A great alternative to the traditional epidural, but ideally needs careful patient selection.

Important to have discussion with parturient if you feel an epidural would be in her best interests, or would be a better option.

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Suits low risk primips in spontaneous labour making good progress, or multips known to have laboured well and delivered normally before.

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Less ideal candidates include:

• primip inductions not yet in established labour

• women with high BMI - either primips or multips who have not previously delivered without intervention where an epidural would be more advantageous

• women with high risk of intervention in theatre

• women with hypertensive disorders, particularly pre-eclamptics

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Contra-indications include:

• allergy to other opioid drugs

• recent pethidine or codeine (4hrs)

• sleep apnoea - caution, higher risk of apnoeas

• IUDs

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