Even the best-laid plans can go awry, especially in the delivery room. If you've planned on getting an epidural, here are a few reasons it might not happen.

By Kristi Pahr
January 13, 2020
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Being pregnant is never a walk in the park. Along with a tiny hitchhiker taking up residence in your uterus and all the fun that comes along with that, there's a veritable laundry list of decisions you have to make. Which OB to choose? Where to give birth? Want to know the sex of your baby? What color to paint the nursery? And the biggie, do you want a medicated or unmedicated birth?

Despite legions of folks online who like to insist otherwise, either decision is fine—having an epidural in place to ease the pain or soldiering through those contractions med-free. It's entirely your choice and one you should discuss with your doctor or midwife and not base it on what the moms in your due date group say is best. Your birth, your choice.

But there are some conditions that makes epidural anesthesia risky or not possible during your delivery. Here's what you need to know about your likelihood of getting an epidural during delivery.

What Is An Epidural?

According to the American Pregnancy Association, epidural anesthesia is one of the most common types of anesthesia for labor and delivery—it's estimated that around 50 percent of people who give birth in U.S. hospitals receive one. To perform an epidural, an anesthesiologist places a needle into the space surrounding the spinal cord then inserts a small tube through the needle. The needle is removed and the tube, called a catheter, is taped in place. The catheter is then used to infuse a measured dose of medicine at regular intervals or via constant infusion. The medicine blocks the nerves that feed the lower body and the result, when performed correctly, is pain relief.

Epidurals can result in a more relaxed birth experience, allowing the mother to rest between contractions and not be completely exhausted when the marathon of labor is finally over and there's a baby to snuggle.

Reasons You Might Not Recieve An Epidural

Despite the proven safety of epidural anesthesia, there are those who are unable to have one. Several conditions make epidurals problematic, or downright dangerous, for laboring moms.

Pre-existing Medical Conditions

Many people with complex medical histories are aware of any limitations they may have regarding epidurals prior to going into labor. A pregnant person may not be a candidate for an epidural if they have abnormal blood coagulation, certain neurologic conditions like spinal aneurysm, systemic or local skin infections, certain cardiac conditions, and low blood volume (people with heavy bleeding or who are in shock), explains Eduardo Hariton, M.D., an OB-GYN at the University of California San Francisco.

Also, doctors may have trouble placing an epidural for those with spinal abnormalities like scoliosis or rheumatic diseases and those with a history of spinal surgery or trauma. If the spaces between the vertebrae are cramped or smaller than is typical an anesthesiologist might not be able to insert the needle in the space.

If complications arise during your pregnancy, your OB or midwife can help determine what anesthesia options are right for you and set up a consultation with an anesthesiologist just to be safe. Jeremy Dennis M.D., assistant professor of clinical anesthesiology at Yale-New Haven Hospital, Yale University, explains that an anesthesia consultation prior to labor is not the norm. "Consults are always good to have but are quite rare due to logistics," he says. "In most cases, they probably aren't necessary unless there are extenuating circumstances."

Labor Moves Too Quickly

Sometimes even those who plan to have an epidural and have no complications during pregnancy are unable to have one placed. Babies come on their own schedule and occasionally labor moves too quickly for an epidural to be effective. Though there's no definitive cut-off during labor where an epidural can't be placed, Dr. Dennis explains that sometimes it not worth the risk. "While epidurals are generally safe, there are always risks with any procedure," he says. "If the patient isn't going to be able to get the benefit of the epidural because the baby comes too fast, then it's not worth taking the risk. "

An Anesthesiologist is Not Available

Also worth noting, if you plan on laboring at a smaller hospital or birthing center, there's a chance an anesthesiologist may not be available to place an epidural when you want one. If you know early in pregnancy that you would like an epidural during delivery, speak with your OB to find out if anesthesiologists are frequently available where you plan to deliver.

The Epidural Doesn't Work

There are also some occasions when the anesthesiologist is available and attempts to place the epidural but is unable to do so. This may be due to previously unknown structural abnormalities, the timing of the epidural placement, or incorrect placement of the epidural. If labor is progressing quickly, the medicine may not have time to take effect before you enter the pushing stage. Occasionally, the epidural may slip out of the correct placement, meaning the medicine doesn't reach the nerves it should reach to provide pain relief.

The Bottom Line

It's a good idea to discuss your birth plan with your OB or midwife so you can discuss your ability and access to get an epidural if that is what you want. But remember: Despite the best-laid plans, you may be left without the pain control you wanted.

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