A Case of Sciatica During Labor Due to an Occiput Posterior Fetus

A 28-year-old term G3P0020 received an epidural with complete pain relief. Approximately 19 hours after the epidural placement, the pain increased. Sensory levels were rechecked and were bilateral and adequate at T8. Further discussion revealed that the pain was unrelated to her contractions; it was in her buttocks and radiating down the leg. The possibility of the fetus being positioned occiput posterior (OP) was discussed. The patient was placed into knee-chest position with instantaneous relief of her pain. This is the only known case report of epidural breakthrough pain due to an OP fetal malposition with successful intra-partum pain management solely by position change.