There are a few reasons that would incline an
anaesthetist not to use or recommend an epidural for a Caesarean birth. 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 used or recommended include:
The epidural does not work
Bleeding tendencies
Heavy vaginal bleeding
A blood infection
Back injuries
Woman's preference
The epidural does not work. Not all epidurals will work adequately enough to perform the operation. Generally, an epidural will be effective for about 80 to 85% of women. It will partially work for about 12 to 15 % (which will usually not be enough to provide adequate anaesthesia for the operation and will not work at all for about 3 to 5 % of women. This will mean that the woman will need a general anaesthetic.
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 are 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.