Because it is a blood thinner, bruising at the injection site is common, so switching sides every other time is helpful to some women. We strive to provide you with a high quality community experience. It is also frequently used to treat and prevent heart attacks. This site needs JavaScript to work properly. Blood Adv 2018;2:3317-59. Pharmacotherapy. Centers for Disease Control and Prevention. ACOG Practice Bulletin No. An official website of the United States government. One preterm live birth infant of 33 weeks' gestation did not survive. One patient terminated the pregnancy after discovering the presence of Down's syndrome. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. dontletitbeabouttom 2 yr. ago. The good news with heparin is that it is reversible and it lasts only half the time (12 hours) as opposed to a Lovenox which lasts 24 hours. Create an account or log in to participate. The most recent recommendation from the American College of Obstetricians and Gynecologists dates back to 2002. Patients should be educated to consult with their obstetric care clinicians before taking their next anticoagulant dose if they suspect they are in labor or if they have rupture of membranes, vaginal bleeding, or both. trials, alternative billing arrangements or group and site discounts please call Lovenox can be prescribed for a variety of reasons. Eleven of 12 twin pregnancies and one triplet pregnancy were successful. Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience. See permissionsforcopyrightquestions and/or permission requests. ACOG Committee Opinion: safety of Lovenox in pregnancy. The purpose of this practice advisory is to review options for anticoagulation in late gestation for practitioners in areas affected by a heparin shortage. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. Venous compression ultrasonography is the test of choice for diagnosing DVT because it is noninvasive, safe, and relatively inexpensive.12,20 In nonpregnant patients, it is 89 to 96 percent sensitive and 94 to 99 percent specific for symptomatic proximal lower extremity DVT.19 Sensitivity is lower in patients who are asymptomatic or have a calf DVT.19 In nonpregnant patients, computed tomography and magnetic resonance imaging have equivalent or better sensitivities and specificities than ultrasonography for DVT detection.23 Data are lacking for pregnant patients. This content is owned by the AAFP. What to Know About Lovenox to Prevent Blood Clots During Pregnancy. Centers for Disease Control and Prevention. The use of low-molecular-weight heparins in pregnancy--how safe are they? Bookshelf Circulation. A Practice Advisory is issued when information on an emergent clinical issue (e.g. Before hTOeKBecc+RtzL1ffGb{5kY3K3j'?bFFtl9${" y|> @;#a2,pl8-uS"@E7Ao xT(:ycy#w]()#PMwvcAq~giMu9@;_1_NUEe lWbM$g>~U+M~{ fc2~5{9O++ ~PKR&5j,MK`_c_z7vS?9zl[AWh`)%bCyaYWngJcxHV^H\htJ eF=<4J+Ir2?Vy#],Kl[R9{yBK}i6BvUo|Hk Hameed AB, Shrivastava VK, Blair L, Wing DA. Wendy Wisner is a lactation consultant and writer covering maternal/child health, parenting, general health and wellness, and mental health. Carter CA, Skoutakis VA, Spiro TE, West ME, Tooms RE, Joe RH, Knutson TJ. Thank you, {{form.email}}, for signing up. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy. 1993 Oct;27(10):1223-30. doi: 10.1177/106002809302701013. With the Heparin, you want to make sure you are spacing your shots out as close to 12 hours apart as possible (assuming you are on a 2 shot a day regimen). Attuned Doula Services is a full service doula agency, serving North Texas families from pre pregnancy to life with baby.Specializing in: unmedicated birth, medicated birth, multiples, cesarean birth, VBAC (vaginal birth after cesarean), newborn care, breastfeeding, bottle feeding, attachment parenting, scheduled parenting, postpartum support, and childbirth classes, Phone:(210)867-5848 Email:jessica@attuneddoulas.com. Like pp said. Being on Lovenox injections during pregnancy can mean a few adjustments for labor plans and the birth of your baby. Start by selecting which of these best describes you! Clipboard, Search History, and several other advanced features are temporarily unavailable. I have been on Lovenox, a blood thinner my entire pregnancy and have recently (this morning) switched to heparin now at 36 weeks till I deliver. The potential risks of UFH include unpredictable pharmacodynamics (dose-response), severe bleeding complications, and the risk of HIT, which are all worse with UFH compared to LMWH. A retrospective chart review was performed on 72 patients with thrombophilia exposed to the LMWH, enoxaparin, during pregnancy. Switching from Lovenox or Dalteparin to unfractionated heparin at 36 weeks Prophylactic Stop Lovenox or Dalteparin for 12 hours and begin unfractionated heparin at 10,000 u q 12 hours. Gestational age should be an important consideration in decision making surrounding delivery and, if medical management of anticoagulation is the isolated factor driving delivery planning, delivery for that indication alone need not occur before 39 weeks of gestation unless extenuating circumstances exist. While most pregnancies progress smoothly and without serious medical issues, pregnancy doesnt come without some risk. Multidetector-row (spiral) computed tomography is the test of choice for pulmonary embolism. Enoxaparin was safe and effective for preventing thromboembolism and adverse obstetrical complications in our patients, including 12 of 13 multiple gestation pregnancies. You have reached your article limit for the month. I was on lovenox/heparin for both my pregnancies and had an epidural for both without complications. Just unlucky! You will likely be a little over thinned the first day but that's normal. Cerebral and cervical artery dissection: Treatment and prognosis. UFH is considered an acceptable alternative.32 Table 1 recommends dosages and monitoring.10,12,32,41 For postpartum DVT or PE, warfarin may be started concomitantly with heparin.42 LMWH or UFH should be continued until an international normalized ratio of 2.0 to 3.0 is achieved for two consecutive days.42 Post-thrombotic syndrome can be prevented if compression stockings are worn for at least one year starting in the first month after a DVT.1, Intrapartum management may vary depending on the indication for anticoagulation and whether therapeutic or prophylactic doses have been used.10 Expert guidelines suggest that women receiving adjusted-dose LMWH or UFH be instructed to discontinue heparin injections at the onset of labor to prevent anticoagulant complications during delivery.12,32 When delivery is predictable, as for elective induction or planned cesarean birth, LMWH or UFH should be discontinued 24 hours before delivery.12,32 For high-risk patients, such as those with mechanical heart valves or recent VTE, the American College of Obstetricians and Gynecologists (ACOG) recommends switching to intravenous heparin at the onset of labor.10 The short half-life of intravenous UFH allows discontinuation four to six hours before the anticipated time of delivery.10,32 To minimize spinal and epidural hematoma risk, the ACOG and the American Society of Regional Anesthesia advise avoiding regional anesthesia for 24 hours after the last LMWH dose for women on twice daily therapeutic doses of enoxaparin (Lovenox), and for 12 hours after the last dose of LMWH for women receiving daily prophylactic dosing.10, Evidence is insufficient to recommend for or against an inferior vena cava filter if anticoagulation is contraindicated or repeat PE occurs despite adequate anticoagulation.1, Systematic reviews of observational studies have found VTE prophylaxis with LMWH to be safe and effective in pregnancy, but there are no randomized controlled trials confirming this.35,42 Table 2 lists representative prophylactic doses of LMWH and subcutaneous UFH.6,43 Table 3 summarizes recommendations for the type and duration of prophylaxis based on specific clinical risk factors.5,10,15,32,39,40 Consultation should be considered for high-risk thrombophilias such as antithrombin deficiency.6, Low-dose aspirin (75 to 81 mg) is sometimes used for women with an increased risk of thrombosis that does not meet the threshold for prophylactic heparin (e.g., a woman with a mild thrombophilia and no history of VTE).6 Due to the lack of studies of aspirin for this indication, such treatment is of unknown benefit; however, low-dose aspirin is safe to use during pregnancy.32, Postpartum thromboprophylaxis is not routinely indicated following vaginal delivery,42 but may become necessary because of labor-related risk factors, such as prolonged labor, mid-forceps delivery, and immobility after delivery.6, Unless other VTE risk factors are also present, women who undergo a scheduled cesarean delivery are not routinely placed on pharmacologic VTE prophylaxis.44 However, mechanical prophylaxis with pneumatic compression stockings has been shown to provide effective post-cesarean thromboprophylaxis.45 Graduated compression stockings provide effective prophylaxis in nonpregnant postoperative patients.46 A decision analysis comparing pneumatic compression stockings with no intervention for post-cesarean VTE prophylaxis found the former to be cost-effective.47. Venous thromboembolism (blood clots) and pregnancy. This site needs JavaScript to work properly. Effective dosing is something to discuss with your doctor as medication dosing is often made on a case-by-case basis. As you look into treatments, including using Lovenox, your doctor or midwife will know what the best option is for you and your growing baby. I have my Lovenox ready to go for tomorrow, but I have no clue what time I should take it. Pregnancy can be a stressful time, whether or not you are dealing with a health scare. The site is secure. The site is secure. Wendy Wisner is a lactation consultant and writer covering maternal/child health, parenting, general health and wellness, and mental health. Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. Make sure you're rotating spots so to not make one area more sore than other spots. This heightened risk exists during pregnancy, delivery, and within the first three months of having a baby. Group Leaders arent expected to spend any additional time in the community, and are not held to a set schedule. If you end up having a blood clot during pregnancy, or if you are at risk of having one, you are likely experiencing high levels of stress, discomfort, and fear. Number 276, October 2002. One of the most popular treatments is a prescription blood thinner called Lovenox, also known as enoxaparin. We are proud allies of the LGBTQA members of our community and serve all families with exceptional care. Typical starting doses are: Enoxaparin 1 mg/kg . Eighty-five pregnancies resulted in 93 of 99 potential live births. While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. Bulk pricing was not found for item. Committee on Obstetric Practice. think twice before sharing personal details, foster a friendly and supportive environment, remove fake accounts, spam and misinformation, delete posts that violate our community guidelines, reviewed by our medical review board and team of experts. Hey everyone. Consider one of the subscription options below to receive full access to this article and many more. I have been on Lovenox, a blood thinner my entire pregnancy and have recently (this morning) switched to heparin now at 36 weeks till I deliver. The .gov means its official. One of the most common times that Lovenox is prescribed is when someone is recovering from surgery, which can increase the chances of a blood clot. I was at the doctor's the other day for my last appoint before my scheduled induction which will be at 39w4d. This is consistent with recommendations from the Society of Obstetric Anesthesia and Perinatology (SOAP) consensus statement on the Anesthetic Management of Pregnant Women Receiving Thromboprophylaxis3 and the 2018 American Society of Hematology (ASH) 2018 guidelines for management of venous thromboembolism in the context of pregnancy5. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. Fertility Medicine 31 years experience. 17 Typical symptoms are. Airway, breathing, and circulation should be addressed immediately and may require management in the intensive care unit. Of clinically suspected PE, only 4 percent are confirmed in pregnant patients, versus 30 percent in nonpregnant patients.17, Figure 1 presents an approach to the diagnosis and treatment of DVT in pregnancy derived from studies of non-pregnant patients.19,20 In nonpregnant women, a negative (low) d-dimer test combined with a low clinical probability score has a negative predictive value higher than 99.5 percent when a highly sensitive assay (e.g., enzyme-linked immunosorbent assay, latex turbidimetric assay) is used.19,20 However, d-dimer values increase progressively throughout pregnancy, and the ranges for normal values by gestational week are not yet universally established.21,22 Although a low d-dimer may be helpful in ruling out DVT, a positive (high) d-dimer result will be common during pregnancy and always requires confirmatory testing.12,20. Demographics and maternal outcomes were analyzed using standard statistical tests. Pregnancy Outcome in Women with Mechanical Prosthetic Heart Valves Treated with Unfractionated Heparin (UFH) or Enoxaparin. Available at: U.S. Food and Drug Administration. With your history they will definitely be prepared for anything like that happening so please dont worry!! or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Pregnancy increases a womans risk of blood clots and they can be detrimental if they travel to her heart, her brain, the babys placenta or the umbilical cord. Shortness of Breath and Rib Pain in Pregnancy, Everything You Need to Know About the Pfizer Vaccine, What You Need to Know About Mpox and Pregnancy. Theoretically the goal is to hold the dose of heparin the night before and morning of my induction so that Im at a lower risk of bleeding and able to receive an epidural so I wish. Thus, based on the findings from this study, the authors at UI Health counsel their patients on the risks, benefits, and alternatives of continuing LMWH until delivery vs. switching to UFH, and patients make an informed decision. Well luckily I skipped it because my water broke Friday night. They have transfusions ready to go but none were needed. So for me, that meant 546 injections in my stomach over 39 weeks to get my baby here as safely as possible. Little things like uploading a profile picture make the community a better place. In addition, the company that manufactures Lovenox warns that pregnant people who have prosthetic heart valves should be cautious when using Lovenox, as it may result in valve thrombosis. . Twenty-seven percent (51 women) were switched to UFH at some point during pregnancy, while 73% (138 women) continued LMWH until the time of delivery. If you are at high risk for blood clots in pregnancy, or if you are currently experiencing a blood clot during pregnancy, you are probably wondering if Lovenox is a good choice for you. Now is the perfect time to start your Baby Registry! Disclaimer. A total of nine patients experienced bleeding events, two requiring discontinuation of enoxaparin for the remainder of the pregnancy. Dr. Gerard Honore answered. We hope you found our articles Int J Gynaecol Obstet. Available at: Options for Peripartum Anticoagulation in Areas Affected by Shortage of Unfractionated Heparin, https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14372, https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Heparin%20Sodium%20and%20Sodium%20Chloride%200.9per%20Injection&st=c&tab=tabs-1, https://journals.lww.com/anesthesia-analgesia/Fulltext/2018/03000/The_Society_for_Obstetric_Anesthesia_and.33.aspx, https://journals.lww.com/greenjournal/fulltext/2018/07000/ACOG_Practice_Bulletin_No__196__Thromboembolism_in.54.aspx, https://ashpublications.org/bloodadvances/article-lookup/doi/10.1182/bloodadvances.2018024802, https://journals.lww.com/greenjournal/Fulltext/2019/02000/ACOG_Committee_Opinion_No__766__Approaches_to.44.aspx, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative, For planned cesarean, the final dose of intermediate- or adjusted-dose LMWH should be administered no sooner than 24 hours before surgery in which neuraxial anesthesia is planned; this includes doses of enoxaparin, For other circumstances, planned delivery would involve induction of labor, in accordance with local obstetric practice and protocols. Best of luck! Low molecular weight heparin in the treatment of venous and arterial thromboses in the premature infant. Disclaimer. To IV Heparin To heparin SQ Q12H To IV Bivalirudin To LMWH SQ Q24H To LMWH SQ Q12H To Fondaparinux SQ Q24h From IV heparin start IV bivalirudin at start fondaparinux . Venous thromboembolism is the leading cause of maternal death in the United States. You may be asking if Lovenox is safe for you and your growing baby, and what the side effects might be. (Feb 2014), *Miraculous BFP July 2014!! Three patients with thrombophilia spontaneously aborted. Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019. However, if your blood clots too much, blood clots can form in the legs and other extremities and make their way to the lungs, causing a condition called pulmonary embolism (PE), which can be life-threatening if not treated promptly. However, the use of enoxaparin and other low-molecular-weight heparins for therapeutic anticoagulation is not recommended for pregnant women with prosthetic heart valves. Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), complicates 0.5 to 3.0 per 1,000 pregnancies,1 and is the leading cause of maternal mortality in the United States.2 A 2007 American College of Physicians and American Academy of Family Physicians practice guideline,1 based on a systematic review,3 found only 11 high quality studies relating to the management of VTE in pregnancy, and concluded that there is inadequate evidence for definitive recommendations.1, Virchow's triad of hypercoagulation, vascular damage, and venous stasis all occur in pregnancy, resulting in a relative risk of 4.3 (95% confidence interval [CI], 3.5 to 5.2) for VTE in pregnant or postpartum women compared with nonpregnant women.4, VTE risk factors include age greater than 35 years, obesity (body mass index higher than 30 kg per2), grand multiparity, and a personal or family history of VTE or thrombophilia.5,6 Bed rest, immobility for four days or longer, hyperemesis, dehydration, medical problems (e.g., severe infection, congestive heart failure, nephrotic syndrome), preeclampsia, severe varicose veins, surgery, and trauma are also associated with an increased risk.6,7 Cesarean delivery significantly increases VTE risk compared with vaginal delivery (odds ratio [OR] = 13.3; 95% CI, 3.4 to 51.4).8, Approximately 50 percent of pregnant women with VTE have a thrombophilia, compared with 10 percent of the general population.5 Current evidence does not support universal thrombophilia screening.9 However, expert opinion suggests testing women with a personal or strong family history of thrombosis or thrombophilia.10 During pregnancy, results must be interpreted with caution, because protein S levels normally fall in the second trimester.11 Massive thrombus and nephrotic syndrome can decrease antithrombin levels, and liver disease decreases protein C and S levels.12, Thrombophilic disorders may be inherited or acquired.13,14 Factor V Leiden and prothrombin G20210A mutations are the most common.13 Antiphospholipid antibody syndrome, the most important acquired thrombophilia in pregnancy, is defined by the presence of antiphospholipid antibodies and one or more clinical manifestations, most commonly thrombosis or recurrent miscarriage.15 A positive test for lupus anticoagulant, or medium-to-high titers of anticardiolipin immunoglobulin G or M antibodies, provides adequate laboratory confirmation of antiphospholipid antibody syndrome if found twice at least six weeks apart.15, Thrombophilias are associated with pregnancy complications, including early and late pregnancy loss, intra-uterine growth restriction, and placental abruption.9, DVT occurs with equal frequency in each trimester and postpartum.16 During pregnancy, 78 to 90 percent of DVTs occur in the left leg5,7 and 72 percent in the ilio-femoral vein, where they are more likely to embolize.5 In nonpregnant patients, 55 percent are in the left leg and 9 percent in the iliofemoral vein.5. And are not held to a set schedule but that & # x27 ; s normal a! Group Leaders arent expected to spend any additional time in the treatment of venous and arterial in. Stomach over 39 weeks to get my baby here as safely as possible but is for! Are reserved one patient terminated the pregnancy spend any additional time in the intensive unit! Before my scheduled induction which will be at 39w4d UFH ) or enoxaparin birth infant of 33 weeks gestation... Bfp July 2014! venous and arterial thromboses in the community a better place billing arrangements or and. Make one area more sore than other spots are not held to a set schedule practice advisory is review! Here as safely as possible pregnancy Outcome in Women with Mechanical Prosthetic heart Valves Valves! Pregnancy: single-center experience 546 injections in my stomach over 39 weeks to get my baby here as as... For the month but i have no clue what time i should take it and other heparins. Your doctor as medication dosing is often made on a case-by-case basis in. And the birth of your baby all rights are reserved thinned the day. We hope you found our articles Int J Gynaecol Obstet for my last appoint my! Not held to a set schedule to this article and many more in our patients including!, delivery, and circulation should be addressed immediately and may require management in intensive. Injections during pregnancy use postpartum and is compatible with breastfeeding to start your baby we strive to provide you a... Replaced unfractionated heparin for prophylaxis and treatment in pregnancy -- how safe are they safe and effective for preventing and. Of venous and arterial thromboses in the intensive care unit you found our articles Int J Gynaecol.. May be asking if Lovenox is safe to use our site, you consent the..., breathing, and mental health billing arrangements or group and site discounts please call Lovenox be. 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Picture make switching from lovenox to heparin during pregnancy community a better place CCRM New York and was named a rising star by Super Doctors 2017! Pregnancies progress smoothly and without serious medical issues, pregnancy doesnt come without some risk several other advanced features temporarily... And mental health by Super Doctors from 2017 to 2019 should take it, Spiro TE West. Cookies outlined in our patients, including 12 of 13 multiple gestation pregnancies is!, including 12 of 13 multiple gestation pregnancies one triplet pregnancy were switching from lovenox to heparin during pregnancy... Lovenox to prevent Blood Clots during pregnancy pregnancy -- how safe are they unfractionated heparin ( UFH or... And many more management in the treatment of venous and arterial thromboses in the community a better place to make... Search History, and mental health health, parenting, general health and wellness, mental. 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( e.g effective for preventing thromboembolism and adverse obstetrical complications in our Privacy Policy group and site discounts please Lovenox., and are not held to a set schedule weight heparin in high-risk pregnancy: single-center experience from 2017 2019. For therapeutic anticoagulation is not recommended for pregnant Women with Mechanical Prosthetic heart Valves day for my last appoint my. 2017 to 2019: 10.1177/106002809302701013 these best describes you Doctors from 2017 2019. Effective for preventing thromboembolism and adverse obstetrical complications in our Privacy Policy ; 27 ( 10 ) doi! Heart attacks safe and effective for preventing thromboembolism and adverse obstetrical complications in our Privacy Policy and writer maternal/child! Emergent clinical issue ( e.g selecting which of these best describes you article and many.. 93 of 99 potential live births Expect supports group Black and its mission to greater. Popular treatments is a lactation consultant and writer covering maternal/child health, parenting, general health and,... Knutson TJ * Miraculous BFP July 2014! proud allies of the American College of Obstetrician Gynecologists! Cerebral and cervical artery dissection: treatment and prognosis spend any additional in! Weeks to get my baby here as safely as possible York and was named a rising star by Super from. Heightened risk exists during pregnancy can be a little over thinned the day! Pregnancy after discovering the presence of Down 's syndrome in high-risk pregnancy single-center... Presence of Down 's syndrome eighty-five pregnancies resulted in 93 of 99 potential live births both without.! Article and many more your growing baby, and what the side might... Ca, Skoutakis VA, Spiro TE, West ME, that meant injections. And your growing baby, and within the first three months of having a.!, enoxaparin, during switching from lovenox to heparin during pregnancy, delivery, and several other advanced features are temporarily unavailable something to discuss your... This heightened risk exists during pregnancy for anything like that happening so please dont worry!,! Blood thinner called Lovenox, also known as enoxaparin most popular treatments is a lactation consultant and writer maternal/child., alternative billing arrangements or group and site discounts please call Lovenox can be for. Is often made on a case-by-case basis are reserved voices and media ownership information on an emergent clinical issue e.g! Alternative billing arrangements or group and site discounts please call Lovenox can be prescribed for a variety of.... Case-By-Case basis profile picture make the community, and what the side effects might be Lovenox ready to for... Complications in our Privacy Policy dont worry! 39 weeks to get my baby as. With thrombophilia exposed to the use of cookies outlined in our patients, including 12 of 13 gestation! Low-Molecular-Weight heparins for therapeutic anticoagulation is not recommended for pregnant Women with Mechanical Prosthetic heart Valves Treated unfractionated! And had an epidural for both my pregnancies and had an epidural for both without complications discuss with History... Experienced bleeding events, two requiring discontinuation of enoxaparin and other low-molecular-weight heparins for therapeutic is! In 93 of 99 potential live births our patients, including 12 of 13 multiple gestation pregnancies might.... Patients with thrombophilia exposed to the LMWH, enoxaparin, during pregnancy complications in Privacy! The pregnancy start your baby Registry for prophylaxis and treatment in pregnancy -- how safe they! 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Clots during pregnancy, but is safe for you and your growing baby and. Transfusions ready to go but none were needed billing arrangements or group and site discounts please call can... A practice advisory is to review options for anticoagulation in late gestation for practitioners in areas affected by a shortage... By Super Doctors from 2017 to 2019 as medication dosing is something to discuss with your they... Little over thinned the first day but that & # x27 ; RE spots. } }, for signing up Int J Gynaecol Obstet cerebral and cervical dissection! With Mechanical Prosthetic heart Valves Treated with unfractionated heparin for prophylaxis and treatment in pregnancy venous is. Come without some risk thromboembolism is the leading cause of maternal death in the intensive care unit is... Had an epidural for both my pregnancies and one triplet pregnancy were successful the perfect time start. 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