Continuing to Induction After Foley Bulb

What Is a Foley Bulb Induction?

A Foley bulb catheter, which is also called a Foley balloon catheter, is sometimes used for labor induction to promote contractions and dilation of the cervix. This induction method is an effective, safe option for induction for many pregnant people. 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 and inflated, which puts pressure on the cervix to promote dilation and contractions.

The Foley balloon is the most commonly used mechanical method of induction.

Verywell / Alexandra Gordon

How It Works

This induction method begins by your practitioner inserting the Foley balloon, sometimes using a speculum, into the uterus via the vagina. The balloon is placed 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. It's taped to your thigh to provide gentle traction. The catheter will typically fall out on its own once you're 3 centimeters dilated.

When This Induction Method Is Used

A Foley bulb catheter may be used for induction in a variety of situations, including when a provider deems it is necessary to induce labor as opposed to awaiting spontaneous onset of labor or when you're at or past full-term or your water breaks but you're not in labor. The procedure is used when the baby is in the head-down position and no placenta problems (such as placenta previa) are present. This induction method can be used either on its own or in conjunction with other induction techniques.

This technique is an effective induction alternative for pregnant people who are not good candidates for induction using medications or for those who would rather not use these medications.

How It Feels

This induction procedure is performed with the pregnant person in a reclined position with their feet in stirrups. People's experience with this induction method varies depending on the condition of your cervix at the time of insertion, the technique used, and if you've had a baby before (which may make your cervix more favorable to induction).

Many people say that insertion is the most uncomfortable part of the procedure. It may feel similar to having a pelvic exam, a feeling of pressure, and/or pain. Some describe having sharp pelvic pain during insertion, but the pain usually recedes after insertion. After the catheter has been placed, it just may feel a little strange, possibly like having a large tampon in. Contractions and dilation may begin soon after the balloon is inflated—or it may take 12 to 24 hours for labor to begin.

Note that unlike uterine contractions, dilation isn't something that a pregnant person can feel as it happens. So, your doctor or nurse will check you periodically to see how much progress your cervix is making.

Pros and Cons of Foley Bulb Induction

The goal of this induction is to cause the cervix to mechanically open. Sometimes this will start labor spontaneously or it may simply make the cervix more favorable for a Pitocin or other drug induction or amniotomy (breaking the bag of waters).

Pros

• Effective, Safe Procedure

• Medicine-free intervention

• Often results in dilation and delivery within 24 hours

Cons

• May not be effective

• Pain upon insertion

• Slight risk of complications

Benefits

The use of the Foley balloon catheter has a very good track record of pregnant people giving 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. Still, 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 method is less likely to cause fetal distress.

The success rate of using the Foley catheter for induction is around 70%.

Potential Risks

The main drawbacks of this procedure are that it can be painful during insertion of the catheter and it might not induce labor, perhaps necessitating another method of induction. Uncommon complications of this procedure include the following:

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

Vaginal Birth After Cesarean

The Foley catheter may be suggested because of a previous cesarean section or scarred uterus. 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%. Complications were within the normal range.

Outpatient Use

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 that it may be appropriate for carefully selected patients. However, this technique is typically used in a hospital setting.

A Word From Verywell

It can be upsetting to hear that labor needs to be induced (and it can be hard to be overdue). This low-risk method may be helpful to jumpstart dilation and contractions for many pregnant people. Overall, the use of the Foley balloon catheter is a safe and effective method of induction for most pregnant women. If you have any questions or concerns, discuss them with your obstetrician.

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Gu N, Ru T, Wang Z, et al. Foley Catheter for Induction of Labor at Term: An Open-Label, Randomized Controlled Trial.PLoS One. 2015;10(8):e0136856. doi:10.1371/journal.pone.0136856

2. Diederen M, Gommers J, Wilkinson C, Turnbull D, Mol B. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG. 2018;125(9):1086-1095. doi:10.1111/1471-0528.15047

3. Sarreau M, Leufflen L, Monceau E, et al. Maturation du col utérin défavorable par ballonnet supra-cervical sur utérus cicatriciel : étude rétrospective multicentrique de 151 patientes.Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 2014;43(1):46-55. doi:10.1016/j.jgyn.2013.06.006.

4. Wilkinson C, Adelson P, Turnbull D. A comparison of inpatient with outpatient balloon catheter cervical ripening: a pilot randomized controlled trial.BMC Pregnancy Childbirth. 2015;15:126. doi:10.1186/s12884-015-0550-z

5. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114(2 Pt 1):386-97. doi:10.1097/AOG.0b013e3181b48ef5,

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

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Source: https://www.verywellfamily.com/what-is-a-foley-catheter-induction-of-labor-2758962

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