Quality Care Means Access to Adequate Pain Relief

I've previously blogged about the epidural rate in British Columbia - in short it is very low and varies fairly substantially between areas of the province. Depending on the reasons for it's lack of use in this province, it might be very concerning as failure to provide access to pain relief when requested, in my opinion, is "a bit of a failure to provide quality care."

The rate has improved somewhat between last year and this year - but it remains low. Among first time mothers in British Columbia with labour, nearly 50 percent of them had an epidural (49.7% - source BC Perinatal Services) in 2010/11. This ranged from a high of 66.2% of moms giving birth at BC Children and Women's hospital to a low of 32.5% of moms giving in the Northern Health Authority. In Vancouver Island Health Authority, 46.4% of first time moms with labour had an epidural, up from 43.8% the year before. In some jurisdictions in North America the epidural rate for first time mothers exceeds 80 percent.

According to the Canadian Institutes for Health Information - the use of epidurals for all vaginal deliveries in British Columbia in 2009/10 was 30.3%, compared to a Canadian average of 56%. This suggests that the use of epidural anaesthesia is even lower among women who have previously given birth.

Anecdotally, I know of women who gave birth in Vancouver Island Health Authority who wanted epidural anesthesia and could not get access to it - I was one of them when I gave birth in 2010.

However, much like how the specific process of giving birth (c-section versus vaginal) should not be used to judge the quality of care - neither should the specific mode of pain relief. A very low rate of epidural use tells me very little about the reasons for the low rate. Given the extreme variation regionally - I suspect that it is a matter of accessibility. However, at the end of the day, I don't care about how a woman achieves relief from her labour pain - rather I care about her right to achieve that relief from her pain if she desires to be relieved of it and her ability to access pain relief that indeed does relieve her of the pain. Unfortunately, there's a "bit of a gap" in the statistics in this regard - and at the very least the discrepency between what is observed (low epidural rates relative to some parts of BC and the rest of Canada) and what would be expected should be investigated further.

Quality care means access to adequate pain relief.

Nauseously Optimistic

Morning sickness has struck - and unlike my last pregnancy its not in its mild form but rather has caused me to feel like I want to puke, and the rare times when I don't want to puke, I want to sleep. This state of being is not good for clear thought - thus the relative pause in blogging.

That being said - one of my contacts through blogging has given me the name of someone who may be able to assist me in the 'end of pregnancy' matters. I am nauseously optimistic at this lead, as it seems to be legitimate. Further, as the lead is within the confines of my province, it would be considerably more economical than the current plan A (go to Oregon to have the baby). The logistics of this potential plan are appealing.

It would still involve some travelling but that is not neccessarily a bad thing, as given my prior experience of Victoria General Hospital - I truly wish to avoid it for baby number 2.

Progress is good - and a little help from the blogosphere has gone a long way. I'm nauseously optimistic at this point.

The Challenge of Finding a CDMR Friendly Doctor in Canada

Maternal request c-section in Canada is controversial - the Society of Obstetricians and Gynaecologists of Canada is explicit in its criticism of the practice and government has aggressively promoted normal birth (see The Power to Push campaign).

In all honesty, it is far easier in BC to find providers supportive of Homebirth, even for first time mothers; than it is to find providers supportive of maternal request c-section. There is no listing of maternal request c-section friendly providers (you can actually google 'home birth' Victoria, BC and get a bunch of names of providers who support this service - including the "Home Birth Association of BC"). Further, providers in Canada must operate within the constraints of the health authorities. As such a mother who requests a c-section, without any underlying medical indication, is directly at odds with aggressive attempts to lower the c-section rate - and at odds with all the other demands for the same set of resources. As such there is little to protect a woman's right to choose delivery mode and have her choice respected.

Today I go to my doctor, much as I did over two years ago - and will ask to be referred to a maternity care provider. Except, this time, I will be more blunt - this time, I will not trust blindly. I'm nervous...and rightly so - I have no confidence that if I were to give birth here, that I could expect any different of an outcome than I had last time.