The goal of this clinical trial is to compare traditional palpation to pre-procedural lumbar ultrasound prior to epidural placement in obese (BMI >40) obstetric patient population. The main questions it aims to answer are:

• Is a pre-procedural lumbar ultrasound superior to traditional palpation in terms of total number of epidural needle redirections during epidural placement?
• Is there no difference in time to epidural loss between pre-procedural lumbar ultrasound and traditional palpation during epidural placement? Participants will be randomized to either a pre-procedural lumbar ultrasound or traditional palpation at the time of epidural placement.

Inclusion Criteria:

• 18 years or older
• English Speaking
• BMI (Body Mass Index) > 40
• Ability to provide informed consent and verbally disclose their medical history

Exclusion Criteria:

• History of spine surgery, scoliosis, or other spinal abnormality which could complicate epidural placement
• Patients with platelet counts <70,000 or patients who are on anticoagulation, or patients who are on anticoagulation, both would exclude any patient from receiving an epidural.
• Minors
• Adults unable to make their own decisions or with cognitive issues or developmental delays
• Prisoners

This study is only being completed in pregnant patients.