A nationwide epidural shortage in Canada is panicking expecting parents, forcing them to consider other pain management options and adding to the anxiety of childbirth.
Kiersten Bellmore-Nidd, 28, is 27 weeks pregnant with her second child — a boy. Already a mom to her 3-year-old son, Bellmore-Nidd says it took some candid discussions with her husband before she was ready to have another child.
"My first birth was so traumatic, I was nervous to give birth again," Bellmore-Nidd told TODAY Parents. “If I was still on the fence about having a baby, I would have postponed if I had heard about the shortage earlier."
An epidural blocks pain during childbirth. A laboratory technician living in Ottawa, Canada, Bellmore-Nidd heard about the nationwide epidural shortage through work. Facing the possibility of giving birth without the option of an epidural — something she utilized when giving birth to her first — she's feeling more anxious than ever.
"I feel robbed this time around," she said. "You want to have options, so when one of your options is taken away it feels like some of your control gets taken away from you."
What is causing the epidural shortage?
Supply chain issues caused by the ongoing COVID-19 pandemic has created a shortage of plastic catheters, or tubes, used to deliver the pain medication used in epidurals.
There is enough supply of pain medication, but there is a shortage of the catheters used to administer that medication continually.
"When we insert an epidural, we use a needle to insert a catheter about five centimeters into the lower back or epidural space. We use that catheter to then infuse local anesthetic medication, much like the numbing medication you have when going to the dentist," Dr. Lucie Filteau, an anesthesiologist practicing in Ottawa and vice president of the Canadian Anesthesiologists’ Society, told TODAY.
"That numbing medication puts the nerves to sleep so that you get a band of numbness around where you'd have contractions," she added. "Having a catheter there allows for more continuous administration of local anesthetic as opposed to just a one-time injection, which would wear off."
Filteau says hospitals across the country and around the world have long dealt with supply chain shortages in equipment, products and medications, but shortages have been more frequent in the last two years as a result of the pandemic.
The epidural shortage in particular has gained worldwide attention.
"Instead of having months of backlog supplies, some hospitals have found themselves with a four day supply and at the edge of running out," Filteau said.
A written statement provided to TODAY from William Osler Health System (Osler), a hospital system in Canada, said hospitals were "alerted in July" about the upcoming shortages of epidural catheters.
Experts believe the epidural shortage will not hit the United States. The U.S. Food and Drug Administration (FDA) does not list epidural catheters on the agency's medical device shortage list, and the Society for Obstetric Anesthesia and Perinatology said in a written statement that while the committee has received sporadic reports of prepackaged epidural kit shortages, it is "unaware of centers with a complete lack of supply" and some hospitals have reported "multiple substitution kits and frequent vendor changes in order to keep a steady supply."
How hospitals are responding
Epidurals are used in over 58% of all vaginal births in Canada, according to the most recent data from the Canadian Institute for Health Information.
Filteau says hospitals are working with the Canadian government to increase the amount of epidural catheters in stock to ensure no one is labor is denied an epidural for any reason that isn't medical.
Filteau says the Canadian government has been able to import catheters from other countries to help.
Most Canadian people should have access to an epidural in childbirth, Filteau said. "I have heard of a few isolated case reports of women not being able to get an epidural — a very few, small handful. But I'm not currently hearing that that is happening now with this international importation."
Filteau said the shortage does affect physicians and hospital staff, too.
"We've all been deeply impacted by this," Filteau said. "We've chosen careers to help people, and I think one of the most frustrating things is if the tools we have to help people become unavailable it leaves us feeling more helpless in our goals."
Patients are looking for alternatives
While most pregnant people will likely have access to an epidural during labor, moms like Bellmore-Nidd are planning for the worst case scenario.
"I'm trying to mentally prepare myself for the possibility an epidural won't be on the table," Bellmore-Nidd explained. "I'm willing to try just about anything that will help me be more comfortable."
In addition to researching alternative pain management options, Bellmore-Nidd hired a doula, a person who supports someone in labor.
"The demand for doulas is getting higher just because clients don't know if they're going to be able to default to an epidural," Chelsea Loutsenko, a doula and childbirth educator practicing in Kingston, Canada, told TODAY. "We have had a lot of people hire us specifically to reduce the risk of needing pain medication."
Loutsenko says doulas will go through various medical and natural pain relief methods and coping techniques — everything from mindfulness, dancing, water births and counter-pressure techniques, to morphine injections and nitrous oxide (laughing gas).
"Even our staunchest clients who say they'll never use medication for pain relief find comfort in knowing an epidural is an option if they decide in the moment that they want it," she added. "So we are focusing on building up clients' confidence."
Bellmore-Nidd says she is preparing to give birth — with or without an epidural — by practicing yoga, mental medication and breathing techniques to relax.
"I've been just telling myself, 'You've gone through this before — you can do it. You just have to do the best you can with what you're given,'" she explained. "And that's all I can do. I have to accept that an epidural option might not be there. And it's going to get done, no matter what. A baby's got to come out. So I keep telling myself: 'You can do it.'"