The midwives at my hospital have noticed a lot of 15-17 year old, 1st pregnancy women coming in with badly scarred cervix - no previous surgical hx (D&C etc). Sexual abuse against native women is really high in this area of Mexico (85% +), and we suspect that much of the scarring is from abuse at a very young age.

This can make cervical dilation really problematic. In the past we've shipped them off to a government hospital, but care there is atrocious, and outcomes our poor - usually they'll just put them in a corner and ignore them until there's a really serious issue.

The midwifes want to start manually dilating these scarred cervix of these laboring girls if needed, so we can keep more of those ladies here. No more than a couple minutes of anesthesia needed.

I am considering an epidural with a lido bolus vs a micro-SAB. I used to do high risk OB where every patient got a CSE.... 0.8ml 0.2% Ropiv + 10mcg fentanyl prior to epidural placement.

Pros/Cons? Alternate ideas? Suggestions? I'm open to whatever. Hyperbaric Bupiv for spinals comes in 0.5% ampules here.