Moms who have opted for the epidural and were pleasantly surprised by the sweet relief that followed have a Spanish military surgeon to thank for the pain relief. Fidel Pagés was the first doctor who decided to use the epidural space for a dose of anesthesia. Of course, his 1921 version was a single shot of pain meds – not the continuous flow we have today. However, his idea sparked the beginning of the epidural that we know today. The epidural that laboring moms know and love today brings pain relief via a catheter, where the medication can keep on flowing; it can easily be increased or decreased depending on the needs of mom. This method of epidural anesthesia started to become regular during the 1970’s.
Today more than half of laboring moms opt for the epidural to help them cope with the pain of contractions. Sixty-four percent of women in their 20’s opted for an epidural while only 59% of women in their 30’s were more likely to have an epidural. Either way, that’s a lot of women who can give praise to Dr. Pagés.
Unfortunately, not every laboring mom is able to receive an epidural. It may seem totally unfair, but it’s true – not every mom is given the green light on the epi. Here are 15 reasons why mom will have to kiss the epidural goodbye.
15It's Too Late
Unlike the million doctor appointments that pregnant women must schedule during pregnancy, her appointment at the hospital isn’t scheduled. (Unless, of course, you’re getting induced or getting a C-section.. then you are scheduled but you still might need to come in days before your schedule time so my point still stands.) You may not be able to schedule your vaginal birth, but you can be too late.
If you arrive too late – like your baby was born in the car or you were arrived at 9 centimeters – you can kiss your epidural wishes adios. Getting an epidural placed takes time, and if you there isn’t enough time to do the proper labs and get the catheter situated, your nurse will tell you point blank that you can’t have one.
Trust me on this one – no matter how much begging you do, they won’t give you an epidural at 9 cm.
14Meds Not Mixing Well
Fortunately, this obstacle is something you can learn about and prepare for before you’re actually in labor: certain medications make you ineligible for an epidural. This is one of the really important reasons why you should always be truthful on those in-take forms at the hospital. Some drugs just don’t mix well. In the case of an epidural, certain medications are big no-no’s. Blood thinners are just one example.
If you are concerned about any of your medications and the ability to get an epidural during labor, speak with your doctor. Sure, some medications are not negotiable, and you must take them daily. But maybe some can be weaned off before labor – if AND ONLY IF, your doctor gives you the go-ahead.
But, if you can’t temporarily press the pause button on your meds, then you too can say goodbye to your epidural.
13High Risk For Blood Clots
Remember how I said it takes a while to get an epidural in place? Part of that is because getting an epidural is a whole process – a process that starts with a little lab work. Before any doctor can clear you for an epidural, you must have blood work done to show that your body can even handle an epidural.
What exactly are the doctors looking for? Your doctor just wants to make sure the platelet levels in your blood are high enough. Low platelets – which means your body has a limited ability to form clots - puts mom at risk for an spinal epidural hematoma.
So if your blood comes back showing low platelets, no doctor or no anesthesiologist will give you an epidural. It may seem unfair or even cruel , but it’s done for your safety, so at least there’s that.
One of the more well-known ( and common) side effects of an epidural is that it can cause low blood pressure. In fact, this side effect is so common, that doctors order IV fluids before the epidural is even placed. Once you receive the epidural, your blood pressure is constantly monitored to make sure it stays in the appropriate range. Why is low BP such a big deal? Low blood pressure can cause minor problems like feeling faint to major problems like heart problems for mom and issues with baby’s blood supply.
Because low blood pressure can cause some big problems, it’s no big shocker, then, that if mom already has low blood pressure (or is already bleeding and thus at risk for low BP), the OB and anesthesiologist will put a nix on the epidural. Bye bye hopes of an epidural!
11No Anesthesiologist On Staff
Nurses give shots and injections all the time; they even place IVs and manage them. Nurses can even administer the IV pain meds if a mom chooses to go that route. Doctors also are capable of giving shots, performing stitches, and countless other procedures. Yet, when it comes to the epidural, nurses cannot administer them and only certain doctors are allowed to; and that doctor is called the anesthesiologist.
Getting an epidural is a lot more complicated than just drawing blood or giving a shot, and there’s no way around the rules than only a anesthesiologist gives the epi drugs. So if there is an unfortunate lack of anesthesiologists on duty, mama can kiss her epidural goodbye. It seems almost inhumane to not have an anesthesiologist on staff 24/7 but the truth is – not every hospital can or does. This is more of a problem in smaller communities where there might only be one or two anesthesiologist on staff at the hospital.
Before choosing a hospital to give birth, check to see your hospital’s policy: is there an anesthesiologist on staff 24/7?
10Rash On The Back
The nice thing about IVs is that you have many places on your body that can accept on IV. If your left hand has a scar from a burn, no fear, your nurse can place your IV on your right side. Unfortunately, your body doesn’t come equipped with multiple epidural spaces suitable for an epidural catheter. That means if your back is compromised in some way, you may not be able to get an epidural during labor.
What exactly is a compromised back? Some skin issues or skin infections can present too many problems. For instance, if you have eczema on your back and it is infected, your anesthesiologist will most likely advise against an epidural because of an increased risk of infection.
It totally stinks, but skin issues on your back are just another reason Mom might have to forgo the epidural.
9At Least 4 Cm Dilated
For mamas who are on Pitocin, the very beginning contractions aren’t there to ease you in; they start off rough. Pitocin aside, contractions hurt. Plain and simple. Even the less intense contractions still hurt – especially when they just keep on coming. Wave after wave after wave.
However, despite any pain you have or how intense your contractions are, hospital policies may stand in your way of getting an epidural. What? Many hospitals do not permit the use of epidurals unless the laboring mother is at least 4 centimeters dilated. Although this seems like an arbitrary rule, it was designed to help prevent labors stalling or slowing down so early in the process. (Remember: slowed labor is a potential side effect of an epidural.)
But still… those rules may be the reason you can’t get an epidural – at least for the time being.
The opposite of the previous point: you can also kiss your epidural goodbye if you wait too long to ask for it. Like when you’re pushing. Although, once you’re that far into labor, pushing is actually a relief all by itself.
Doctors won’t let you get an epidural during the pushing phase for many reasons. The first, and most obvious, reason is that you wouldn’t be able to sit in the correct position for epidural while pushing. To get an epidural, you sit up, hunch over a pillow, lean into a nurse, and must remain utterly motionless. It simply wouldn’t work. Second, there wouldn’t be enough time to do your labs, get your IV fluids, and get the catheter put it; by the time you got all that, your baby would be born anyway. Third, the epidural doesn’t save you from the ring of fire so you might as well push through it.
7Can't Find The Spine
When the anesthesiologist administers an epidural, he first numbs the area with a small numbing shot. Then, the placing the catheter into the epidural space in your back. The pain medication is then administered through the tube directly into the epidural space of your back. Of course, everyone’s back is slightly different, and the anesthesiologist actually does this part blindly – meaning no CT or ultrasound is guiding him. So what if your anesthesiologist can’t find the epidural space? Well, then you definitely can’t have an epidural.
An anesthesiologist might not be able to find the epidural space for several reasons. One example is if you have a case of scoliosis or if you have had a spinal fusion surgery. If you are worried about your back problems, you can speak with your doctor ahead of time. At least, if your epidural is denied, then you can know ahead of time.
6A Little Help
Pregnancy is filled with weird “pregnancy only” disorders. It doesn’t even seem fair, does it? We’re already doing a lot of hard work by bringing a baby into the world, and now we have to watch out for these crazy issues that only afflict pregnant women?!
One of these “pregnancy only” conditions is called HELLP syndrome. HELLP syndrome is definitely serious; it is characterized by HELLP: hemolysis, elevated liver enzymes, low platelet count. Usually this diagnosis means an induction or schedule C-section ASAP.
However, take a look at the last part of the syndrome: low platelet count. Remember all that lab work that epidurals require, and how the blood work is tested for platelet levels? Low platelet count means no epidural. So not only does a HELLP mama have to deal with all of the HELLP syndrome, but now she can’t have an epidural either. Great.
5More Blood Issues
Alright so we already know that low platelet levels in your blood mean no epidural, but that is not the end of the link between blood and the ability to get an epidural during labor. Mamas with bleeding disorders can also kiss their epidurals goodbye.
How does a bleeding disorder affect an epidural? Bleeding disorders – such as von Willebrand disease – can affect the blood’s ability to clot. So first, that raises her chance of getting a spinal hematoma. Second, bleeding disorders increases mama’s chance of hemorrhage, which lowers the blood pressure, which is another big risk when an epidural is already in place.
Chances are you probably know if you have a bleeding disorder well before you’re actually in labor. For instance, von Willebrand disease typically caused excessively heavy menstrual periods. So at least you’ll be aware of your no-epi status before you’re in labor.
4All Tatted Up?
Maybe you got a cool flower tattoo on your lower back during college or maybe you’ve been slowing adding art to your entire back over the years. Regardless of when you got your tattoo or what your tattoo represents, you probably weren’t thinking about an epidural when you got your tattoo.
Although a lower back tat won’t definitely ban you from getting an epidural, it might. For instance, if your tattoo is raised, swollen or infected, or if the tattoo was recent, an anesthesiologist probably won’t administer an epidural to you. An infected tattoo is a no-go because that infection could spread once the skin is punctured. A recent tattoo with healing skin is also a no-go for the same reason; it risks too much infection.
Although keep in mind that if the anesthesiologist does go ahead with the epidural, you might end up with a tiny scar on your tattoo.
3She Did What In The Car?
Although it is rare (and terrifying), sometimes a mama has no choice but to give birth in her own car on the way to the hospital. Sometimes traffic jams are to blame; seriously, rush hour traffic be Insane with a capital I. Other times, traffic isn’t to blame; the baby simply came fast and furious with no regard to where his mother was actually located for the birth. I think we all saw the viral video of the woman from Texas who had her baby in the car; she was just as surprised as anybody!
So, this goes without saying, but if you give birth before you get to the hospital, you are forced to say goodbye to your epidural while strapped into your car. It may not have been the birth you planned (who plans a car birth?), but that’s the birth you got.
2Home Sweet Home
Does it seem like home births are on the trendy thing to do now? More and more moms are choosing home births. Some moms go this route because they want the comforts of home during labor; other moms opt for home births to get away from the “interventions”. Still, other moms may choose home birth for religious reasons.
Despite the internet making us think that all the trendy hippy moms are having home births, only 1.36% of all births are actually homebirths. (In 2011, that number was 1.26% and in 2004, that number was 0.87%) Despite the rise in home births, not all moms are willing to birth at home. You want to know why? The minute you choose a homebirth, that’s the minute you say goodbye to an epidural. (Which is totally fine if you’re okay with that.) But if you think you may want an epidural, a home birth is not for you.
Perhaps the most frustrating reason a mama has to miss out on the relief of an epidural is that it failed.
You’re in labor. You do the blood work and it’s great. You get the IV fluids. The anesthesiologist is on duty and headed your way – there was no one else in line ahead of you! He numbs you up and places the catheter… but nothing. It doesn’t work. He pumps up the meds, but still nothing. You still feel wave and after of contractions with no difference.
After all of the build up to finally getting an epidural and you got the dud. No one told you that you couldn’t have an epidural. In fact, they all told you that you could have an epidural. THAT is the most disappointing way to say adios to an epidural. At least, a failed epidural doesn’t mean you can’t try other pain management methods.
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