the OP-baby block

When to suspect a malpositioned baby block

• the midwife /obstetrician tells you

• post epidural insertion the mother describes lower back and bottom pain, worse with contractions

• the need to push when not fully is more common

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This can be a challenging situation. Ideally if fetal position is known prior to insertion, it can form part of the epidural consent process. Explain that contraction pain may improve, but this pain can be difficult to treat.

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Options for adjuncts to try and improve pain:

• concurrent entonox use

• PCEA bolus

• More concentrated local anaesthetic bolus - e.g 5ml 0.5% marcain, with patient sat up to encourage saddle block

• opiate, e.g. fentanyl 25-75mcg

Resiting epidural in these circumstances rarely improve pain associated with an OP baby, it is caused by pressure of fetal occiput on pelvis.

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