‘Difficult discussions’ as NHS faces shortage of childbirth pain relief

The NHS has been hit by a shortage of epidural kits to give mothers-to-be, a key form of pain relief during childbirth, as well as the drug that women are offered as an alternative.

Supplies of epidural kits and the painkiller Remifentanil are now under such pressure that some hospitals cannot offer pregnant women their usual right to choose which one they want to reduce labour pains.

Anaesthetists have told the Guardian that the simultaneous shortage of both forms of pain management has led to “difficult discussions” with women who had been told during their antenatal care that they would have that choice but were upset to learn that it was not available.

The disruption to supplies of epidural kits is so acute that NHS Supply Chain (NHSSC), the health service body that ensures hospitals in England and Wales receive regular supplies of drugs and equipment, to ration deliveries to just one week’s worth of stock.

Childbirth organisations voiced their concern and warned that the disruption to supplies meant some women in labour were already facing long delays before they received pain relief.

“Offering a choice of options during birth is an integral element of good maternity care, and this includes pain relief. It is concerning that the shortage of epidural kits and Remifentanil could be denying many that right”, said Jo Corfield, the NCT’s head of communications and campaigns.

“We don’t yet fully understand the impact this shortage is having but we have heard of long waiting times to receive pain relief and epidurals.”

Francesca Treadaway, the director of engagement at Birthrights, said: “Limited access to pain relief without good reason could be seen as a breach of the Human Rights Act.

“Article 3 prohibits inhuman or degrading treatment. For example, if midwives or doctors fail to provide care which is needed to avoid preventable suffering, such as pain relief, this could be inhuman or degrading treatment.”

An epidural is a procedure during which an anaesthetist gives a woman in labour nerve-blocking drugs through a plastic tube into the “epidural space” in her back.

The shortage of epidural kits began several months ago but has come to light as a result of anaesthetists alerting the Guardian to the problems it is causing.

NHSSC has issued six “important customer notice” updates about the shortages of epidural kits made by Smiths Medical – a major supplier – since 29 April, especially those that use a “loss of resistance” syringe as part of the procedure. The most recent update, issued on 27 July, said it was dealing with a shortage of 21 Smiths Medical products, “12 of which are suspended as they are subject to control demand management”.

Smiths Medical have been unable to manufacture their usual number of epidural kits for several months amid a worldwide lack of the blue dye used to distinguish epidural syringes from other types, because of their role in locating the epidural space. That has led to a global shortage, affecting countries including Canada and Australia.

That problem has been compounded by the drug Remifentanil, a short-acting opioid, also being in short supply. One anaesthetist at a hospital in the north of England said: “These shortages are worrying for clinicians across the country providing obstetric anaesthesia. We have not been able to offer women in labour Remifentanil entirely based on patient choice. This has led to difficult discussions as women had been counselled antenatally about the option to request Remifentanil.

“However, due to the nationwide shortage we’re having to ration it and reserve it exclusively for patients who cannot have an epidural [for medical reasons]. We’re being told to safeguard stocks for patients with allergies or a clinical need for it rather than [giving it upon] a maternal request.”

He added: “The loss of Smiths Medical epidural kits is having a knock-on effect on the availability of kits from other manufacturers. We have had to quickly adapt to using new epidural kits and pumps in a short period of time with ever-changing kits being supplied by the NHS centrally in small amounts. As a result anaesthetists have had to cobble together the right equipment to provide epidurals to patients.”

The scarcity of epidural kits and Remifentanil are the latest in a series of shortages of key drugs and equipment the NHS has faced in recent years. They have included bottles needed to give patients a blood test and personal protective equipment for NHS staff during the Covid pandemic.

On 25 May the Obstetric Anaesthetists’ Association and three other anaesthetic bodies in the UK issued a joint statement on the sudden scarcity of Smiths Medical products. “This is due to difficulty obtaining a dye required for the plastic of the loss of resistance syringe and has led to a temporary disruption in production and supply. The estimated recovery is the end of June or beginning of July 2022.” However, 10 weeks later, the shortage is as bad as ever.

NHS Supply Chain’s update on 16 June said that the loss of supply of epidurals and syringes was “now anticipated to be resolved by the end of August 2022”. But anaesthetists say there was no sign of normal supplies being resumed any time soon and that problems may continue into 2023.

A Department of Health and Social Care spokesperson said: “We routinely share information about medicine supply issues directly with the NHS so they can put plans in place to reduce the risk of any shortage impacting patients, including offering alternative medication and medical devices.”