Once the first dose has been given, further management varies somewhat between different centres While some women deliver without requiring any further pain relief, most women find that the initial dose wears off after an hour or two. Further "topups" can be given via the catheter without having to go through the whole procedure again. "Topups" are generally given by either the midwife or anaesthetist depending upon the centre. As an alternative to this, some hospitals attach the epidural to a special syringe pump which delivers the drugs continuously just like an intravenous pump. This is called a continuous epidural infusion. There are even pumps now available which allow you to give yourself further doses when you feel like it. These pumps are similar to those used for Intravenous Patient Controlled Analgesia and the technique is called Patient Controlled Epidural Analgesia.