A shortage of epidural tubes, used to provide pain relief mainly during labor and delivery, is affecting most provinces, but supply problems appear to be worse in Western Canada, says the vice-president of the Canadian Society of Anesthesiologists.
Dr. Lucie Filteau said “murmurs” about a shortage of tubes or catheters began recently on a private online page of about 300 anesthesiologists nationwide.
“We thought there were just isolated little pockets, and people are starting to realize it’s more widespread,” said Filto, an anesthesiologist at the Ottawa Hospital.
She said the apparent lack of information about the shortage from manufacturers to Health Canada and from governments to health care providers is “frustrating, basically across the board” because of the lack of a coordinated approach across all provinces and territories.
British Columbia, Alberta, Saskatchewan and Manitoba appear to be most affected by the shortage, Filto said.
“If the shortage is global, maybe it won’t matter. But I really think that on the communication side, on the supply chain side and the existing protocols, there’s room for improvement.”
The lack of multiple providers, if that’s the case, could create a “perfect storm” involving the equipment, which is also used to provide pain relief to patients after major chest or abdominal surgery, Filto said.
A Health Canada report listing the medical device shortages said the epidural catheterization kit and the kit used to deliver anesthesia included a single manufacturer, Arrow International LLC of Pennsylvania. It said the shortage, which began on July 18, was expected to last until the end of December.
Health Canada could not immediately respond to a question about whether the manufacturer had notified it of an impending shortage.
On average, about 50 to 60 percent of pregnant women in Canada rely on an epidural to manage pain. The highest utilization, up to 80 percent, is in urban areas where there are more anesthesiologists to provide this service, especially to those having their first baby, Filto said.
“If you’re having your second or third baby and you’re at the point where you’re just getting them out, then it’s not used as much.”
The tube allows the anesthesiologist to deliver pain medication into the epidural space around the spinal cord and nerve roots to create a band of numbness around the lower body while still allowing someone to push when it’s time to give birth.
Nitrous oxide or laughing gas can also be used, as well as morphine or fentanyl, or local anesthesia if no catheter is available, Filto said.
While these techniques help “take the edge off,” they are not as effective as epidurals, which are the gold standard for providing continuous pain relief, for hours or days, compared to a single injection, she added.
“I think women are going to have to adjust their expectations about their birth plan and the level of pain relief they can expect,” she said of those worried about tolerating pain.
Filteau said women should consider childbirth instructors and learn about alternatives to prepare in case an epidural cannot be provided.
“I would suggest that they don’t overwhelm their family doctors’ offices with phone calls or their OB-GYNs’ offices with phone calls, because they won’t be able to help them with knowledge about accessing epidurals.”
The Society of Canadian Anesthesiologists is communicating by email with members across the country and is planning a webinar next week to review alternative pain relief techniques, Filto said.
“It’s going to be difficult for us to deal with a potential sortie-type situation. No one wants to be in this position involving the ethical, moral, medical, legal aspect of withholding care due to lack of resources. As practitioners, as pain relief providers, we’re quite frustrated that we don’t have the tools that we need to provide the standard of care that Canadians expect.”
Jen Allen, a doula in Vancouver, said one of her clients requested an epidural at BC Women’s Hospital last week, but the anesthesiologist didn’t seem concerned about the equipment shortage at the time.
Shortages going forward will be “concerning,” Allen said.
“We have a diverse skill set on how to support clients through natural birth. Having said that, it would obviously be very concerning because it should be something that is available to any person in labor if they choose to use it,” she said, adding an epidural is used in most caesarean births.
“If this is really going to affect people locally, I really think there are a lot of women who are going to be very concerned because the epidural rate at BC Women’s (Hospital) is 80 percent.”
Provincial health officials said the hospital’s epidural rate is about 50 percent and has approximately 1,300 epidural tubes in stock, enough for “several months.”
Saskatchewan health officials said a supply chain issue could affect the ability of care teams to provide epidurals to pregnant women and those who may need them after major surgery.
“(The health authority) is working to secure additional supplies and ensure care teams make optimal use of available supplies,” it said in a statement. “During pregnancy, there are several medical considerations where the use of an epidural improves the health and well-being of both mother and baby. It is vital that the supply is maintained to reduce the risks to these patients.’
This report by The Canadian Press was first published on July 28, 2022.
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