There are a few medical reasons that would incline a caregiver not to recommend an epidural, even if one is available to the woman. You can discuss your individual health circumstances with your anaesthetist, who should explain why this may be the case and what your alternatives are.
Some reasons why an epidural may not be recommended include:
Bleeding tendencies
Heavy vaginal bleeding
A blood infection
Back injuries
Woman's request
Bleeding tendencies. If the woman has very high blood pressure or a liver disorder, then this can sometimes affect the ability of her blood to clot normally. This is detected by a blood test in early labour for '
platelet' levels. Platelets are blood cells that help the blood to clot to control bleeding. If the platelet levels were too low, then an epidural would not be recommended in case the epidural needle causes heavy bleeding in the spinal area.
Women on medications to 'thin the blood' such as aspirin and heparin may have 'prolonged blood clotting times'. This means it takes the body longer to control any bleeding because they delay the normal clotting of the blood. Some medications used to stop premature labour (known as '
prostaglandin inhibitors') can also have this effect. The use of an epidural in these cases would need to be discussed with the anaesthetist.
Heavy vaginal bleeding. If the woman has complications causing heavy bleeding, such as placenta previa or a placental abruption, her blood pressure will probably be lower than normal. Giving the woman an epidural can further decrease her blood pressure, putting her and the baby at risk and therefore may not be recommended.
A blood infection. This is a very rare complication called 'septicaemia'. If the woman has a high fever or it is suspected that her blood is infected, it is unlikely that an epidural will be performed.