Congratulations! Pregnancy is a wonderful time for women and their partners. Preparing for the birth of a child is a special time in your life filled with anticipation, excitement and, naturally a little anxiety. Don’t worry – We’ve got some of the country’s finest gynaecologists, obstetricians, neonatologists, and paediatricians for you.
At Motherhood we are happy to care for all women during their pregnancy.We are a centre of Excellence for Pregnancy Care. We guide you through all stages of pregnancy to delivery and beyond.
Preparing To Get Pregnant?
Caring for your health before you become pregnant is good for you and your baby. There are many important steps that a couple needs to take when getting ready to conceive a child. It is very important that both partners are prepared both physically and emotionally for this life-enhancing event.
The goal is to check for any potential risks to you and your baby during pregnancy and to address any medical issues you may have before you get pregnant. Start by scheduling a preconception counseling with your Obstetrician/Gynecologist
Wondering Why You Need Prenatal Care
The answer is simple, to keep you & your baby healthy.
You have a life growing inside you and along with that precious little life your body is going through a lot of change & you need to ensure you stay healthy to cope up with the changes.
During Prenatal care the doctor will make sure you and your baby are healthy and strong. These regular checkups are your chance to learn how to manage the discomforts of pregnancy, have any testing you may need, learn warning signs, and ask any questions you may have. Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.
In case of planned pregnancies,the best advice would be to start taking care of yourselves before you start getting pregnant. This is called Pre-conception counselling. It means knowing how health conditions and risk factors could affect you or your unborn baby if you become pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived.
Talk to your doctor before pregnancy to learn what you can do to prepare your body.
Why Postnatal Care?
The first six weeks following a baby’s birth can simultaneously be one of the most joyous and most difficult times for any woman. There are many changes and adjustments to be made physically,emotionally and socially, and many challenges to be faced.Just as every child is unique, so is every pregnancy, birth and postnatal period.
The postpartum period lasts six to eight weeks, beginning right after the baby is born.
During this period, the mother goes through many physical and emotional changes while learning to care for her newborn.
Schedule a checkup with your doctor after delivery to discuss symptoms and receive proper treatment
A pregnancy is considered high-risk when there are potential complications that could affect you, your baby or both. We, at Motherhood examine the full range of challenges in general obstetrics, medical complications, fetal disease, labor and delivery. Conditions that can complicate a pregnancy include high BP, STDs, heart diseases, heredity, cancer and diabetes.
Tackling the unknown risks of Motherhood
Motherhood is one of the most beautiful experience in a woman’s life. The health of both the mother and the fetus is of paramount importance and regular checkups and good prenatal care can ensure a safe and healthy delivery.
However, an unforeseen illness or a preexisting disease can complicate the pregnancy, which can put the mother or the child at risk. A pregnancy is considered to be of high risk when there are potential complications that could hamper the health of the mother, the baby or both. Such cases need special intervention by specialists to ensure that both the mother and the baby have the best outcome.
Conditions that put the Mother and the baby at higher risk:
- Women getting pregnant at and after 35 years.
- Women with Neurological disorders like epilepsy, multiple sclerosis, brain tumours, past history of cerebral venous thrombosis and Psychiatric illness can add to high risk pregnancy.
- Women with preexisting conditions like: Hypertension, Diabetes mellitus, Cardiac disease, Anemia, blood dyscrasia, haemoglobinopathy, platelet disorders, Liver problems are the major reasons of high risk pregnancy.
- Women with previous history of thromboembolism (obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation,) strokes, myocardial infarction, preterm labour, postpartum haemorrhage, third trimester fetal losses.
- Some women who has autoimmune diseases, thyroid, other endocrine disorders, renal disorders, placenta praevia (In this the placenta covers the cervix and can cause heavy bleeding specially if a women has contraction,) are also at high risk of Pregnancy.
- Obesity and Lifestyle choices like smoking cigarettes, drinking alcohol can put a pregnancy at risk
Every wannabe and expecting mothers has to follow certain basic guidelines to ensure safe and healthy delivery. Some of them include:
- Schedule a preconception appointment – If you are thinking about becoming pregnant, consult your health care provider. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy.
- Seek regular prenatal care – Prenatal visits can help your health care provider monitor your health and your baby’s health.
- Eat a healthy diet – During pregnancy, you’ll need more folic acid, calcium, iron and other essential nutrients. A daily prenatal vitamin can help fill any gaps.
- Gaining the right amount of weight can support your baby’s health and make it easier to shed the extra pounds after delivery.
- Avoid risky substances such as cigarette and drugs. Consult your health care provider’s before you start or stop taking any medications or supplements.
- Always opt for a tertiary center as in this all the speciality doctors will be available and will be beneficial to both mother and baby
It’s quite natural to feel anxious and concerned when you are pregnant, but it’s all the more worrisome for the expecting parent if you have any of the conditions of high risk pregnancy. To tackle these apprehensions, some studies suggest that certain techniques, such as imagining pleasant objects or experiences or listening to music, yoga and Lamaze can create a positive atmosphere for the expectant mother.
It’s imperative to consult your treating doctor about how to manage any medical conditions you might have during your pregnancy and how your health might affect labour and delivery. Do not hesitate to discuss with your doctor if you see any of the below specific signs or symptoms during the pregnancy period such as:
- Vaginal bleeding
- Persistent headaches
- Pain or cramping in the lower abdomen
- Watery vaginal discharge in a gush or a trickle
- Regular or frequent contractions — a tightening sensation in the abdomen
- Decreased foetal activity
- Pain or burning with urination
- Changes in vision, including blurred vision
A high-risk pregnancy can sound like a ‘mammoth’ word, but it certainly can be dealt with timely and effective medical care.
At Motherhood our doctors will be with you throughout your pregnancy and will watch for these pregnancy complications, using physical exams, lab tests, and ultrasounds. Meanwhile, you can help us by attending all your prenatal appointments and reporting any troubling symptoms.
miscarriages are incredibly common, despite it they are rarely discussed or talked about.
Miscarriage is the loss of a pregnancy in the first 20 weeks.Instead of morning sickness or a craving for ice cream, miscarriage ( loss before the 20-week mark) is actually the most common event during pregnancy. About 30 percent of pregnancies are lost before a woman even knows she is pregnant; it is estimated that around 15 percent of confirmed pregnancies end in miscarriage. Most first-trimester miscarriages are believed to be caused by chromosomal abnormalities in the fertilized egg that keep the embryo from developing.
Signs Of Miscarriage
- Bleeding/ Vaginal Spotting – It is typically the first sign of a miscarriage, but it may be misleading. About 30 percent of women will have bleeding during their pregnancies,but not all of them will miscarry. Contact your doctor at the first sign of bleeding so she can check your health and your baby’s.
- Pain – It is the other leading symptom of a miscarriage. The pain may be located in the abdomen, pelvic area, or lower back, and can range from dull and aching to period-like cramping. It may be difficult to distinguish if the pain is normal, since round ligament pain and even cramps can be common during early pregnancy as your body expands for the growing uterus.
- Decreased activity of the baby – The majority of miscarriages occur during the first trimester, but signs of a loss later on in the pregnancy may be different. One of the primary ways to determine your baby’s health is staying attentive to her activity. If you notice a sudden or drastic decrease in her activity, be sure inform your doctor so they can determine if further testing is necessary.
- Change in pregnancy symptoms – Less common but still noticeable symptoms of a miscarriage could include a decrease in pregnancy-related symptoms such as nausea and vomiting or breast tenderness. A blood test to measure the levels of pregnancy hormones can be done to determine if the pregnancy is still viable.
Always be sure to speak to your doctor if you’re experiencing any of these symptoms or have concerns about your own risk of a miscarriage.Motherhood is open to your needs 24*7 & if the doctor suspects a miscarriage, she’ll order an ultrasound to see what’s going on in your uterus and possibly do a blood test.
It’s a scary but true that complications can strike an expecting mother at any time during pregnancy. One of the most serious and, sadly, a leading cause is preeclampsia, a condition that affects 5 to 8 percent of all pregnancies
Preeclampsia is one of those perplexing pregnancy disorders that seem to have no rhyme or reason; it can occur in any woman, and while most cases develop in the third trimester (particularly after 37 weeks of pregnancy), it can develop as early as 20 weeks.
You’re diagnosed with preeclampsia if you have high blood pressure and protein in your urine or liver or kidney abnormalities after 20 weeks of pregnancy.
Most expectant mothers who get preeclampsia develop mild symptoms near their due date, and they and their babies do fine with proper care. But it can progress quickly, and severe preeclampsia can affect many organs and cause serious or even life-threatening problems. Women whose preeclampsia is severe or getting worse need to deliver early.
Here’s what to expect if you’re expecting and you develop preeclampsia:
Strict monitoring – We will not only monitor your blood pressure to ensure that it’s not going too high, but we will also require testing of your urine and blood done, too. Doctors will check your urine for rising protein levels (preeclampsia causes protein from your cells to spill over into your urine) and perform lab work to give them a more accurate picture of how preeclampsia is affecting your kidneys, liver, and other organs.
Your baby will also be carefully monitored, with non-stress testing (NSTs) and more frequent ultrasounds to measure amniotic fluid levels and markers for fetal well-being, like heart rate and breathing.
Medications – Although the only real “cure” for preeclampsia is delivering your baby, the disorder may be managed with antihypertensive medications to lower your blood pressure. In many cases, you’ll need to continue taking these after delivery as well, as the high blood pressure caused by the preeclampsia can last up to a year post birth. Other preventive measures include a daily dose of baby aspirin, which help prevent preeclampsia from worsening. Once you’re in labor, your doctor may also give you magnesium sulfate, a smooth muscle relaxant that’s infused through an IV, as a preventive measure to ward off seizures. And if you’re delivering before 37 weeks, doctors may prescribe special steroids for your baby to help with respiratory function, as his lungs may not be fully developed.
Hospitalization & Observation – If your preeclampsia becomes severe enough,the doctor will suggest you to be hospitalized so they can monitor your condition more closely & carefully. All preeclampsia cases are treated on an individual basis, for you and your baby’s best interest.
Placenta Previa (Low lying Placenta)
Having placenta previa means your placenta is located near the bottom of the uterus instead of on the side or closer to the top so it covers all or part of the inner opening of the cervix.
Placenta previa can happen to anyone, but occurs most often in women who are pregnant with multiples or for the second or third time, who smoke or use recreational drugs, who are older than 35, or who have had uterine surgery like a c-section or D&C
Placenta previa isn’t usually a problem early in pregnancy. But if the placenta remains dangerously low as your pregnancy progresses, it can cause bleeding, which can lead to other complications and may require you to deliver early.
The location of your placenta will be checked during your mid pregnancy ultrasound exam, but only a small percentage of women who have placenta previa in mid pregnancy still have it when they deliver their baby. Placenta previa is present in up to 1 in 200 deliveries. Women who have placenta previa when they give birth have to deliver by c-section
Gestational diabetes, or diabetes that is diagnosed during pregnancy in a woman who previously did not have diabetes, occurs when the pancreas fails to produce enough insulin to regulate blood sugar efficiently. That might not sound like many, but the condition is common enough and serious enough that pregnant women routinely get a glucose screening between 24 and 28 weeks to test for it.
If you develop gestational diabetes,we will recommend diet modifications, such as limiting carbohydrates, and regular exercise to get the condition under control quickly and normalize blood sugar levels. But some women may require daily glucose testing and more intensive treatment, such as insulin injections.
Most women are able to keep their blood sugar levels under control with diet and exercise and deliver healthy babies. But poorly controlled diabetes can have serious consequences for the baby.For mothers with gestational diabetes, there’s a 25 to 50 percent chance of developing type 2 diabetes later in life, though this risk can be significantly reduced by maintaining a healthy weight and lifestyle.
Ectopic (out of place) pregnancies occur in one out of every 100 cases.When a fertilized egg implants outside the uterus, it’s an ectopic pregnancy. Because the vast majority of ectopic pregnancies occur in a fallopian tube, they’re often called “tubal” pregnancies.
It’s important to catch this type of pregnancy early Typically this happens if your fallopian tube is blocked by scar tissue or has an abnormality. Eventually the abnormal pregnancy will grow and could cause the tube to rupture; if this occurs, severe abdominal pain and bleeding will result. Most ectopic pregnancies are diagnosed in time to prevent this.
How do you know if you have an ectopic pregnancy?
In addition to vaginal spotting or bleeding, you might suffer from
- Abdominal or pelvic pain and vomiting.
- You may also have an odd pain in the tip of your shoulder, caused by internal bleeding that irritates nerves that travel to your shoulders.
If you have any of these symptoms, call your doctor immediately.Since there’s no way to transplant an ectopic pregnancy into the uterus, ending the pregnancy is the only option.
Going into preterm labor does not mean you’ll have a premature baby. Up to half of the women who experience preterm labor eventually deliver at 37 weeks or later.
If you or your baby have a complication and are not doing well, the medical team might decide to induce labor early or perform a cesarean section before 37 weeks.
Signs and symptoms of preterm labor
- Blood or other fluid leaking from your vagina (call your doctor right away if you have this symptom)
- Menstrual-like cramps, which may come and go
- Low, dull backache
- Pelvic pressure (may feel like the baby is pushing down)
- Change in vaginal discharge
- Abdominal cramps (with or without diarrhea
- Uterine contractions (coming every ten minutes or more often)
Premature Babies- Are they healthy?
Preterm birth can cause serious health problems or even be fatal for a baby, particularly if it happens very early.Some preterm babies may have problems breathing & are more prone to infection and jaundice and may have difficulty feeding as well as trouble maintaining their body temperature.
Every family hopes that their baby be born healthy and normal, but should your baby need specialized care, our team of expert neonatologists and neonatal nursing staff will provide it. The Neonatal Intensive Care Unit (NICU) at Motherhood is a level III unit. We offer the most advanced care for premature and critically ill newborns.
Premature labour is also called preterm labour. It’s when your body starts getting ready for birth too early in your pregnancy. Labour is premature if it starts more than three weeks before your due date.
Premature labor can lead to an early birth. But the good news is that doctors can do a lot to delay an early delivery. The longer your baby gets to grow inside you — right up to your due date — the less likely he or she is to have problems after birth.
What Increases Your Risk?
Lots of different things can increase your risk of premature labor. Some of them are:
- Being very overweight or underweight before pregnancy
- Not getting good prenatal care
- Drinking alcohol during pregnancy
- Having health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, or infections
- Being pregnant with a baby that has certain birth defects
- Being pregnant with a baby from in vitro fertilization
- Being pregnant with twins or other multiples
- A family or personal history of premature labor
- Getting pregnant too soon after having a baby
What does premature birth mean?
Once you reach 37 completed weeks of pregnancy, your baby is what’s called “term”. Your baby will be premature if he arrives before you’re 37 weeks pregnant. Most premature babies arrive after 32 weeks and have a good chance of surviving and growing up to be healthy.
Intensive care for extremely early babies has improved dramatically, and survival rates are much better than they used to be. However, there can sometimes be long-lasting effects for babies arriving very early, including cerebral palsy and learning difficulties.
Most babies who are relatively early, at around 34 weeks to 36 weeks, thrive and do well. However, they can be at greater risk of long-term developmental problems when compared with babies born at term.
Generally, the further on in your pregnancy you are, the more likely it is that your baby will do well. His organs will be more mature, his lungs better prepared for breathing, and he’ll have more strength for sucking and feeding.
Why does premature birth happen?
The majority of premature births happen when labour starts by itself, without the waters breaking. However, about a quarter of premature births are planned early inductions or caesareans, performed because of complications affecting either the mum or the baby.
Premature birth is much more common among pregnancies with more than one baby, where the risk is as high as one in two. In single pregnancies though, it’s very common for there to be no explanation as to why a baby has arrived early.
What will happen when my baby is born?
If your baby is born:
- Extremely early (27 weeks or earlier), he will need to be cared for in a neonatal intensive care unit (NICU). He’ll need to be kept very warm as he’ll have a high risk of hypothermia, and will need dextrose to prevent low blood sugar. He will also be at risk of low blood pressure and infection, and will need help with his breathing.
- Very early (28 weeks to 31 weeks), he is likely to be cared for in a special care baby unit (SCBU) or local neonatal unit (LNU). He will be stronger than younger babies but still at risk of hypothermia, low blood sugar and infection. He may need more specialised care at an NICU.
- Moderately early (32 weeks to 33 weeks), he may have problems with breathing, feeding and infection which require specialised care. He may be able to stay with you on a transitional care ward, or be taken straight to an LNU or SCBU.
- Early (34 weeks to 36 weeks), he may not need any treatment. He may look small but still be able to go straight to the postnatal ward with you. Or he may be admitted with you to a transitional care ward. It will depend on how well he’s feeding, and whether he has problems with blood sugar levels, blood pressure or infection.
Vaginal Delivery (Natural Birth)
A vaginal delivery occurs when your baby is born through your vagina (birth canal). There are three stages of labor that occur during a vaginal delivery. At Motherhood we recommend our expecting Mothers to plan for vaginal birth unless there is a medical reason for a cesarean.
- The first stage begins when you start having contractions, the tightening of your uterine (womb) muscles.
- The second stage begins when your baby enters your birth canal and ends when your baby is born.
- The third stage begins after your baby is born and ends when your placenta is delivered. The placenta provides oxygen and food to your baby during pregnancy.
Benefits of Vaginal Delivery:
- Shorter hospital stays
- Lower infection rates
- Quicker recovery
- Babies born vaginally have a lower risk of respiratory problem
A vacuum extraction is a procedure sometimes done during the course of vaginal childbirth. During vacuum extraction, a health care provider applies the vacuum (a soft or rigid cup with a handle and a vacuum pump) to the baby’s head to help guide the baby out of the birth canal.
A forceps delivery is a type of operative vaginal delivery. It’s sometimes needed in the course of vaginal childbirth. In a forceps delivery, a health care provider applies forceps (an instrument shaped like a pair of large spoons or salad tongs) to the baby’s head to help guide the baby out of the birth canal.
Caring For The Episiotomy Wound
The perineum is the skin between the vagina and the anus, which thins out and stretches as the baby is delivered. Many women will need stitches to repair any tears or cuts (episiotomy) of the perineum that occur during childbirth. The perineal tear usually heals in two to three weeks, depending on the size of the incision and the type of sutures used to close the wound.
- Keep the wound clean by washing with water, dry and dab gently after every toilet visit.
- Change sanitary pads every two to three hours.
- Reduce discomfort by:
- Using Epikool (pads with cooling gel)
- Lying on the bed or resting on your side every few hours. Avoid sitting for long periods.
- Taking prescribed painkillers to help control any pain.
- Use a sitz bath:
- Add two teaspoons of salt into cool/ lukewarm water in the sitz bath basin.
- Ease yourself in the basin until water touches your perineum.
- Immerse yourself for approximately 20 minutes, three times a day.
- The stitches will dissolve on their own and do not need to be removed.
Please consult your doctor if you experience any of the following:
- Pus-like/ foul-smelling discharge from vagina
- Bleeding from episiotomy wound
- Fever and/ or chills
- Severe or increased perineal pain
A c-section, or cesarean section, is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it’s done in response to an unforeseen complication.
Sometimes it’s clear that a woman will need a c-section even before she goes into labor.
You may require a planned c-section if:
- You’ve had a previous cesarean or more than one previous c-section. Both of these significantly increase the risk that your uterus will rupture during a vaginal delivery.
- If you’ve had only one previous c-section with a horizontal uterine incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC.
- You’ve had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).
- You’re carrying more than one baby. (Some twins can be delivered vaginally, but most of the time higher-order multiples require a c-section.)
- Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you’re diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.
- Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)
- You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).
- You have an obstruction, such as a large fibroid, that would make a vaginal delivery difficult or impossible.
- The baby has a known malformation or abnormality that would make a vaginal birth risky, such as some cases of open neural tube defects.
- You’re HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.
Note: Your surgery will be scheduled for no earlier than 39 weeks,unless there is a medical reason to do so in order to make sure the baby is mature enough to be born healthy.
Emergency C- section
You may need to have an emergency c-section if problems arise that make continuing or inducing labor dangerous to you or your baby. These include the following:
- Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven’t worked.
- Your baby’s heart rate gives your practitioner cause for concern, and she decides that your baby can’t withstand continued labor or induction.
- The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.
- Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won’t get enough oxygen unless he’s delivered right away.
- You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.
Caring For The Caesarean Wound
- In the first week after operation, always keep the dressing clean and dry.
- If it gets wet, visit the nearest GP clinic/ polyclinic to change it.
- Removal of dressing is to be advised by nurses or as indicated by your doctor.
- Removal of stitches depends on the type of sutures used and is to be done according to the doctor’s instructions.
- Observe for bleeding, redness or pus around the wound area, which may suggest wound infection. Please return to the hospital if you have any of these symptoms and/ or fever.
- Do not lift heavy objects for at least two months.
- Avoid strenuous activity that may cause injury or pain. This will allow your wound to heal promptly.
As one grows old, threshold to bear pain also reduces but epidural anaesthesia increases chances of having normal deliveries. Epidural anesthesia is the most popular method of pain relief during labor.
What is epidural anesthesia?
Epidural anesthesia is a regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.
Benefits of Epidural Anesthesia
- Allows you to rest if your labor is prolonged.
- By reducing the discomfort of childbirth, some women have a more positive birth experience.
- Normally, an epidural will allow you to stay alerted and remain an active participant in your birth.
- If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
- When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
Does the placement of epidural anesthesia hurt?
Some women describe an epidural placement as creating a bit of discomfort in the area where the back was numbed, and a feeling of pressure as the small tube or catheter was placed.
When will my epidural be placed?
Typically epidurals are placed when the cervix is dilated to 4-5 centimeters and you are in true active labor.
How can my epidural affect labor?
Your epidural can cause your labor to slow down and make your contractions weaker. If this occurs, you may be given the medicine to help speed up labor.
How can an epidural affect my baby?
How much of an effect these medications will have is difficult to predetermine and can vary based on dosage, the length of labor, and the characteristics of each individual baby.
How will I feel after the placement of epidural?
The nerves of the uterus should begin to numb within a few minutes after the initial dose. You will probably feel the entire numbing effect after 10-20 minutes. As the anesthetic dose begins to wear off, more doses will be given–usually every one to two hours.
Will I be able to push?
You might not be able to tell that you are having a contraction because of your epidural anesthesia. If you can not feel your contractions, then pushing may be difficult to control. For this reason, your baby might need additional help coming down the birth canal. This is usually done by the use of forceps.
Does an epidural always work?
For the most part, epidurals are effective in relieving pain during labor. Some women complain of being able to feel pain, or they feel that the drug worked better on one side of the body.
When can an epidural NOT be used?
An epidural may not be an option to relieve pain during labor if any of the following apply:
- You use blood thinners
- Have low platelet counts
- Have an infection in the back
- Have a blood infection
- If you are not at least 4 cm dilated
- Epidural space can not be located by the physician
- If labor is moving too fast and there is not enough time to administer the drug.