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Expecting families are being advised they may need to change their birthing plans due to a Canada-wide epidural shortage.
The shortage is due to a supply chain issue with one component of the epidural catheter kit.
The vice-president of the Canadian Anesthesiologists’ Society says the issue is more widespread than they initially thought — with all provinces, except for Nova Scotia, being impacted by the shortage or an anticipated shortage. The epidural shortage is also impacting the U.S. and Australia.
Dr. Lucie Filteau says the shortage will impact a lot of Canadian people going into labour as the popular form of pain management is used by 50 to 60 percent of patients. That number jumps closer to 80 percent for those going into labour for the first time.
It’s not just pregnant people who use this type of pain control when giving birth, but patients who are having major abdominal surgery as well, Filteau says.
What this issue has highlighted Filteau says, is a need for better communication from manufacturers to governments, provincial health care associations and hospitals.
She says earlier notification would allow healthcare providers to conserve resources, use the materials more sparingly, make plans to adopt alternate strategies, and seek alternate sources of equipment.
How long will the epidural shortage in Canada last?
In a statement to Yahoo Canada, Health Canada says two manufacturers have indicated different end dates for the shortage.
“One manufacturer, Smiths Medical, has indicated it expects its supply to resume to normal levels by the end of August (August 26) while another, Teleflex, has reported an estimated shortage end date of Dec. 30, 2022,” the statement reads.
The health authority says it’s also “actively following up with other licensed suppliers in Canada to gather information on their ongoing supply capacity.”
“In this particular case, according to Health Canada, one company was specifically reporting an issue with the ink that was used to mark the centimetres on the catheter. And then another company was reporting quote-unquote, production issues, but specifics are not provided,” Filteau says. “I do suspect there are multiple contributing factors if it's such a global issue.”
Is it up to the provinces to individually deal with epidural shortages?
According to Filteau, it’s difficult to summarize how the issue is being handled because Canada doesn’t have one healthcare system.
“We have 15 separate healthcare systems. That's one for each province, each territory, Aboriginal health, and veteran's health,” Filteau notes. “Everybody will be dealing with this in their own way.”
While it was previously reported that B.C., Alberta, Saskatchewan and Manitoba were seeing the biggest impact of the shortage, Filteau confirms the issue is much more widespread.
Yahoo Canada reached out to five provincial health authorities to understand how each one is dealing with the issue.
The Provincial Health Services Authority in B.C. says it’s currently receiving limited stock from vendors and is working to secure more.
It's also working with “clinical stakeholders to explore various solutions such as conservation of products and alternative clinical practice until we are able to find a stable supply of a clinically suitable substitute.”
The health authority says patients can be assured that supplies will be available when needed. As for a timeline for a resolution of the supply disruption, it says that’s unknown at this time.
Alberta Health Services says it currently has more than three weeks’ worth of supply and there is no imminent impact on patients.
Given the international shortage, AHS says it’s “considering safe alterations of practice to ensure patients receive an appropriate alternative and will support the continued availability of supply where no clinically appropriate alternative can be used.”
AHS is also working with its vendors to have urgent shipments sent as soon as possible and alternate suppliers are “providing alternate acceptable products in adequate amounts at this time.”
The health authority is monitoring the situation closely and will work with patients directly to discuss options as required.
The Saskatchewan Health Authority anticipates its epidural kits and catheter supplies are available for approximately six weeks, “assuming routine utilization.”
It says, “while conservative utilization of epidural supply is encouraged, formal triage of patients is not required at this time.”
The health authority is working with its vendor to secure additional stock as it becomes available and it’s also looking to other vendors for “acceptable alternatives.”
“This is a very fluid and dynamic situation, and we are striving to keep our supplies and stock as close to normal as possible while providing safe care for our patients,” it notes in a statement.
A spokesperson with Shared Health in Manitoba says they are aware of the supply chain issues and have fortunately secured an alternate supply of epidural catheters for the immediate future while the supplier experiencing the disruption “rectifies the situation.”
They add that “access to the alternate supply is available for the longer term as well should that be required.” As a result, patients are not being impacted by the shortage in the province.
The Ministry of Health in Ontario says the province has an adequate supply of epidural catheters and people can access epidurals for childbirth.
Along with Ontario Health, the ministry is actively engaging with Health Canada, suppliers, distributors, and manufacturers across the province to understand the current situation and mitigate any potential impact on patients.
There are alternative pain control options to epidural
While epidurals are the most effective and widely accepted method of pain relief for labour, according to Toronto’s Mount Sinai Hospital, there have always been alternative pain control strategies for those who can’t have an epidural due to medical reasons.
Some of these options include narcotics like a combination of morphine and Gravol, an intravenous injection of opioids, nitrous oxide, also known as laughing gas, and local anesthesia freezing techniques without a catheter.
Filteau says breathing techniques, massages, position changes, hot tubs and hot and cold packs can help with the pain.
“We will adapt the plan to whatever the supply issues are and to the patient's individual circumstances,” she adds. “None of these methods are as effective or long-lasting as the epidural, but healthcare teams at the time will do the best that they can to provide the best labour experience.”
People may need to 'update' their birthing plan, Filteau says
As the situation evolves, Filteau says it’s difficult to predict the availability in hospitals and it will depend on the location, timing, and individual circumstances.
She advises patients not to call their family doctors or obstetricians in a panic, because they will not be able to provide further information.
“I would suggest that they [expecting parents] adapt their birthing plan, have flexibility with regards to their expectations and that when they come into the hospital in labour, the health care team will review what the options are and what the best recommendations would be for their individual circumstances,” she says.