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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Hematology

Can You Get an Epidural with Von Willebrand Disease?

At a Glance

Yes, you can get an epidural with Von Willebrand Disease. Your VWF and Factor VIII activity levels must be at or above 50 IU/dL for safety. Your doctor will test your levels during your third trimester. If they are too low, you can receive IV factor concentrates before the epidural is placed.

Yes, you can get an epidural for pain relief during childbirth if you have Von Willebrand Disease (VWD). However, it requires careful planning and a coordinated delivery plan between your obstetrician, hematologist, and the anesthesiology team [1][2].

The Third Trimester Check

During pregnancy, levels of Von Willebrand factor (VWF) and Factor VIII naturally increase, particularly in women with Type 1 VWD [3][4]. However, this natural increase is not guaranteed for everyone, and women with Type 2 or Type 3 VWD are much less likely to experience this protective boost [1][5].

To determine if an epidural is an option, your hematologist must measure your VWF and Factor VIII levels during your third trimester—typically around 34 to 36 weeks of pregnancy [6][7]. These test results are the blueprint for your delivery plan. If you go into premature labor before these labs are drawn, your team will generally assume your levels are low and provide immediate medical treatment to ensure your safety [1][8].

Target Levels for a Safe Epidural

According to the 2021 clinical guidelines and expert consensus, your VWF and Factor VIII levels generally must be at or above 50 IU/dL (also written as 0.50 IU/mL) for an epidural to be safely placed [9][10][11].

Important note for your lab reports: This 50 IU/dL target applies specifically to your VWF activity (how well the factor works to form a clot, often listed as VWF:RCo or similar), not just your VWF antigen (how much of the protein is present) [12][13].

Meeting this target activity threshold is critical to minimize the risk of a spinal epidural hematoma, a very rare but serious complication where bleeding occurs around the spinal cord [9][14]. When proper planning is followed and these target levels are achieved, large reviews show that the incidence of adverse anesthetic events is extremely low, making epidurals a safe option for women with VWD [10][15].

What If Your Levels Are Too Low?

If your 34–36 week testing shows that your levels remain below 50 IU/dL, you can often still receive an epidural. Your medical team will use prophylactic factor replacement therapy—which simply means giving you medicine through an IV to temporarily boost your clotting levels before the procedure [16][17].

  • Factor Concentrates: Plasma-derived VWF/FVIII concentrates are the preferred treatment to safely and predictably raise your levels before the epidural needle is placed [18][19].
  • Why not DDAVP? While you might use DDAVP (Desmopressin) for other minor procedures, it is generally avoided during labor. DDAVP can cause severe fluid retention and an electrolyte imbalance (hyponatremia) when combined with the intravenous (IV) fluids given during childbirth [20][21]. This risk is severely compounded if you are given oxytocin (Pitocin) to induce labor, as it also causes fluid retention [20].

Managing Your Delivery Plan

Do not assume your obstetrician and hematologist are automatically communicating. By your second trimester, you should ask your hematologist to write a specific, formal delivery protocol for your medical chart [22][2]. It is highly recommended to request a physical copy of this protocol to keep in your hospital bag so you can hand it directly to the on-call anesthesiologist when you arrive in labor [22].

Post-Delivery Considerations

Your factor levels will naturally drop shortly after delivery [23]. Because the epidural catheter must be safely removed without bleeding risks, your team will continue to monitor your levels [19]. You may require additional factor concentrates after childbirth to safely remove the catheter and to prevent postpartum hemorrhage (delayed bleeding after delivery) [23][11].

Common questions in this guide

Can You Develop Von Willebrand Disease Later in Life?Can You Have Iron Deficiency Without Anemia in VWD?Can You Play Sports with Von Willebrand Disease?Does Stress Affect Von Willebrand Disease Test Results?How Do Antifibrinolytics Work for VWD Bleeding?How Does Type O Blood Affect Von Willebrand Disease?How Is Von Willebrand Disease Inherited?Dental Work with Von Willebrand Disease: How to PrepareIs an IUD Safe for Women with Von Willebrand Disease?What Causes Delayed Postpartum Hemorrhage in VWD?What is a DDAVP Challenge Test for Von Willebrand Disease?What Is a Heavy Period with Von Willebrand Disease?Low VWF vs. Type 1 VWD: What is the Difference?Type 2N VWD vs. Hemophilia A: What's the Difference?Does Von Willebrand Disease Affect Life Expectancy?What Pain Meds Are Safe for Von Willebrand Disease?What's in a VWD Emergency Travel Letter?When Are Nosebleeds a Sign of Von Willebrand Disease?Why Must I Restrict Fluids After DDAVP?
Can I get an epidural if I have Von Willebrand Disease?
Yes, you can safely get an epidural with VWD, but it requires careful planning. Your healthcare team will need to ensure your blood clotting factor levels are high enough before placing the epidural to minimize bleeding risks.
What Von Willebrand factor levels do I need for a safe epidural?
According to clinical guidelines, your VWF and Factor VIII activity levels generally must be at or above 50 IU/dL. This ensures your blood can clot properly and prevents serious complications like spinal bleeding.
What happens if my VWF levels are too low during labor?
If your levels are below the target, you can receive prophylactic factor replacement therapy through an IV. This temporarily boosts your clotting levels so you can safely receive the epidural.
When should my doctor check my clotting levels before childbirth?
Your hematologist should measure your VWF and Factor VIII levels during your third trimester, typically around 34 to 36 weeks of pregnancy. These test results are used to create your specific delivery plan.
Why is DDAVP avoided during labor for VWD patients?
DDAVP can cause severe fluid retention and an electrolyte imbalance when combined with IV fluids and medications like Pitocin used during childbirth. Because of this risk, factor concentrates are the preferred treatment instead.

Questions for Your Doctor

6 questions

  • •What is my specific VWD type, and what is the likelihood my VWF activity levels will naturally rise above 50 IU/dL by my third trimester?
  • •At exactly what week of pregnancy will we check my VWF activity and Factor VIII levels to finalize my delivery plan?
  • •Can you provide a formal, written delivery and anesthesia protocol for my chart, and print a physical copy for my hospital bag?
  • •If I go into premature labor before my third-trimester labs are drawn, what is the emergency protocol for safely administering an epidural?
  • •If my levels are too low, will the hospital pharmacy have VWF/FVIII factor concentrates readily stocked and available when I go into labor?
  • •How long after delivery will my levels be monitored to ensure the epidural catheter is safely removed without bleeding risks?

Questions for You

4 questions

  • •What were my baseline VWF activity and Factor VIII levels before I became pregnant, and do I have a copy of those lab results?
  • •Have I previously had reactions or issues with factor concentrates or DDAVP during past medical procedures?
  • •Do I feel confident that my hematologist and obstetrician are communicating, or do I need to schedule a joint consultation to force the conversation?
  • •What are my personal preferences for pain management if an epidural is temporarily delayed while I receive factor replacement therapy?

References

References (23)
  1. 1

    ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease.

    Connell NT, Flood VH, Brignardello-Petersen R, et al.

    Blood advances 2021; (5(1)):301-325 doi:10.1182/bloodadvances.2020003264.

    PMID: 33570647
  2. 2

    Peripartum management of caesarean delivery in type 2 von Willebrand disease.

    Kaur S, Kaur A, Jain R, et al.

    BMJ case reports 2026; (19(2)) doi:10.1136/bcr-2025-269612.

    PMID: 41713889
  3. 3

    The Course of von Willebrand Factor and Factor VIII Activity in Patients with von Willebrand Disease during Pregnancy.

    Delbrück C, Miesbach W

    Acta haematologica 2019; (142(2)):71-78 doi:10.1159/000496820.

    PMID: 31085919
  4. 4

    Monitoring Therapy during Treatment of von Willebrand Disease.

    Favaloro EJ, Pasalic L, Curnow J

    Seminars in thrombosis and hemostasis 2017; (43(3)):338-354 doi:10.1055/s-0036-1585080.

    PMID: 27472426
  5. 5

    Present day management of inherited bleeding disorders in pregnancy.

    Kouides PA

    Expert review of hematology 2016; (9(10)):987-95 doi:10.1080/17474086.2016.1216312.

    PMID: 27459638
  6. 6

    Laboratory monitoring during pregnancy and post-partum hemorrhage in women with von Willebrand disease.

    O'Brien SH, Stanek JR, Kaur D, et al.

    Journal of thrombosis and haemostasis : JTH 2020; (18(3)):604-608 doi:10.1111/jth.14696.

    PMID: 31808272
  7. 7

    2025 ASH ISTH NBDF WFH monitoring report on the 2021 clinical guidelines on the diagnosis and management of von Willebrand disease.

    James PD, Flood VH, Connell NT

    Blood advances 2025; (9(14)):3553-3555 doi:10.1182/bloodadvances.2025016512.

    PMID: 40273329
  8. 8

    Treatment of von Willebrand disease.

    Connell NT

    Blood advances 2026; (10(3)):794-801 doi:10.1182/bloodadvances.2025016487.

    PMID: 41201390
  9. 9

    Von Willebrand Disease and Pregnancy: A Review of Evidence and Expert Opinion.

    Reynen E, James P

    Seminars in thrombosis and hemostasis 2016; (42(7)):717-723 doi:10.1055/s-0036-1587686.

    PMID: 27648611
  10. 10

    Anesthetic Management of Von Willebrand Disease in Pregnancy: A Retrospective Analysis of a Large Case Series.

    Reale SC, Farber MK, Lumbreras-Marquez MI, et al.

    Anesthesia and analgesia 2021; (133(5)):1244-1250 doi:10.1213/ANE.0000000000005502.

    PMID: 33913917
  11. 11

    Neuraxial labor analgesia in type 2N von Willebrand disease: a case report.

    Li K, Li Y, Hess PE, Berger AA

    International journal of obstetric anesthesia 2026; (65()):104823 doi:10.1016/j.ijoa.2025.104823.

    PMID: 41330092
  12. 12

    Examining international practices in the management of pregnant women with von Willebrand disease.

    Lavin M, Sánchez Luceros A, Kouides P, et al.

    Journal of thrombosis and haemostasis : JTH 2022; (20(1)):82-91 doi:10.1111/jth.15561.

    PMID: 34661341
  13. 13

    Challenges in the management of women with type 2B von Willebrand disease during pregnancy and the postpartum period: evidence from literature and data from an international registry and physicians' survey-communication from the Scientific and Standardization Committees of the International Society on Thrombosis and Haemostasis.

    Miljic P, Noureldin A, Lavin M, et al.

    Journal of thrombosis and haemostasis : JTH 2023; (21(1)):154-163 doi:10.1016/j.jtha.2022.10.019.

    PMID: 36695378
  14. 14

    Spontaneous pyohaemothorax in a teenager with von Willebrand disease: a case report and review of literature.

    Nagarajan VD, Shenoi A, Burgess L, Radulescu VC

    BMJ case reports 2021; (14(8)) doi:10.1136/bcr-2021-241613.

    PMID: 34404645
  15. 15

    Case Report: Anesthetic management for Cesarean section in a parturient with unspecified inherited bleeding disorder.

    Li L, Johnsen JM, Doan CX, Bollag LA

    F1000Research 2018; (7()):1482 doi:10.12688/f1000research.16097.2.

    PMID: 30581553
  16. 16

    Practical aspects of factor concentrate use in patients with von Willebrand disease undergoing invasive procedures: a European survey.

    Windyga J, Dolan G, Altisent C, et al.

    Haemophilia : the official journal of the World Federation of Hemophilia 2016; (22(5)):739-51 doi:10.1111/hae.12955.

    PMID: 27292438
  17. 17

    Analysis of current perioperative management with Haemate® P/Humate P® in von Willebrand disease: Identifying the need for personalized treatment.

    Hazendonk HCAM, Heijdra JM, de Jager NCB, et al.

    Haemophilia : the official journal of the World Federation of Hemophilia 2018; (24(3)):460-470 doi:10.1111/hae.13451.

    PMID: 29573506
  18. 18

    Von Willebrand disease - the 'Dos' and 'Don'ts' in surgery.

    Miesbach W, Berntorp E

    European journal of haematology 2017; (98(2)):121-127 doi:10.1111/ejh.12809.

    PMID: 27622750
  19. 19

    Von Willebrand Disease and Pregnancy: Management Protocol From Labor to the Postpartum Period.

    Muñoz Vargas BA, Contreras Valero SJ, Aragon Mendoza RL, et al.

    Cureus 2024; (16(2)):e53465 doi:10.7759/cureus.53465.

    PMID: 38435184
  20. 20

    Subdural Hemorrhage Due to Acquired Von Willebrand Syndrome in a Patient With Polycythemia Vera.

    Shalaby K, Correia Lima J, Szulawski R

    Cureus 2021; (13(7)):e16625 doi:10.7759/cureus.16625.

    PMID: 34458036
  21. 21

    Effect of DDAVP on Platelet Activation and Platelet-Derived Microparticle Generation.

    Persyn M, Athanase N, Trossaërt M, et al.

    Hamostaseologie 2022; (42(3)):185-192 doi:10.1055/a-1476-7768.

    PMID: 34139772
  22. 22

    Successful management of multiple pregnancies in a family with varying severity of Von Willebrand disease.

    Harrington P, Kyle P, Cutler J, Madan B

    Obstetric medicine 2018; (11(4)):192-194 doi:10.1177/1753495X17754150.

    PMID: 30574182
  23. 23

    Pregnancy and delivery in women with von Willebrand disease.

    Castaman G, James PD

    European journal of haematology 2019; (103(2)):73-79 doi:10.1111/ejh.13250.

    PMID: 31107984

This page is for informational purposes only and does not replace professional medical advice. Always discuss your delivery and anesthesia plans with your obstetrician and hematologist.

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