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.