Ontario epidural shortage paired with nursing crunch could have a 'cascade effect' on childbirth

Ontario health-care workers say the shortage of epidural catheters paired with staffing crunches spanning the province could have a “whole cascade effect” on pain and anxiety during childbirth.

Ontario Health told CTV News Toronto approximately 16 per cent of hospitals in the province reported less than a week’s worth of epidural catheters on Aug. 17 when provincial inventory was last surveyed – up two per cent from Aug. 10.

An epidural catheter, or tube, is used to administer pain medication most commonly during childbirth. A global supply shortage of the device hit western Canada in late July and has surfaced locally in recent weeks.

“The majority of these sites have not flagged their level of supply as an urgent concern,” an Ontario Health spokesperson said.

While there is variability in supply across the province, Ontario Health said in all cases to date, shortages have been resolved by sharing between hospitals or escalating requests with suppliers.

These epidural catheter shortages are layered on top of staffing crunches, which nursing unions have described as the “exodus” of “exhausted” and “demoralized” employees leaving the sector in droves due to years of underinvestment and understaffing. As a result, dozens of hospitals have reduced their beds, and in some cases, closed entire intensive care units, this summer.

“Any clinical situation where pain needs to be managed pharmacologically … will be affected doubly by the fact that nurses … don't have the necessary time to do so despite them wanting to do that and patients needing that,” Registered Nurses’ Association of Ontario (RNAO) CEO Doris Grinspun said.

“Stress in itself will increase pain too, and anxiety,” she added. “All of this is detrimental for the health of the woman.”

Dr. Tali Bogler, chair of family medicine obstetrics at St. Michael’s Hospital, explained that when a pregnant person is in a lot of pain and anxious, it can be challenging to see a delivery progress.

“Overall, people are often anxious when they are pregnant and the last thing they want to know is they are not going to get the care they need and the pain relief they need,” Bogler said.

With the aim of accommodating every patient, Bogler said first, she prioritizes inductions for higher-risk patients, such as an individual with high blood pressure.

“I think what hospitals are trying to do is, we are trying to avoid unnecessary inductions, because of the recent epidural shortage or nursing shortage,” Bogler said.

Typically, a pregnant person with a standard vaginal delivery has one-on-one care from a nurse, according to Amie Archibald-Varley, a registered nurse and health equity specialist in the Hamilton-Niagara region. But when hospitals are short on staff, nurses can be doubled up with patients, which she said can be difficult when simultaneously managing someone's pain.

“That can be very challenging and morally distressing,” she said.

Archibald-Varley said patients are concerned and they have a right to be.

Another nurse, who has worked for more than three decades in Toronto labour and delivery rooms, said the shortage of staff, paired with the shortage of epidurals, could have a “whole cascade effect” on the success of a delivery. She asked for her identity to remain anonymous to protect her employment.

“If women are thrown into a [natural birth] with no idea what is happening … that’s a real panic button right there,” she said. “A lot of women when they are in pain, their body doesn't open because their body is saying no.”

Ideally, the one-on-one care of a nurse would help alleviate that anxiety. However, she said that personalized care is hard to come by now.

At times on her labour and delivery floor in Toronto, she said they only have three nurses on a shift in total – including one who is triaging patients as they come in.

Without that support, she fears patients will be “traumatized.”

“Women are super vulnerable [during childbirth] and they need to know what’s happening,” she said.