7 Reasons You Can't Have an Epidural

Planning on having epidural anesthesia?  Just because you want one doesn't mean you'll get it! 
Here are seven reasons why you may not be able to have one...

7 Reasons You Can't Have an Epidural

by Robin Elise Weiss

Epidural anesthesia is the most popular form of medicinal pain medication for labor and birth. Many women decide on using an epidural prior to labor and don't even look at other forms of pain relief for labor and birth. This is not necessarily a wise choice for labor and birth because there are many reasons why an epidural may not be in your future. Here are a few of the reasons you might not be able to have an epidural:

1. You are taking certain medications.
   Medications that you take can effect how likely you are to be able to get an epidural. The biggest culprit are blood thinners.
2. Your blood work isn't just right.
   If you have a low platelet count or sometimes other problems with your blood work may make the placement of an epidural more risky.
3. The doctor can't find the right space.
   Sometimes due to the normal growth of your back, your weight or back problems, including scoliosis, it may be impossible for the anesthesiologist to find the epidural space. Therefore you can't have the epidural placed in labor.
4. You are bleeding heavily.
   If you are bleeding heavily or are suffering from shock, you will not be given an epidural for safety reasons. Since many women tend to have lower blood pressure with an epidural, this may be made even more dangerous with the lowered blood pressure of some of these problems.
5. You have an infection of the back.
   It is not in your best interest to have your anesthesiologist place an epidural through an area that is infected. This can cause the infection to spread to the spine and other areas of your body and can potentially cause a great deal of damage.
6. No anesthesiologist is available.
   Your hospital may only have an anesthetist available during certain hours of the day or days of the week. You may also have an anesthesia department that covers an entire hospital and not just the labor and delivery unit.
7. Labor restrictions.
   Some hospitals will place restrictions on when you can have an epidural. It may be that you must be at a certain point in labor, like four (4) centimeters before an epidural can be given. Other hospitals may decide that epidural should not be given after a certain point of labor, for example when you've reached full dilation (10 centimeters).

What to Do if the Doctor Says No

You might be able to find out beforehand that an epidural is not in your laboring future. If this happens you are able to prepare by looking at other methods of pain relief for labor. A good childbirth class that focuses on many different types of pain relief from medications to natural forms of relief of pain may be the best option for filling your birth bag with many tools to cope with labor, particularly for the surprise revelation that you can't have an epidural.

Enlist support for getting through labor. Labor is hard work, with or without pain medications. Consider hiring a doula, even if you prefer an epidural. A professional labor assistant can help you and your partner through different pain relief options including natural pain relief like relaxation, positioning, massage, etc. She will also be trained in letting you know what your other options are for pain relief like Transcutaneous Electrical Nerve Stimulation (TENS), IV medications, etc.

If you are concerned about these issues be sure to talk to your doctor or midwife about your fears. It's also possible and highly recommended in some cases to actually visit the hospital and have a consultation with the anesthesiology department. They may do a physical exam of your spine, take a medical history, etc. This can help answer questions you may have about epidurals and labor. Being informed ahead of time is your best solution.

Moral of the story... GET A DOULA! :)