COVID-19 and access to labour epidural analgesia in UK hospitals.

Abstract

Even before coronavirus disease 2019 (COVID-19) had a significant impact on public health in the UK, there were media reports that access to epidural analgesia for women during labour was being restricted in some National Health Service (NHS) hospitals [1]. To determine whether the crisis management of COVID-19 in NHS hospitals was having an adverse effect on the availability of labour epidural analgesia, the Obstetric Anaesthetists’ Association (OAA) surveyed consultant anaesthetists who are service leads for obstetric anaesthesia in their hospital. The link to an online survey was posted on a WhatsApp group, created for consultant service leads for obstetric anaesthesia to share information about COVID-19 disease, and was also emailed to all 209 consultants who the OAA believed to be service leads. The survey comprised questions about the size and location of the participants’ hospitals and details regarding labour epidural availability since the start of the COVID-19 crisis. There were 198 (95%) responses to the survey. Geographical locations and sizes of the participants’ hospitals are shown in Table 1. No restriction in access to labour epidural analgesia during the COVID-19 crisis was reported by 182 (92%) of participants. Six (3%) reported a restriction in access to labour epidural analgesia; three stated it was due to anaesthetist availability; two stated that it was due to personal protective equipment availability; one stated it was due to delivery unit management; and one attributed it to equipment/drug availability issues. The other 10 (5%) participants either did not know or did not have a labour epidural analgesia service in their hospital. A total of 168 (85%) participants reported that monthly data were routinely collected on the number of epidurals provided for labour analgesia in their hospital. This subset of participants was asked to compare the number of epidurals in the past month during the COVID-19 crisis with the monthly average for their hospital. Eighty-nine (53%) of this subset reported that the number of monthly epidurals was similar (± 10%), 10 (6%) reported that the number had increased by > 10%, 5 (3%) that it was less by > 10% and 64 (38%) did not know. We are unable to confirm that all participants worked in different hospitals, as participation in the survey was anonymous, and we did not collect data on hospital identity. The results show that very few participants identified that women’s access to labour epidural analgesia has been restricted due to COVID-19 disease. This view represents that of the anaesthetist and may not be the views of women or midwives whose perspectives are currently being researched by other surveys [2]. The Care Quality Commission has recently started collecting national data in England on anaesthetic response times to labour epidural requests, and this may also provide information on the impact of COVID-19 disease in maternity units. In addition to the well-established analgesic benefits of labour epidurals, they also play an essential part in safety in maternity units; enabling rapid anaesthesia for intrapartum caesarean section and, therefore, reducing the need for general anaesthesia. Until further data become available, this snapshot survey provides reassurance that COVID-19 disease is not having a widespread adverse impact on the delivery of epidural analgesia to labouring women.