As doulas, pain management and comfort measures is typically the number one client concern. Birth can be intense, naturally, many people are interested in pain management options. You may have seen articles floating around about an epidural catheter shortage. Is this something doulas and expectant parents need to worry about?
At IDI, we want to ensure our doulas are up to date with current birthing news. We took the time to speak with a Philadelphia, PA, based anesthesiologist to find out what we need to know.
Is There An Epidural Catheter Shortage?
While keeping up with current birthing news, the IDI team noticed several articles referencing an epidural catheter shortage. For doulas, this could be extremely important news as we seek to prepare and support families during birth.
As of now, this shortage is mostly contained to Western Canada. There are minor anecdotal reports in some US hospitals, but it does not appear to be a widespread issue in several countries.
That said, as an international organization, all our doulas deserve up-to-date information to best support their clients.
Health Canada recently added Flex-Tip epidural catheterization kits to its list of medical device shortages. The shortage began on July 18 and is expected to potentially continue until the end of the year.
“If the shortage is global, maybe it wouldn’t make a difference. But I do think that on the communication side, on the supply-chain side and the protocols that exist, there’s room for improvement,” Dr. Lucie Filteau told The Canadian Press. “We thought there were just isolated little pockets, and people started to become aware that it was more widespread.”
There are potential shortages in the UK and Australia as well. However, currently there does not appear to be a large-scale shortage.
What Do Doula Need to Know About Epidural Shortages?
Dr. Stuart Sidlow, an anesthesiologist in Philadelphia, spoke with IDI regarding the shortage. He told us it is important to understand that many hospitals have preferred standard epidural kits. These kits contain the epidural needle, catheter, syringes, and more.
When hospitals are talking about shortages, what they often mean is a shortage of a preferred kit, or brand.
Dr. Sidlow said, “Earlier in the year, our hospital’s specific [preferred] kit was on low supply. We simply switched to another until our preferred was more readily available.”
While hospitals have contracts with specific medical supply providers, preferences, etc., there are almost always alternatives available. Dr. Sidlow also shared that they recently experienced a shortage of kits one weekend. However, it was due to human error and not supply chain issue. The new tech in charge had forgotten to order more. Fortunately, they found extras in storage.
If they had not had extras in storage, they would have been able to borrow from another hospital in their network. He shared this is one advantage of working with a large medical system rather than an independent, small, hospital.
What Do Parents Need to Know About Epidural Shortages?
At this point, Dr. Sidlow shared he does not think parents really need to know anything. While the internet can be wonderful, it can also be a source of anxiety. Outside of the impact in Western Canada, parents really do not need to even read or hear about these shortages.
While it is amazing and wonderful to know what is happening on a global scale, it often provides us with concerns we can inadvertently apply to our circumstances. If your clients have heard about these shortages, and you are not in an area actually affected by them, it is important to reassure them.
If your clients have not heard about these shortages, it is likely best not to bring it up. Sharing articles unrelated to birthing in your area can inadvertently cause stress to new parents.
Dr. Sidlow shared, “I don’t really think anyone needs to worry. I don’t think we need to be discussing this ahead of time with parents and causing them stress. If a parent asks, I say certainly I can’t tell you with 100% certainty we will have an epidural kit for you – because life has no guarantees. However, the reality is there’s a 99.9% likelihood we will have a kit for you.”
He also shared that if there were to be a shortage, sort of the “worst case” scenario for parents might be less access to the long-term pain relief of a typical epidural during a vaginal birth. The alternative could be a mini spinal, this lasts about 1-1.5 hours. In the case of a c-section, a spinal is typically preferred to an epidural anyway. And of course, there is always the option of general anesthesia for a c-section, though they like to see 80-90% of c-sections sticking with regional anesthesia.
What Else Should Doulas Know About Epidurals?
While we had time to speak with Dr. Sidlow, he did have one important message for parents considering epidurals. He finds it vital that doulas, nurses, etc., prepare parents for the reality of epidural pain relief.
Often, parents come in expecting an epidural to completely eliminate all sensations. However, “It’s really important patients understand they will still feel. They may have some pain, often definitely some pressure. This does not mean the epidural did not work. It simply means that it is a regional anesthetic, it is not general anesthesia where you can be left feeling nothing.”
When parents are properly prepared, they are more likely to have a positive birth experience. Whether your clients are planning a medicated or unmedicated birth, it is important to educate them about comfort measures and coping techniques for birth.
He also believes it is important for patients to understand that long-term back pain and headaches are very rare. There is sometimes self-limited regional back pain due to bruising and irritation from the placement. However, pregnancy and labor in and of themselves are more common culprits of backpain. In the postpartum period, aches and pains are common due to the strain of pregnancy, different birthing positions, and the fluctuations in hormones.