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Childbirth: contraindications to an epidural
A bleeding disorder
If the mechanisms that allow blood to clot are disrupted, it can lead to bleeding. The danger is that a hematoma will form and compress the small nerve roots located in the epidural space, causing paralysis. This can happen if the mother-to-be has a congenital disease affecting coagulation, is on anticoagulant therapy to prevent phlebitis, or if the level of platelets (elements of the blood involved in clotting) has fallen. The latter case sometimes manifests itself in severe preeclampsia.
Possible infection
When the mother-to-be presents a skin wound, an abscess or pimples in the lumbar region, the microbes may spread, through the bite point, into the cerebrospinal fluid. Complications can be serious, such as meningitis, for example. Same thing in case of fever higher than 38 °. This is the reason why we systematically control the maternal temperature when entering the birth room.
A neurological problem
A major neurological disease or tumor may in some cases contraindicate an epidural. In general the concern is known before childbirth and the decision or not to ask it is made with the neurologist, the obstetrician and the anesthesiologist. It depends of course on the severity and the possible consequences of the disorder.
A risk of allergy
Allergies to products (local anesthetics, morphines) used during an epidural are extremely rare. However, they can be serious for the mother. This is why future mothers should report all their allergies, even mild ones, to the anesthetist.
Back malformation
A straight back is generally the guarantee of an easy and worry-free installation of the epidural. But if the mother has had an operation or suffers from major scoliosis, the technical gesture becomes more complicated. Usually the anesthetist deviates a little to find the most favorable place and manages to put it in place. To avoid a last minute surprise, a careful examination of your back during the consultation is essential.
A badly placed tattoo
Be careful, if you have decided to get a tattoo on your lower back, you may have to do without an epidural! Do not panic if you sport a very small and discreet one but if it is gigantic, and just in the area of the bite, it is not won. The reason ? Ink may migrate into the cerebrospinal fluid and cause neurological complications. It is more a question of prudence because at the present time it has never happened.
See also our article : What alternatives to the epidural?