Balloon Catheters for Induction of Labor - An Overview

Introduction:

Balloon catheters, also known as Foley balloons, is a safe and effective method to induce labor during pregnancy. This procedure involves the insertion of a catheter into the cervix (lower end of the uterus) and filling it with saline solution. The inflated balloon causes the cervix to dilate, and labor begins shortly after. A balloon catheter procedure takes little time and has minimal or no side effects. In addition, this procedure can be used with or without medications.

What Is a Balloon Catheter?

A balloon catheter is a soft rubber tube containing an inflatable balloon on one end, where the doctor fills air or sterile water.

How Do Balloon Catheters Help in the Induction of Labor?

A balloon catheter is a device inserted into the uterus through the cervix (opening to the uterus at the top of the vagina) by the healthcare provider. The catheter contains a balloon end; this end sits under the baby's head at the bottom of the uterus. A saline solution is used to inflate the balloon. This inflated balloon puts pressure on the cervix and stimulates the opening to prepare for labor. Once the cervix opens, the catheter falls out of it. This usually happens at 3 cm to 5 cm dilation. A 10 cm dilation is required to deliver the baby. A balloon catheter is not just a mechanical dilator of the cervix; it also stimulates the release of endogenous prostaglandins from the membranes of the fetus.

What Happens during a Balloon Catheter Induction?

The following procedures are undertaken for a balloon catheter induction of labor:

• The provider monitors the fetus's heart rate for about 20 minutes and confirms whether the fetus is head down in the uterus (vertex position).

• The patient is asked to lay on the examination table on her back (in a lithotomy position), arms at the side, with feet in stirrups, an instrument used to support the foot when giving birth).

• The perineal area (area between the vagina and anus) will be cleaned using a medical solution.

• The provider then checks the cervix for dilation.

• The balloon catheter is then inserted with a speculum (a device used to examine hollow openings in the body) into the uterus through the cervix opening. The foley balloon will be placed between the amniotic sac and the bottom part of the uterus beyond the cervix.

• Once the balloon catheter is inserted, the provider inflates the Foley bulb with about 1 ounce of saline.

• The catheter is tied and tucked into the vagina or taped into the thigh for gentle traction (grip).

• It takes around 12 to 24 hours for the cervix to dilate under the balloon pressure. Once the cervix dilates to about 3 cm, the foley bulb falls on its own.

• If labor does not start and cervical dilation does not occur, the provider will remove the bulb and move to another method of inducing the labor.

How Does a Balloon Catheter Induction Work?

In a balloon catheter, the balloon rubs against the cervix to produce a hormone known as prostaglandin. This hormone causes the cervix to become soft and short, which prepares the cervix for labor. With the release of hormones and stretching of the cervix, the water breaks naturally with the onset of labor. Sometimes, labor contractions do not begin even when the cervix dilates. In such cases, the provider might decide to rupture the membrane (break the water) artificially or may start the patient on oxytocin to induce contractions.

Does Foley Catheter Insertion Hurt?

The experience of foley catheter induction depends on the technique used, the condition of the cervix at the time of insertion, and if the patient has had a baby before (this makes the cervix more favorable for induction). For most people, insertion is the most uncomfortable part of the procedure. Insertion might feel like a pelvic examination with pain or pressure. Individuals also feel sharp pelvic pain during insertion, usually receding after insertion. After the insertion of the catheter, one has a sensation of having a giant tampon on.

Can Pregnant Woman Go Home after the Insertion of the Catheter?

Yes, if the Foley bulb is placed as an outpatient procedure., The patient can go home after the insertion of the catheter. Normal day-to-day activities like bathing, walking, or showering can be done at home. However, it is recommended to avoid sexual intercourse. In case of bleeding, contractions, balloon falling out, or if the water breaks, it is necessary to visit the hospital. However, if the procedure is done after admission, they will be asked to stay in the hospital.

What Are the Advantages and Disadvantages of a Balloon Catheter?

A balloon catheter induction is safe and effective for inducing labor in pregnant women past term. Some of the advantages of balloon catheters are:

• Medication free.

• Cervix is dilated within 12 hours for most pregnant women.

• The complication rate is lower compared to other induction methods.

• It is used along with medication to speed up labor.

• It has a good record of women giving birth within 24 hours of catheter insertion.

• It is a safe option if the patient has had a cesarean section in the previous pregnancy.

• It has lower cesarean rates than any other method of induction.

• It also has the lowest risk of overstimulating the uterus compared to other induction methods.

Even though balloon catheters are considered a low-risk procedure, some of the disadvantages of using balloon catheters include

• Pain upon insertion.

• Very rarely developing a fever or infection.

• Unsafe changes in the baby's heart rate.

• Vaginal bleeding.

• The catheter doesn't work, or the bulb falls out.

When Is a Balloon Catheter Induction Recommended?

A balloon catheter induction is recommended when pregnant women have signs of high blood pressure, gestational diabetes, or excess amniotic fluid. A Foley catheter induction is recommended if the patient meets specific criteria like:

• If the pregnancy is over 37 gestational weeks.

• Older than 18 years.

• If the amniotic membrane is intact (no rupture of membranes).

A pregnant individual can choose to induce labor if the labor does not start naturally, and this is called an elective induction.

When Is a Balloon Catheter Induction Not Recommended?

A balloon catheter is not recommended if the membrane has already ruptured (water has already broken), in conditions like placenta previa (a condition in pregnancy when the placenta blocks the cervix completely or partially, thereby blocking the baby's exit during delivery), active genital herpes (sexually transmitted infection), and if the baby is a breech (baby positioned feet or bottom first in the uterus).

Conclusion:

A balloon catheter is a safe and effective method of inducing labor. This low-risk associated procedure helps with the onset of dilation and contractions for most pregnant women by mechanically dilating the cervix and helping release prostaglandin hormones. A balloon catheter has benefits like little time, minimal or no side effects, and it can be used with or without medications.