Clotting and Hemoglobin Studies Before Epidural

Last night in our childbirth class, the nurse said something that concerned me. She was telling us about the procedures that are done when a woman in labor first arrives at the hospital, and she said that blood is drawn. She said that if your hemoglobin is low and/or your bleeding time is bad, you won't be able to get an epidural. I have been plagued by low iron resulting in a low hemoglobin for several months in my pregnancy. I am taking an iron supplement on top of my prenatal vitamins with iron and eating Total cereal several times a week, but now I'm worried this won't be enough and my hemoglobin won't be high enough. To be honest, an epidural has been an important part of my birth plan since day one, and the thought of not having that option and going "cold turkey" sends me into a panic. Have you ever heard of this before?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

One would never want to administer an epidural or any other form of regional anesthesia to a woman with a clotting disorder. The risk of hemorrhage at the site or into the cerebral spinal fluid could be disastrous. If your platelet count is below 100,000 epidural anesthesia is usually not recommended.

If a clotting disorder is suspected, a routine coagulation battery (RCB) consisting of prothrombin time, partial thromboplastin time, platelet count, and bleeding time, is commonly performed to assess coagulation status.

I have never seen such testing as a requirement for epidural. Usually the anesthesiologist will take a history to see if the client may be at risk for bleeding.

Such routine screening is a matter that depends upon the site and your hospital protocols are probably a result of a previous "incident."

It is very unlikely that your values will be abnormal. They are looking for true anemia, probably less than 9 to 10. Many pregnant women have below normal hemoglobins. They are also looking for women with low values for both, not just a low hemoglobin.

I would discuss your concerns with your doctor or midwife.

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