Obstetric units should be able to provide neuraxial analgesia on request. Smaller units may be unable to provide a 24-hour service; women booking at such units should be made aware that neuraxial analgesia may not always be available.55
Midwifery care of a woman receiving neuraxial analgesia in labour should comply with local guidelines that have been agreed with the anaesthetic department. Local guidelines should include required competencies, maintenance of those competencies and frequency of training. If the level of midwifery staffing is considered inadequate, neuraxial analgesia block should not be provided.
Units should have local guidelines on the recognition and management of complications of neuraxial analgesia that include training on the recognition of complications and access to appropriate imaging facilities when neurological injury is suspected.
Neuraxial analgesia should not be used in labour unless the obstetric team is immediately available.
There should be a locally agreed neuraxial analgesia record and a protocol for the prescription and administration of drugs.
When the anaesthetist is informed of a request for neuraxial analgesia (and the circumstances would be suitable for this type of analgesia) the anaesthetist should attend within 30 minutes of being informed. Only in exceptional circumstances should this period be longer, and in all cases attendance should be within one hour. This should be the subject of regular audits.27,115
When remifentanil PCA is provided as an alternative to neuraxial analgesia, there should be local multidisciplinary guidelines.116
Midwives caring for women receiving remifentanil PCA should be trained specifically in the use of the technique, and stay with the woman continuously without any break in observation. Remifentanil PCA should only be provided in units where it is frequently used. Rapid reversal of respiratory depression/arrest and airway resuscitation equipment should be immediately available.
As a result of the assessment, the appropriate level of postoperative care can be determined and booked in a day surgery facility, ward, high dependency unit (level 2 care) or critical care unit (level 3 care), enabling both optimum care and efficient planning
