"Patient Refusal" as Contraindication to Epidural Anesthesia?

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By Jill

There are few absolute contraindications to the use of epidural analgesia during labor. Contraindications to the use of a neuraxial (i.e., epidural or subarachnoid) technique include patient refusal, active maternal hemorrhage, septicemia, infection at or near the site of needle insertion and clinical signs of coagulopathy. (AAFP web site)

“Patient refusal” would definitely make the use of an epidural inadvisable, therefore making it a contraindication by one definition. I think this struck me as weird because I’m assuming, perhaps incorrectly, that “patient refusal” is not something frequently listed as a contraindication for treatments or procedures in any other area. 

Even if epidural anesthesia is viewed as a routine procedure and a cultural norm, is opting out of it really a contraindication?