Adequate supply of epidurals in Waterloo region despite shortage concerns, hospitals say

Local hospitals want soon-to-be parents to know: There is an adequate supply of epidurals in Waterloo region, and patient care is not being affected by a shortage.

That's according to a group managing usage across Cambridge Memorial, Guelph General, Groves Memorial and Grand River hospitals.

Members of the leadership team at each of the four hospitals that deliver infants in the region formed the group and meet three times a week to discuss inventory.

Patricia Blancher, who is program director of the children's and childbirth program at Grand River Hospital, says they are keeping a close eye on inventory and there is a plan in place should the situation worsen.

"We do have an epidural supply currently in all of our regional hospitals and we continue to work diligently at maintaining that supply to ensure that all of our patients receive epidural care should that be what they request," Blancher told CBC News.

Epidural catheters are used to deliver pain relief directly into the spine of patients giving birth. 

"At this time we have no restrictions on epidural usage in the region.- Patricia Blancher, Grand River Hospital

Blancher says while a shortage of tubes has been affecting hospitals in Western Canada for more than a month now, pregnant women in Waterloo region can be assured that they won't be refused an epidural if they need one.

"We're currently monitoring not only our normal vendors and what we would normally receive for epidural usage, but we also have, all of us as a region, reached out to alternate suppliers and we're actually starting to receive some additional inventory," Blancher said. 

"At this time we have no restrictions on epidural usage in the region … we're actually working on a two-week basis at this time, which is most of the provinces as well. We all work on a two-week window of inventory and at this point, we have inventory to provide care for the next two weeks."

Contingency plan for 'highest risk women'

Meanwhile, Blancher says there is a plan in place for "the highest risk women" to be "prioritized for an epidural use … should we get to the point, as a province, where we don't have enough epidural supply for all."

Included in the list of patients at highest risk are those that are:

• Very young or have a higher maternal age.
• Carrying multiple infants.
• Concerned due to having had issues with previous anesthetic use.
• Having a vaginal labour after they've had a C-section previously.
• Experiencing significant high blood pressure during pregnancy or a higher body mass index.
• COVID-19 positive or symptomatic for the virus. 
• Those whose babies that are deemed small or large for gestational size.
• Those with preterm infants. 
• Those with breech deliveries.

Blancher says there are alternative pain management options for people who are not in the highest risk category.

Jasmin Tecson, president of the Association of Ontario Midwives (AOM), says while the issue is out of the hands of her association, she is happy to see the level of co-operation being demonstrated by the hospitals.

"What I've heard on the ground is that hospitals are co-ordinating and co-operating with each other to try to maintain a consistent supply and to basically see each other through and looking at all alternatives until this supply issue can be sorted out," Tecson told CBC News. 

"Of course it's incredibly frustrating for everybody, not just midwives and their clients, especially for anaesthetists to be frustrated in not being able to provide a key component of their care."

'Feeling of vulnerability'

Meanwhile, Tecson said hearing about a shortage of epidurals "creates or exacerbates a feeling of vulnerability" for midwifery clients who "choose or need pain relief." 

She said that approximately 18 per cent of midwifery clients use nitrous oxide. 

"Specific to epidurals, you have a provincial rate of roughly 37 per cent of midwifery clients using epidurals," Tecson said.

"So, when midwifery clients are thinking about having an epidural, it's something that people are often thinking about as having in their back pocket if they need it, so it's never off the table," she added.

"For a pregnant person to suddenly potentially not have that option or to think that that might not be an option, that can be intimidating, maybe even scary for people."