Re: [ozmidwifery] re epidural top ups

[Marilyn Kleidon]

LOvely, Alesa that is exactly how I had experienced epidurals being set up in the USA. However, I have been told here that these large syringes that require top ups are more innovative than the infusion (pcea) pumps : I can't see how, even though I can see (in some ways) that if this is the technology we are using then midwives should be ofay with it?? And yes I had never experienced the epidural as being anything but turned off in second stage in fact, at least until 2002 when i left it was common practice to allow passive descent so that active pushing did not commence until the head was on view. With this practice I saw very few instrumental births.  Can anyone give me the justification for these syringe type epidurals requiring top ups over the infusion pumps?   marilyn ----- Original Message ----- From: Alesa Koziol To: ozmidwifery Sent: Friday, May 20, 2005 6:17 AM Subject: [ozmidwifery] re epidural top ups Dear List Have read this thread with great interest. Not wishing to get into the debate regarding whose skill it is to perform this task I just wanted to share our experience. The move away from an epidural that required top ups in labour to infusion pumps came about when the midwives refused to perform the topups or push a bolus down the epidural line manually. We insisted on the anaesthetists doing this task as they were responsible for the integrity of the line and most certainly for its placement. Our anaesthetists got sick of returning again and again to do this and researched an alternative for themselves that we were happy to work with. In our setting a midwife will assist the anaesthetist with equipment required for epidural insertion, however she never ever pushes any fluids down the line manually. Priming the line is all done by the anaesthetist, he/she connects all lines, filter and tubing to a syringe and together they check the settings on the syringe driver and turn it on. Works for us, women have the analgesia they request, midwives turn the pump off when second stage is noted and many women push their infant actively- although there is still a high number of instrumental births Cheers Alesa   Alesa Koziol Clinical Midwifery Educator Melbourne