A national shortage of epidural bags in the UK is now expected to drag on until at least March 2026, raising uncomfortable questions about how resilient our maternity system really is – and how transparent it is prepared to be with women in labour.
On paper, the official line is calm: alternative products exist, women should still come to hospital as normal, and patient safety remains the “top priority”. In reality, anaesthetists, pharmacists and midwives are being asked to re-engineer pain relief protocols for some of the most high-risk and emotionally charged moments in healthcare – birth – while already working in services the Care Quality Commission (CQC) has warned are under heavy and persistent strain.
This is not panic territory. But it is a warning light – not just about medicines supply, but about how honestly we talk about risk, choice and safety in maternity care.
What’s actually in short supply?
The shortage isn’t of epidurals themselves as a procedure, but of commercially prepared epidural infusion bags – ready-made bags containing local anaesthetic (such as bupivacaine or levobupivacaine, sometimes combined with fentanyl) that are used in pumps to provide continuous pain relief in labour and other procedures.
The Department of Health and Social Care (DHSC) and MHRA issued a National Patient Safety Alert on 2 December 2025, after supply problems hit bags from two major suppliers, Sandoz (licensed) and Fresenius Kabi (unlicensed).
Key facts from official sources:
- Supply problems affect bags containing:
- Bupivacaine only
- Bupivacaine + fentanyl
- Levobupivacaine + fentanyl
- The disruption is expected to last until at least March 2026.
- “Alternative licensed and unlicensed bags”, including imported products, are available – but they differ in drug concentration, bag size and composition, so they cannot just be swapped in without careful planning.
That last point is crucial. This isn’t like changing the brand of paracetamol. These are high-risk medicines delivered directly into the spine. A wrong concentration, wrongly programmed pump or poorly mixed solution can be catastrophic.
How are hospitals being told to cope?
The MHRA alert and subsequent guidance from the Royal College of Anaesthetists (RCoA) place a heavy onus on local NHS trusts to redesign their practice safely:
- Each trust must set up a multi-professional working group, led by a senior anaesthetist, with pharmacy, theatres, maternity and critical care represented.
- This group must decide:
- Which patient groups should be prioritised for the most familiar, lower-risk solutions
- How to safely adopt new bags (different concentrations, different bag sizes)
- How to avoid unsafe “ad-hoc mixing” of epidural infusions in clinical areas
- Services are strongly advised to avoid preparing epidural bags at the bedside from individual components because of the high risk of dosing errors and contamination.
On paper, this is sensible, safety-first guidance. In practice, it means:
- Anaesthetic and maternity teams must re-write protocols on the fly.
- Pharmacy must find safe aseptic capacity to prepare bespoke infusions where needed.
- Already stretched staff must absorb another layer of cognitive load and risk management.
All of that is happening in a system where nearly half of maternity units have already been rated “requires improvement” or “inadequate” for safety.
What does this mean for women in labour?
The NHS has been clear: women should still attend for care as usual, and epidurals remain available. That statement is technically true – but it doesn’t answer the questions many women will reasonably have:
- Will my hospital have the standard low-dose epidural mix they usually use?
- Could I be encouraged towards other pain relief options because supplies are tight?
- Will staff have had time to train properly on any new bags or protocols?
RCoA guidance explicitly warns that using higher-concentration solutions (0.125%) in units that normally use 0.1% for labour can increase motor block and obstetric interventions, which is one reason 0.1% has become standard in UK labour wards.
So if a trust quietly switches to a stronger solution because of supply constraints, there are potential knock-on effects:
- More instrumental births
- Less mobility in labour
- A different balance of risks and benefits than women were expecting
At the same time, research from Scotland has highlighted that epidurals may reduce severe maternal complications at a population level, and that access to epidurals is already unequal – with women from ethnic minority backgrounds and deprived areas less likely to receive them.
Put bluntly: a supply shock in epidurals lands on top of existing inequities in access and existing safety concerns in maternity care. That’s where the real risk lies – not that every woman will suddenly be denied an epidural, but that the most marginalised women will bear the brunt of any “flexibility” in practice.
A postcode lottery in the making?
The MHRA alert essentially says: “Alternatives exist, but local trusts must figure out how to use them safely.”
That is both practical and politically convenient. It also almost guarantees variation.
Some trusts will:
- Rapidly assemble senior-led working groups
- Provide clear public information on what’s changing
- Audit any impact on epidural use, intervention rates and patient satisfaction
Others, already battling staff shortages, estates problems and weak governance identified by the CQC, may struggle to do more than the bare minimum.
The CQC’s national maternity inspection programme has already found:
- 47% of services rated “requires improvement” or “inadequate” for safety
- Chronic workforce and triage problems, and
- A pattern of poor communication with women, particularly those from Black and Asian communities, who also face higher risks of death and serious harm.
Overlay a complex drug shortage on top of that and you have the textbook conditions for a postcode lottery, where your access to safe, consistent epidural care depends on your hospital’s leadership capacity as much as on national policy.
How did one manufacturing problem become a national risk?
The uncomfortable truth is that this shortage is not a freak event – it’s another chapter in a long-running story of fragile medicines supply chains.
Hospital pharmacists have reported a growing tide of “critical medicine shortages” across the NHS, with 2024 surveys indicating that all hospital pharmacists had encountered serious supply problems, often for essential or injectable medicines.
Epidural bags hit a particularly sensitive nerve because they sit at the intersection of:
- High-risk medicines
- High-stakes clinical scenarios (labour, major surgery, critical care)
- High public expectations of choice and dignity in birth
From an oversight perspective, several questions need answering:
- Supplier risk
- How many manufacturers does the UK rely on for epidural infusion bags?
- Was there any realistic contingency plan if one of them halted production?
- Strategic stockpiles
- Do we hold central reserves for drugs that underpin emergency and maternity care in the same way we do for, say, vaccines?
- If not, why not?
- Transparency
- Why was the public messaging initially so light, given that this is clearly labelled a “safety critical and complex” alert for acute care hospitals?
Right now, the burden of managing this “system problem” has fallen squarely on individual trusts and front-line teams. That may be unavoidable in the short term, but it should not become the new normal.
Truth vs reassurance: what women deserve to hear
A recurring theme in maternity scandals – from Shrewsbury and Telford to East Kent – has been women reporting that they were not fully informed, not properly listened to, or both. National reviews have warned against normalising risk and downplaying problems in the name of reassurance.
The epidural shortage presents a real test of whether we’ve learned those lessons. A more honest approach would include:
- Clear public information
- Are epidural protocols at your local trust changing?
- Are different concentrations or bag sizes being used?
- How is safety being checked and monitored?
- Open discussion of alternatives
- Not as pressure against epidurals, but so women understand the full range of analgesia options if supplies tighten further in a surge period.
- Monitoring for hidden harms
- National data on epidural uptake, conversion to other forms of pain relief, and any clustering of drug errors or adverse events during the shortage period.
Women don’t need sensational headlines – but they do deserve candour about the pressures their maternity units are under and how that might influence their care.
A chance to fix more than a supply problem
It’s tempting to frame the epidural shortage as just another temporary supply issue – something to be “managed around” until normal service resumes in the spring. But that would miss the deeper lesson.
The shortage has exposed three uncomfortable truths:
- Our medicines supply chain for critical hospital drugs is more brittle than most people realise.
- Maternity services are already running with too little slack, making it harder to absorb shocks safely.
- Communication with women is still the weak link – the area most likely to be sacrificed when staff are overstretched.
Handled well, this episode could become a catalyst for:
- Stronger national oversight of critical medicines for maternity and emergency care
- Mandatory transparency on protocol changes that materially affect women’s choices in labour
- A renewed commitment to equity in access to epidurals and other pain relief – particularly for Black, Asian and deprived communities, who already face higher risks and poorer access.
Handled badly, it risks being one more quiet trauma layered onto a system where too many families already leave maternity care feeling ignored, dismissed or harmed.
For now, the official message is that epidurals remain available and women should attend as normal – and that remains true. But if the UK is serious about rebuilding trust in maternity care, this shortage needs to be treated not just as a logistics problem, but as a moment of reckoning for how we prioritise women’s safety, choices and voices in childbirth.
