Alberta doctors are preparing for a shortage of epidural supplies that could lead to tough decisions about who gets the “gold standard” in pain management and who doesn’t.
According to Alberta Health Services (AHS), supply chain issues are leading to a global shortage of epidural catheters and tubing. It said patient care is not impacted at this time, but it is trying to track down urgent supplies.
The health authority said it has more than two weeks’ worth of the equipment and it is looking at what alternatives can be used in the event supplies do start running out.
Epidurals are used during labour and delivery — for pain management and high-risk births — as well as for other patients needing pain control after surgery.
“It’s not business as usual and it hasn’t been in some time,” said Dr. Fiona Mattatall, an obstetrician-gynecologist at Calgary’s Rockyview General Hospital.
She noted this is the latest in a number of pandemic-driven equipment supply problems.
Mattatall and her colleagues were informed about the epidural catheter shortages just over a week ago. They’re already having conversations with their patients, advising them of the situation, and discussing potential alternatives in the event her hospital in southwest Calgary runs low.
“More information is better for patients rather than to be surprised,” she said.
“We just hope it doesn’t instill a sense of panic for women. Being pregnant and having a baby in a pandemic has not been great for most people to begin with, and this may just add another level of worry to the whole experience.”
4 provinces affected by shortage
Dr. Dolores McKeen, president of the the Canadian Anesthesiologists’ Society, said she is already hearing from physicians in Alberta, and elsewhere, who are worried about running out of epidural catheters, needles and tubing.
“Alberta anesthesiologists are reaching out to us to say that they are hearing that stocks are critically low in their hospitals,” said McKeen, an obstetrical anesthesiologist at Memorial University in St. John’s.
The group has been in contact with Health Canada. McKeen said the agency provided an update Thursday confirming Alberta, British Columbia, Saskatchewan and Manitoba are experiencing catheter and epidural kit shortages.
“Physicians are fearful that their patient populations may not be able to access these services. We’re hearing varied stories as to whether or not patients have been impacted yet.”
In addition to being a mainstay for pain management during labour and delivery, doctors say epidurals are often used for high-risk patients, including women giving birth to twins, because there is already an established mode of pain relief if a C-section is needed suddenly.
“This is a huge concern both from a compassion perspective in terms of being able to provide gold standard medical treatment for labour analgesia,” she said.
“But it’s also a huge patient safety concern for the medically complex obstetrics patients and as well a general anesthesia avoidance strategy, which can have quite significant complications for moms and babies.”
AHS says it has more than 2-week supply
AHS said it has more than two week’s worth of supply and there is no “imminent impact on patients.”
“Given this international shortage, AHS is 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,” spokesperson Kerry Williamson said in a statement emailed to CBC News.
“We are working with our vendors to have urgent shipments sent as soon as possible and are investigating whether alternate supplies we have in stock may be used.”
We may see more people requiring to go off to sleep to have their babies, which is not ideal.– Dr. Fiona Mattatall, obstetrician-gynecologist
Mattatall worries a possible fallout of the shortage could be the need to rely more heavily on general anesthetic, which she said is riskier, eliminates any memory of the birth and often requires birth partners to leave the operating room.
“We may see more people requiring to go off to sleep to have their babies, which is not ideal,” she said.
Epidurals are also helpful during births requiring forceps or a vacuum and for patients with high blood pressure during pregnancy, according to Mattatall.
In a statement provided Thursday evening to CBC News, Health Canada said it is looking into the problem.
“Health Canada has engaged with provincial/territorial health authorities, hospitals and manufacturers to gather information regarding current supplies of epidural catheters in Canada and to determine whether there is a national shortage,” a spokesperson said in an email.
“[We] will take action if needed to help mitigate the impact of the shortage on patients, which may include exploring access to international supply, if possible.”
Meanwhile, according to Mattatall, doctors are preparing for the possibility they may have to make difficult ethical decisions about who is prioritized for epidurals.
“I hope it doesn’t come to this. But if you do have limited resources, it does come to that point where we’re like ‘well, if we only have four epidural catheters and there’s six women in labour, who gets the epidural?'”