4 Reasons You Might Have to Labor Without an Epidural

For some, being pregnant isn't 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? 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, having an epidural to ease the pain or soldiering through those contractions med-free are both perfectly fine choices. You should base your decision on what feels best to you, not what the parents in your due date group say is best. Remember, it's your birth and your choice.

That said, some conditions make epidural anesthesia risky or not possible during your delivery. Read on for what you need to know about your likelihood of getting an epidural during labor.

What Is An Epidural?

According to the American College of Obstetricians and Gynecology (ACOG), epidural anesthesia is a form of regional anesthesia that acts on a specific part of the body. The medication includes a local anesthetic that is usually combined with an opioid analgesic. It is the most common type of anesthesia for labor and delivery.

To perform an epidural, an anesthesiologist places a needle into the space surrounding the spinal cord and 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 drug 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 you to rest between contractions and not be completely exhausted when the marathon of labor is finally over.

Reasons You Might Not Receive an Epidural

Despite the proven safety of epidural anesthesia, some are unable to have one. Several conditions are contraindicated for epidurals.

Pre-existing medical conditions

Many people with complex medical histories are aware of any limitations they may have regarding epidurals before going into labor. According to Eduardo Hariton, M.D., an OB-GYN at the University of California San Francisco, you might not be a candidate for an epidural if you have the following:

• Abnormal blood clotting
• Certain neurologic conditions like spinal aneurysms
• Systemic or local skin infections
• Certain cardiac conditions
• Low blood volume (people with heavy bleeding or who are in shock)

The International Journal of Gynecology and Obstetrics also lists sepsis (a life-threatening body-wide infection) as a contraindication for epidural anesthesia.

Also, health care providers 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. In addition, if the spaces between the vertebrae are cramped or smaller than is typical, an anesthesiologist might be unable to insert the needle.

If complications arise during pregnancy, your health care provider can help determine what anesthesia options are suitable for you and even set up a consultation with an anesthesiologist just to be safe. However, Jeremy Dennis, M.D., assistant professor of clinical anesthesiology at Yale-New Haven Hospital, Yale University, explains that an anesthesia consultation before 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.

That said, according to the American Society of Anesthesiologists, there is no limitation on when you can get an epidural—you can receive them at the beginning, middle, or near the end of labor. However, despite no definitive cut-off during labor where an epidural can't be placed, Dr. Dennis explains that sometimes it's 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 health care provider 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 places the epidural but it is ineffective. This may be due to the following:

• Previously unknown structural abnormalities
• The timing of the epidural placement
• Incorrect placement of the epidural

If labor progresses 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 relieve pain.

The Bottom Line

It's a good idea to discuss your birth plan with your health care provider to determine your ability to access 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.

Since labor can be unpredictable, having an alternative to an epidural in mind is a good idea. Other forms of pain relief, like IV (intravenous) medications, nitrous oxide (laughing gas), or local anesthesia may be available. And it's always a good idea to be prepared with natural coping techniques like relaxation exercises, deep breathing, position changes, and massage.