At my program, there's recently been some conflict between the OBs and us regarding pain management for patients with intrauterine fetal demise. Their opinion is that the patient is in pain form contractions/cervical dilation/etc. and that an epidural is indicated, as in any laboring woman. We have a number of attendings with differing opinions on this, but our section chief feels that: 1) the indication for an invasive procedure (epidural) in a laboring patient is to protect the fetus from systemic analgesics (opiates), and this indication is absent in the IUFD patient. 2) Discomfort in these patients can be effectively managed with opiates and sedatives. 3) The risks and side effects of the epidural outweigh the benefits in these patients, and in addition, patients with IUFD are at increased risk for coagulopathy from DIC. Chestnut is quiet on the subject. What are people doing at other academic programs? What about out in PP?