Obstetricians reassure pregnant patients that alternative medications are available if the epidural tube shortage worsens

Amid a widespread shortage of epidural tubes used to deliver painkillers during labor and delivery, doctors are assuring concerned patients that Canadians will have access to safe alternatives if the need arises.

“Shortage is an issue that worries us, like any drug shortage. But it has been a fact that since the beginning of COVID, we have had drug and device shortages,” said Dr. Diane Francoeur, an obstetrician-gynecologist and executive director of the Canadian Society of Obstetricians and Gynecologists.

“You should be aware, but you shouldn’t worry,” he said.

In a statement to the Star on Monday, Ontario Health said about 14 percent of “reporting sites” have noted that they have less than a seven-day supply as of August 11.

“Most of these sites have not flagged their level of supply as an urgent concern for Ontario Health. Ontario Health and the Ministry of Health continue to work with any hospital experiencing low supply levels. In all cases to date, supply shortages have been resolved by sharing between hospitals or increasing requests with providers,” he said.

While the severity of the shortage may vary by hospital across the country, with some provinces having been more proactive than others in finding alternative supplies, many hospital systems have planned for this and there are safe medications that can be used instead. Francoeur said. .

“Women should have a choice. Any woman who wishes to have an epidural should do so at any time. . . and it is available in most provinces,” she said.

Concerns arise as some hospitals have reported shortages of the epidural catheter, a plastic tube inserted into the lower back to deliver painkillers. Supply chain problems have caused a global shortage. Some provinces have reported supply concerns, including Alberta, Manitoba, Saskatchewan and British Columbia.

The disruptions caused by COVID-19 have led to shortages of many drugs and medical devices, with epidural catheters the latest to cause headaches for hospital systems and concerns for those giving birth.

But hospitals are monitoring shortages and implementing triage protocols, and Health Canada is working with provinces and territories on the issue and “will take action if necessary to help mitigate the impact of shortages on patients, which may include explore access to international supply, if possible,” he told the Star in July.

Dr. Dolores McKeen, president of the Canadian Society of Anesthesiologists, said the current shortage has complex reasons.

Manufacturers have told McKeen that what would normally take eight weeks to manufacture is now taking more than 14 to 18 weeks, he said. Health Canada was also not told in advance by providers what providers must do, and that caught the government and doctors by surprise, McKeen said. Health Canada did not respond to a request to confirm this information by the deadline.

“What we heard is that companies had not anticipated the impact and that they were going to fall short and not be able to make their allocations,” he said.

Pregnant patients expect to be able to ask providers for epidurals, which are “gold standard medical care,” he said. The shortage is causing a “significant amount of concern for our pregnant and surgical patient populations,” she explained.

However, McKeen said there are plenty of safe alternatives.

“I want to assure people who come to have babies that we are not going to leave them with nothing. There are alternatives that are safe and effective…they may not be perfect or as good as an epidural, but we can offer those alternatives without question,” she said.

Alternatives include what is known as “spinal” anesthesia, which is inserted through a thin needle between the bones of the spine.

Other options include laughing gas, injectable opioids or a patient-controlled pain pump, McKeen said.

“They should be used carefully and in a risk-benefit manner… taking into account the clinical context. There are a lot of things to consider, but we think most of these things can be offered safely,” he said.

Triage protocols can also be put in place with shortages, and those policies can vary, but McKeen said people with certain medical conditions who need an epidural to help manage labor will be given first priority.

“If there comes a point where there is a significant critical shortage, there will be a classification where a very low-risk mother who may not have a medically complicated pregnancy and will likely do well on other forms of anesthesia may not be prioritized. . ,” she said.

McKeen’s advice to patients is to have an early conversation with a health care provider about possible alternatives and understand that supply is a fluid situation. “Really be prepared, ask questions ahead of time, and having a healthy mother and a healthy baby is the most important priority and that will always be the anesthesiologists’ priority,” she said.

Several Ontario hospital networks Star has contacted say they have supplies in stock but are monitoring the situation.

Trillium Health Partners said it is working closely with providers, hospital partners and Ontario Health to manage its supply. It currently has supplies in stock and there has been no impact to patients, she said.

Similarly, Lakeridge Health said it has a “steady supply” of epidural catheters; patients have not been affected and the network is working with Ontario Health to understand the situation.

William Osler Health System stated that it began working with providers in July to secure more inventory and “has also developed an epidural catheter supply strategy to meet the urgent and emerging needs of our patients.”

Francoeur said it’s important to view epidurals and other pain relievers for childbirth not as a luxury, but as a necessity. “We fought for that, my entire generation of doctors, because we wanted women to be able to have (medicines). It is the worst pain you will ever have… we advocate for women to have the right to choose, not only with abortion but also with how they have their babies,” she said.

Dr. Gail Robinson, an appointed professor of psychiatry in the department of obstetrics and gynecology at the University of Toronto, said the shortage of epidurals is making patients anxious, but it’s important to know that good alternatives are available.

Robinson recommends that pregnant women discuss their concerns ahead of time with their doctor and seek options such as a doula to help prepare for labor and ease any fears.

“Labor hurts, and it’s not a good way to start your relationship with your child, to be in so much pain. This is not a minor inconvenience. This is a major problem for many women,” she said.

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