during placement of block
- approximate duration of procedure
- approximate time until it starts to work
- need for fetal monitoring
3. An explanation of commonly used terms (catheter, test-dose, top-up)
4. Common 'benign' side-effects:
- shivering
- heaviness or tingling in the legs
- urinary retention
5. Common more serious side-effects:
- hypotension - the importance of avoiding aorto-caval compression (Chapter 28)
- back pain (1, 2) (Chapter 84)
6. Possible effects on the labour (Chapter 102):
- first stage (duration / contractions / fetus)
- second stage (duration / assisted delivery / episiotomy rate)
7. Possible technical difficulties:
- with the insertion
- unequal, patchy or failed blocks (Chapter 94)
8. Rare but potentially serious complications:
- dural tap and post dural puncture headache (Chapter 97)
- intravascular injection (Chapter 36)
- high block (Chapter 8)
- neurological damage (Chapter 112)
It is also worth mentioning that:
1. there may be other medical or therapeutic indications for epidural blockade apart from the provision of analgesia. For example, regional anaesthesia may be required for delivery of a second twin, or management of breech, forceps or occipito-posterior vertex delivery, pre-eclampsia or other maternal diseases, induction of labour or caesarean section. Post-delivery indications such as retained placenta or the suture of tears can also be included;
2. there may be contraindications to an epidural ( sepsis, coagulopathy);
3. epidural analgesia and anaesthesia is a common procedure with a high margin of safety and patient satisfaction. Epidurals are only inserted by specialist anaesthetists or specialists-in-training.
Of course, any discussion of risk should be balanced by a mention of the benefits of epidural analgesia for both the mother and fetus.