Using a Foley Balloon Catheter for Induction of Labor

A Foley balloon catheter may be used for labor induction to help dilate the cervix. This method is not as common as it once was, but it may be gaining popularity for women who are not good candidates for an induction with medications.

The Foley catheter is a device normally used to empty the bladder. But in this use, the balloon portion of it is inserted into the uterus. Your practitioner visualizes the cervix during a speculum exam or with the fingers, feeling that the balloon is between the amniotic sac and the lower uterine segment (bottom of the uterus) on the other side of the cervix. The balloon is then inflated with saline solution and left in place while being taped to your thigh to provide gentle traction. Older methods to apply pressure to the catheter involved attaching a weight or pulling on the catheter a few times per hour, but these don't seem to be common anymore.

The goal of this induction is to cause the cervix to mechanically open. Sometimes this will start labor spontaneously and sometimes it will simply make the cervix more favorable for a Pitocin or other drug induction or amniotomy (breaking the bag of waters). The good news is that the use of the Foley balloon catheter has been shown to provide a very good track record of having women give birth within 24 hours of insertion. It also has similar or lower cesarean rates associated with its use than combinations of the other methods of induction.

There is also the benefit that it is less likely to cause changes in your baby's heart rate or fetal distress than other methods of induction. This may be why the cesarean rate is lower in some usage combinations. You may have to have your baby's heart rate monitored before, during, and just after the procedure to see if the baby tolerated this process, but this is less likely to cause fetal distress.

The risks of using the Foley balloon catheter includes:

• Fever (3 percent)
• Non-reassuring fetal heart tones (2 percent)
• Vaginal bleeding (1.8 percent)
• Pain requiring the removal of the catheter (1.7 percent)
• Baby moving from the head down to breech (1.3 percent)

There are a couple of different types of catheters that can be used. Which is used may depend on what is available at your hospital. If you are interested, talk to your doctor or midwife about the type of catheter that is being used when discussing all of your options for induction of labor or waiting.

There is certainly a range of experiences that will depend on the condition of your cervix at the time of insertion, the technique used, and even if you've had a baby before. Most moms say that insertion is the most uncomfortable, but tolerable. After that, it's just annoying.

Many times the Foley catheter is suggested because of a previous cesarean section or scarred uterus. The use of this method of induction for mothers who are hoping for a vaginal birth after cesarean (VBAC)  is limited but positive. A small study of 151 patients found the rate of vaginal birth was 54 percent. The complications were within the normal range of expected. This is something that should continue to be investigated.

Outpatient use of the Foley balloon for labor induction has been explored in a couple of small studies in Australia of women with low-risk full-term pregnancies. They found that the benefits of the Foley balloon were still present and there were no complications in the groups. The American College of Obstetricians and Gynecologists says in its Practice Bulletin No. 107 that it may be appropriate for carefully selected patients.

Overall, the use of the Foley balloon catheter is a safe, effective, and low-cost method of induction for most pregnant women. If you have any questions or concerns, discuss them with your obstetrician.