Juliana was requested by a midwife to place an epidural for an obstetrical patient who was in labor at 8 cm dilated and fully effaced. The patient was exhausted and in excruciating pain. Juliana took a report from the midwife and proceeded with an uncomplicated epidural. With the epidural in place, Juliana injected 12 ml of 0.5% bupivacaine, and that was the last contraction that the patient felt. It was time to push, and the patient was so “numb”; she did not feel that she had a body below her umbilicus. She made ineffectual attempts at pushing.