Excellent talk. One trick we used to distinguish saline from csf was to add a drop to thiopentone. If the solution turned turbid its cerebrospinal fluid
great talk!!! Obstetrics is and was a nightmare in my training and in my practice. If I can avoid it for life, I will do it. But reality sinks, and I keep placing labor epidurals.
really so helpful. In the new edition on Morgan &Mikhail's they do approach the problem with epidural in labor but they do not define enough the risks and the details of the procedure as you do. Thank you for this impressive presentation.
Other advantages of lateral position for epidural placement....Labor nurses highly favor this position as it is much easier to monitor the baby in lateral position. As well, the labor nurse has much more freedom of movement as she is not needed to help maintain the sitting position. Perhaps the best reason for lateral position is patient comfort. Over the years, I probably took care of several hundred patients who had had epidurals in both lateral and sitting position. Probably less than a handful of patients said that they preferred the sitting position. And, there are always patients that are more difficult than average and longer time is needed for successful placement of the epidural catheter. In these instances, it is MUCH more comfortable for the patient in the lateral position.
