Expert: Dr Ian Jackson - please note UK based - 5/15/2008

Question
Hello ... I am currently 35 weeks pregnant and have been taking 40 mg Lovenox injections once daily.  My OB said she "thinks" it should be okay to have epidural without taking me off Lovenox due to such a low dosage I am taking.  It really scares me as she seems very unsure of her response to me.  I really would like an epidural - as I have such a low pain tolerance.  
Thank you
Lacy

Answer
Lacy
I'm sure you understand the risk here is the development of a blood clot (haematoma) around your spine which can lead to pressure effects and long term damage if not managed quickly. The incidence of this is low but it can happen. Lovenox has an effect on blood clotting and so can make this problem worse.
The risks rather depend on several factors. Are you taking any other medication that affects clotting e.g. aspirin or pain killers belonging to the group called non steroidal anti inflammatories (ibuprofen type). If you are then the answer is you shouldn't have an epidural.
The nest question is Why are you being given the Lovenox? What are the risk factors that led to this being used? What are the risks of stopping it for a period around your delivery?
Then you and your doctors need to weigh up these risks. We do provide epidurals to patients on low dose Lovenox but only 10 hrs after the last injection - so unless your delivery is planned if you were to start in labour a short time after your injection we would not offer an epidural unless there was a strong medical indication that made the risk worthwhile. Finally remember an epidural is not a 'must have' for delivery and despite your feelings about your pain tolerance no one knows just how painful it is going to be until it starts. A large percentage of women breeze through the process with litlle difficulty. So if the risks seem too high then don't have one.