Friday, June 22, 2012

BC, Southern Vancouver Island still lagging in epidural access - are women continuing to be denied access to pain relief in Labour?

The Canadian Institute for Health Information (CIHI) released new data for 2010/2011 on childbirth in Canada on June 21, 2012.  This data shows that British Columbia continues to lag in the provision of epidurals to women in labour and delivery.  While more than half of women (56.2 percent) experiencing a vaginal delivery in Canada received an epidural for their delivery, fewer than one in three (32.5 percent) British Columbians received an epidural for their delivery.  This was just slightly more than the 30.3 percent who received an epidural in 2009-2010.  Among all provinces in Canada, British Columbia had the lowest epidural rate among vaginal deliveries in 2010/2011.  In Quebec, about 70 percent of women having vaginal deliveries received an epidural – the highest rate of epidural use in Canada.

Within British Columbia the rate of epidural use, by place of residence, varied significantly.  Those who reside in Vancouver were by far the most likely to have received an epidural for their vaginal delivery with 49.7 percent having one 2010/2011, up from 48.9 percent in 2009/2010.  The lowest rate of epidural use in British Columbia was among those who reside in the Northwest at 17.4 percent followed by those residing in Fraser East at 17.9 percent.  Among residents of South Vancouver Island – those most likely to be served by Victoria General Hospital – the use of epidurals for vaginal deliveries was 34.8 percent in 2010/2011 compared to 34.1 percent in 2009/2010.  At the current rate of growth (2 percent per year) in epidural use for vaginal deliveries among residents of Southern Vancouver Island it will be 2036 before rates of use will match the 2010/2011 Canadian average.  Women giving birth on Southern Vancouver Island and many other parts of British Columbia are a generation or more behind in terms of access to epidural use for vaginal deliveries than other residents of Canada.

Of course it should be noted that the data available is not sufficient to conclusively say that there is and continues to be an access problem to adequate pain relief for many women giving birth in British Columbia – nor is it sufficient to say that there is an access problem to epidurals specifically.  The data that would be needed to draw conclusions about the adequacy of access to maternity care simply does not exist at this time.  There is no way to know how long those who received epidurals waited (often in agony) from request until placement.  There is no way to know how many women wanted access to an epidural and simply could not get one at all or the reasons why they could not get one.  There is no way to know how many women found alternate methods of pain relief adequate.  There is no way to know whether or not those labouring off hours (during evenings and weekends) experienced less access to these services than those who had the good fortune of going into labour during regular operational hours.  In short, in terms of truly measuring the quality of maternity care services, the statistics fall short.


However, given the huge disparities, both between British Columbia and the rest of Canada – and within British Columbia, and my own experience and the conversations I have had with other moms – I believe that there is an access problem to quality care, at least as far as residents of Southern Vancouver Island are concerned that needs to be addressed.  How long must many British Columbian mothers suffer?  At current rates of improvement my daughter will be 25 before the use of epidurals in Vaginal deliveries on Southern Vancouver Island match the 2010/2011 Canadian average – a whole generation will have been born potentially without reasonable access to what is currently considered the ‘gold standard’ in pain relief for labour and delivery.


For more information, please go to CIHI’s website (, click on “Quick Stats,” select “Interactive Data” under “Type” and “Hospital Care” under “Topic,” then select from the “DAD/HMDB Childbirth Indicators by Place of Residence” or “DAD/HMDB Newborns Born in Hospital” statistics.



  1. Doesn't Vic General have DOBA now? When did DOBA start there? I will be following this with interest...with DOBA the rate at VicGen should quickly rise to be equivalent to Quebec or certaily with BCCH. If it doesn't, there is a serious ideological problem in the anesthesia group.

  2. Yes it does - but there's a lag in the statistics...these are for 2010/2011, the last year for which nationally comparable statistics are available. I'll be watching the rates closely over the next year and am hopeful to see rapid improvements. If it is a culture problem, then that's pretty insidious, if its an access problem, DOBA should have helped....

  3. Hi mrs. W,
    I know you from the skeptical Ob. I am an Ob on Vancouver island and I have and do support women's choices for elective c-section. We should communicate directly. I would love to talk with you.

    1. Thanks for contacting me - and welcome to my blog.

  4. Adequate - I believe DOBA has been in place at Vic General since February 2012...