Childbirth is one of the most painful experiences that human beings can go through, and more than half of these labors involve a specific intervention for pain: an injection called an epidural.
But according to Health Canada, epidural catheters are on its list of medical devices suffering from a shortage, something medical professionals are raising alarms about.
Supply chain constraints are currently affecting Manitoba, Saskatchewan, Alberta and British Columbia to varying degrees, and while patients have not yet been affected, it could be just a matter of weeks for some regions.
Doctors are concerned about the impact this will have on pregnant people if provinces run out of the materials needed to provide epidurals. Epidurals not only help with pain control, but also with high-risk births.
“It’s going to have a huge impact on working women,” Dr. Lucie Filteau told CTV News.
Filteau is the vice-president of the Canadian Anesthesiologist Society. She says that in general, 50 to 60 percent of births use an epidural. Epidurals are also sometimes used for pain management for patients outside of the delivery room, and a shortage would also limit options for those patients.
And the shortage problem isn’t abating, Filteau said.
“What we thought was affecting a Canadian shortage [nearly] indeed, every province is affecting our colleagues in Australia and the United States,” he said.
A statement from Alberta Health Services (AHS) added Tuesday that “supply chain issues are leading to a global shortage of epidural catheters and tubing needed for CADD pumps used for epidural infusions.”
Some Ontario health networks have begun preparing to share supplies if needed.
Last week, the Saskatchewan Health Authority released a statement “asking expectant families to review pain management options with their care providers, in response to the shortage of epidural catheter kits across America from the North”.
Jamie Fiddler’s first child was born via C-section with an epidural, and now the Saskatchewan woman is expecting again. Last week, she told CTV News Saskatoon that the prospect of not having an epidural is terrifying, especially since she anticipates needing a C-section again due to illness.
“I can’t imagine having a C-section without an epidural,” she said.
According to the AHS statement, Alberta currently has “more than two weeks of supply and there is no imminent impact on patients.”
But not everyone is calm.
Preparing to have her first child, Arianna Fierling is worried about the prospect of giving birth without the option of an epidural.
“I think that’s the resource every woman has in the back of her head, knowing there’s going to be an epidural,” she told CTV News.
“You don’t know until you’re in it, so for me, I just think if I can’t do it naturally, I would absolutely get an epidural.”
An epidural works by injecting an anesthetic into a specific space in the tissue layers around the spinal cord. This placement close to the spine is key as it blocks pain signals from traveling from the spine to the brain, with the anesthetic forming almost a cushion around the spine.
But that can’t happen without the epidural catheter, a thin plastic tube that’s inserted into the lower back via a needle to allow technicians to continue administering pain medication to the spinal area throughout labor .
With an epidural, pain relief occurs within minutes.
Filteau says there are other options, such as nitrous oxide, opioids and local anesthetics to help with labor pain.
“Unfortunately, none of them achieve the same feeling of pain relief that you get with an epidural,” he said.
And these are conversations Fierling is already having.
“So we’ve talked about some options, my doctor has done a good job of assuring me that they’re going to be there every step of the way and there’s going to be some options for me either way,” Fierling said.
Health Canada says that if the shortage reaches the national level, they will step in to mitigate the patient shortage, including looking to access international supplies if possible.