Instrumental delivery should be classed as an operative procedure and therefore carried out with adequate analgesia. NICE recommend that instrumental deliveries are carried out under tested, effective regional anaesthesia (spinal/epidural). However, there are exceptions to this rule, when instead a pudendal block and perineal infiltration with local anaesthetic may suffice.
When is it acceptable not to use regional anaesthetic?
- Mother declines anaesthesia
- Urgency of situation (e.g. fetal distress) does not allow time for siting of epidural/spinal
- Outlet deliveries.
In these circumstances use pudendal block and perineal infiltration instead.