I am in the process of board prep and came across an interesting review question and wanted a generalized opinion as I had never heard this throughout school or clinical.

The question:

You are placing an epidural for a parturient who is in the latter stages of labor. How should the epidural catheter best be positioned?

  1. At L1-L2 and directed cephalad
  2. At L1-L2 and directed caudally
  3. At L3-L4 and directed cephalad
  4. At L3-L4 and directed caudally

Correct answer is 4 and is referenced in Nagelhout fourth edition on page 1117.

Do you actually place your epidurals in a caudal direction? My small sample size has all been a no so far. Just wondering.

In advance, I understand that the board is not necessarily based on real world practice and we are not tested on real world practice on the board exam. Thanks.