[midwife2b]

I was wondering how other nurses manage the second stage of labor when the patient has an epidural and/or a foley catheter in place. Do you remove the catheter for pushing, deflate the balloon, or leave it alone? I was helping a new grad last night with a complicated patient who had been pushing for nearly 2 hours. Her foley had clotted blood in it and we ended up removing it and replacing it. As a pretty seasoned nurse I have my own way of managing this, but was interested in some input from others. Thanks!

[SmilingBluEyes]

We deflate the balloon and if the foley stays in place, leave it there. If it comes out, obviously, we keep really good track of the bladder distention after delivery. I find the foley stays in more often than not if taped properly to the leg!

[NurseforPreggers]

We remove the foley before pushing. After delivery we keep a close watch for bladder distention and encourage the pt to void as soon as possible. If the patient is unable to void, or unable to walk to the bathroom we usually straight cath them.

[Spidey's mom]

I feel like I live in an alternate universe . . . . we don't place foleys at all. Not for epidurals, not for regular deliveries. At times the doc or I will do a straight cath if during delivery we see that the bladder is full . . .but a foley? Never. Weird.

I had an epidural for my last child - my first epidural out of 4 babies. No foley. Well, not until I headed back for an emergency cesarean.

steph

[SmilingBluEyes]

Rofl, well, It's not weird to me, Steph, to place a foley in some labor situations

For example, it works great for long labors who have epidurals and to me makes a lot more sense than straight-cathing people repeatedly. But then, I think we debated this before, didn't we? Practices vary, but I would not say others' practices are "weird" just because they differ.....they just do that...differ.

[RNnL&D]

We don't place foleys for laboring with an epidural either. It's rare that any of my patients have had an epidural long enough that they need to be straight cathed more than once or twice. Generally, it's just once, and sometimes, not at all, if their labor goes fast enough.

The only Moms to get foleys, are those going for a csection.

[NurseforPreggers]

Very interesting how practices differ. I would think the risk of infection would decrease by putting a foley in to begin with rather than possibly having to straight cath someone 2 or 3 times. Then again .. the risk of infection would be less to not cath someone at all rather than inserting a foley. I love talking myself in circles.

[amber1142]

Originally Posted by NurseforPreggers

Very interesting how practices differ. I would think the risk of infection would decrease by putting a foley in to begin with rather than possibly having to straight cath someone 2 or 3 times. Then again .. the risk of infection would be less to not cath someone at all rather than inserting a foley. I love talking myself in circles.

This sounds like a job for Evidence-based Practice Woman! I wonder if there are any studies.

[Fiona59]

Had a 27 hour labour with epidural and foley (both were started after 16 hours of labour). I remember the foley came out when the baby was about six hours old and the epidural had been discontinued...

[KaroSnowQueen]

My DD just delivered Saturday and they put in a foley as soon as she got the epidural, took it out to push and put it back in afterwards (but she stayed in L&D for almost 10 hrs afterward d/t complications). But they said they put in foleys again until the epi wore off.