An epidural may be recommended by your caregiver for medical reasons, if the woman has slightly high blood pressure (either detected in the pregnancy or during the labour). This is because one of the side effects of the 'local' types of medications used in an epidural is lowering of the blood pressure. This will usually depend on the individual health circumstances of the woman, you should discuss your options with your caregiver.
Sometimes very high blood pressure levels can affect the woman's blood from clotting adequately. This is detected by a blood test in early labour for 'platelet' levels. If the level is too low, then an epidural would not be recommended in case the epidural needle causes excessive bleeding. You may wish to read more in
high blood pressure during pregnancy.
Twins, premature baby, posterior baby, breech baby and VBAC
In the past, epidurals were routinely recommended for women who were having twins, a premature baby, a posterior baby, a breech baby or for women planning a vaginal birth after a previous Caesarean (or VBAC). This was 'in case' interventions were needed to help deliver the baby(s). There is little research to support the medical benefits for using epidurals routinely in these circumstances, but some caregivers will continue to recommend them (and some women may be happy to accept them).
All the above health concerns do not necessarily mean an epidural will definitely be needed, but you may wish to consider the need for a
general anaesthetic in the case of an emergency. (Of course this is a possible outcome for any woman in labour). Read about the issues carefully, and hopefully you can make a decision you are happy with in accepting or declining an epidural in your labour.
The issues are as follows:
Twins
Premature baby
Posterior baby
Breech baby
VBAC
Twins. Most uncomplicated twin babies can be born vaginally without interventions.