Supply shortage for epidurals causing concern across Canada

Childbirth is one of the most painful experiences that human beings can go through, and more than half of these labours involve one specific intervention for pain: an injection called an epidural.

But according to Health Canada, epidural catheters are on their list of medical devices which are experiencing a shortage — something medical professionals are raising alarms about.

Currently, the supply chain constraints are affecting Saskatchewan, Alberta, New Brunswick, Manitoba and British Columbia to varying degrees, and while patients have not been affected yet, it could be only 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 necessary to offer epidurals. Epidurals not only assist with pain management but also high-risk births.

“It will have a big impact on labouring women,” Dr. Lucie Filteau told CTV News.

Dr. Filteau is the vice president of the Canadian Anesthesiologists' Society. She says that in general, between 50 and 60 per cent of labours use an epidural. Epidurals are also sometimes used for pain management for patients outside of the maternity ward, and a shortage would limit options for those patients as well.

And the problem of the shortage isn’t getting smaller, Filteau said.

"What we thought was a Canadian shortage affecting [nearly] all of the provinces is in fact affecting our colleagues in Australia and the United States,” she said.

A statement from the Alberta Health Services (AHS) on Tuesday added that “supply chain issues are leading to a global shortage of epidural catheters and tubing required for CADD pumps used for epidural infusions.”

New Brunswick’s Vitalite Health Network confirmed that they have also been affected by the supply shortages, stating that they “are currently reviewing our inventory and implementing measure to prevent any impacts on patients.”

While Manitoba has been affected by the shortage, Shared Health said in a statement to CTV News on Thursday that they have secured a solution.

“Our supply chain officials have been able to secure an alternate supply of epidural catheters for the immediate future while the supplier experiencing the disruption rectifies the situation,” the statement read. 

Some Ontario Health networks have started preparing to share supplies if needed.

Last week, the Saskatchewan Health Authority posted a release “asking expecting families to review pain management options with their care providers, in response to a North America-wide shortage of epidural catheter kits.”

Health Canada said in a statement on Thursday that they do not have the authority to “compel a manufacturer to supply or market a device” but that they are working on ways to make up the shortages, “which could include regulatory options to facilitate access to additional supply via the Exceptional Importation and Sale pathway and the Special Access Program (SAP).”

SAP looks at access to medical supplies on a case by case basis when there are shortages, and may provide emergency access to unlicensed medical devices if alternatives are unavailable. The Exceptional Importation and Sale pathway allows the importation of medical devices from other countries that have not been approved by Health Canada but have been approved by similar regulatory bodies. 

Jamie Fiddler’s first child was delivered via a C-section with an epidural, and now the Saskatchewan woman is expecting again. She told CTV News Saskatoon last week that the prospect of having no epidural is terrifying, especially since she is anticipating needing a C-section again due to a medical condition.

“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’ worth of supply, and there is no imminent impact on patients.”

But not everyone is reassured.

Preparing to have her first child, Arianna Fierling is worried about the prospect of labour without the option of an epidural.

“I think that’s every woman’s go-to in the back of their head, knowing that an epidural will be available,” 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 layers of tissue around the spinal cord. This placement near the spine is key, as it blocks the the pain signals from travelling from the spine to the brain, with the anesthetic forming almost a cushion around the spine.

But this can’t happen without the epidural catheter, a thin plastic tube that is inserted into the lower back by a needle to allow doctors to continue delivering pain medication to the spinal area throughout the labour.

With an epidural, pain relief occurs in mere minutes.

Filteau says there are other options, like nitrous oxide, opioids and local anesthetics to aid with the pain of childbirth.

“Unfortunately, none of them reach the same sense of pain relief that you get with the epidural,” she said.

And those are conversations that Fierling is already having.

“So we’ve talked about a few options, my doctor has done a good job reassuring me they’ll be there every step of the way and there will be some options to me either way,” Fierling said.

Health Canada added that one manufacturer, Smiths Medical, has indicated that its supply is expected to return to normal by the end of August, while Teleflex has stated that their shortage is expected to extend until the end of December.

“Health Canada is actively following up with other licensed suppliers in Canada to gather information on their ongoing supply capacity,” the statement read.