Pushing with a foley in place

SmilingBluEyes · Jun 17, 2005

I forgot to add: once baby is out, we turn off the epidural drip. The epidural usually wears off WELL in time for mom to get up and void without the need for straight-cathing at all. If the foley is still in place, we leave it there until mom can get up to the bathroom to do pericare.

It works very well where I am, but I realize practices do vary. I am just saying how we do it and why I don't think it's all that weird.

RNnL&D · Jun 17, 2005

I forgot to add: once baby is out, we turn off the epidural drip. The epidural usually wears off WELL in time for mom to get up and void without the need for straight-cathing at all. If the foley is still in place, we leave it there until mom can get up to the bathroom to do pericare.
It works very well where I am, but I realize practices do vary. I am just saying how we do it and why I don't think it's all that weird.

We don't turn off the epidural until baby is delivered either, but I have heard of it being done.

I don't think using a foley is a weird idea, I think taking it out before delivery then putting it back in after a successful lady partsl delivery is a strange practice. I guess my point is, if the foley is in place due to Mom being "numb" and unable to get up to void, then why does she need a foley after delivery when the epidural is off and she will be able to get up to the BR (at some point)?

Zhlake · Jun 18, 2005

We never do foleys either.

k_cole21 · Jun 18, 2005

At the hospital I'm currently @ we always do foley's. I find it to be most helpful for the sake of repeatedly introducing the st. cath & for saving time for the nurses. However, we do take the foley's out to push b/c it can cause trauma to the urethra if that bulb comes out fully inflated. I've seen that happen a few times. I have run in to some docs that refuse foleys and insist on st caths @ other hospitals.

allnurses Guide · Jun 18, 2005

I can't even remember the last time I had to straight cath a woman in labor with an epidural. So the concern about cathing a woman 2-3 times doesn't apply where I work.

I get the woman up to void before the epidural is placed and usually she delivers within a few hours - we do let the epidural wear off a bit before pushing - we don't have continuous epidurals. The CRNA places the epidural, gives the meds and leaves, checking back in about 20 minutes later when the mom is usually numb. We can call him back in to redose or have the doc redose if necessary but usually it only takes one dosing to get the women complete and to the pushing stage. The epidurual wears off in about 3-4 hours, sometimes less, and she has relaxed enough to get some rest and allow the cervix to dilate. After delivery she is usually up and in the shower and then we move babe and mom to post-partum room. I've never had a problem with a mom not able to void.

I'm not saying one way is better than another - just remarking on the differences.

steph

NurseforPreggers · Jun 18, 2005

Wow. Just last night I had to straight cath my patient because she was too numb to walk to the BR about 3 hours after delivery. She did have an epidural redose right before delivery however. Alot of times even when the mom's can walk they still can't void. I'd say I have to straight cath about 1/10 patients after delivery. I wonder if it has anything to do with the specific epidural med we use, or the dosage.

sbic56, BSN, RN · Jun 18, 2005

I can't even remember the last time I had to straight cath a woman in labor with an epidural. So the concern about cathing a woman 2-3 times doesn't apply where I work.
I get the woman up to void before the epidural is placed and usually she delivers within a few hours - we do let the epidural wear off a bit before pushing - we don't have continuous epidurals. The CRNA places the epidural, gives the meds and leaves, checking back in about 20 minutes later when the mom is usually numb. We can call him back in to redose or have the doc redose if necessary but usually it only takes one dosing to get the women complete and to the pushing stage. The epidurual wears off in about 3-4 hours, sometimes less, and she has relaxed enough to get some rest and allow the cervix to dilate. After delivery she is usually up and in the shower and then we move babe and mom to post-partum room. I've never had a problem with a mom not able to void.
I'm not saying one way is better than another - just remarking on the differences.
steph

I like the single dose method for epidural, if it makes sense to use it, as well. We never place foleys either and rarely do we need to straight cath even with running epidurals. I think smaller rural hospitals like ours are more apt to be less interventive and tend to do only what is really necessary. I can see the blanket policy of everyone getting the same care which includes more intervention in the larger places, as they can't be as personal about the care with the numbrs of deliveries done.

SmilingBluEyes · Jun 18, 2005

I like the single dose method for epidural, if it makes sense to use it, as well. We never place foleys either and rarely do we need to straight cath even with running epidurals. I think smaller rural hospitals like ours are more apt to be less interventive and tend to do only what is really necessary. I can see the blanket policy of everyone getting the same care which includes more intervention in the larger places, as they can't be as I personal about the care with the numbrs of deliveries done.

I am sorry but I have to address this post.

I , too, work in a "smallis" community hospital (we do only about 700-750 del/year), where many get their epidurals early in labor (at their request, naturally), and will have very overdistended bladders if left alone for hours of labor. They cannot get up to void, cannot feel to use a bedpan, either.

We do provide personalized and competent care, on a case by case basis, like most places. But if you think about,it you realize: IF a person is going to request an epidural at 2-3 cm and will labor for 7-8 or more hours, what else might you expect we should do? She has had a fluid load (IV) of at least 1-2 liters prior to and during epidural anesthesia/labor. At some point, her bladder will distend over those hours. I have emptied more than a liter of urine in many indwelling catheters in the course of labor and right after delivery. It may be due to varying medication mixtures and techniques employed by individual CRNA's/MDA's, surely as to how soon a woman "gets her legs back" and can void on her own. It's typical, unfortunately for it to be while for ours---sometimes more than 2 hours after the drip is turned off.

Like I said before, because practices vary; this does not mean a place lacks in personalized care or is doing interventions just because of "blanket policies". We have no blanket policy regarding use of indwelling catheters in labor. I believe the orders read, "monitor for bladder distension and cath prn", not "place an indwelling catheter in all patients receiving epidural anesthesia".

Of note: People receiving shorter-term anesthesia (specifically, intrathecal---perhaps the single-dose method you are referring to) don't get cath'd at all. We realize in the short term, it is usually unnecessary.

The OP was looking for suggestions regarding what to do with a foley catheter during pushing phase, and this is what we do where I work. I was trying to address her original question.

Yes, some practioners don't use them. It is individual, that is all. Hope this post is not offensive, I just wanted to clear up a misconception I saw here. If I am mistaken, I apologize now.

thanks. :)

SmilingBluEyes · Jun 18, 2005

I wonder if it has anything to do with the specific epidural med we use, or the dosage.

You can bet on it. It does pay to know the "cocktail" and method your anesthetist is using.

sbic56, BSN, RN · Jun 18, 2005

Yes, some practioners don't use them. It is individual, that is all. Hope this post is not offensive, I just wanted to clear up a misconception I saw here. If I am mistaken, I apologize now.

No need to apologize, SBE. You read too much into my post and made it a little bit personal is all. I don't mean that care is not good at larger places, but it is more standardized. Your place is right in the middle so I bet you do retain some of the small hospital philosophy there.

I'm thinking of things like IV's going into every labor pateint in big hospitals. Or labors not being allowed to progress slowly, if that's the way it's going. Sometimes, foley catheters go in concurrent with epidurals at some places, too. Things like that.

We don't start epidurals at 2-3 cms around here, but I understand that is the way in some places. They go in when active labor starts and/or by the time anesthesia gets around to it, (covering two hosptal, OR needs come first, etc.) then the patient maybe more like around 6 cm or more. Seen too many that get them placed then deliver within minutes! If only they would have just waited a few minutes more.Intrathecals are usually done if it is expected that the baby will be delivered within a few hours, but anesthesia would rather do epidurals usually, unfortunately.

It's true that when the numbers go way up, personalization of care decreases, because there is no other alternative.I think those who work in OB delivering 300-400 a month would agree. You and I are still small time. :)

SmilingBluEyes · Jun 18, 2005

rofl ok sbic. Actually I was not upset at you at all. I re-read my post and wondered if it sounded defensive, and if it did, I apologize. I do object, however to people saying our practices are "weird" because they differ. You did not say that, I know

I also agree w/the smart folks that say we need to be practicing evidence-based nursing care/intervention. Sometimes, though, it's so hard to "turn the tide", KWIM?????

((friends))

NurseNora, BSN, RN · Jun 19, 2005

In the big city medical center where I used to work, the standing orders read to assess for bladder distention and cath prn. There are (or were) studies indicating that even multiple straight caths are less likely to result in a UTI than an indwelling catheter.

In the small town hospital where I now work, one of our OBs orders a Foley placed immediatly after the epidural. He believes that too many of his patients have had their labor affected by bladder distention. The other OB prefers straight caths for his patients. Aparently his experience with the same nursing and anesthesia staff is different.

As far as when I take out the Foley... If the head is really high, I leave it in for a while. If it's low, or seems to be decending rapidly, I take it out to prevent trauma.

Most patients void spontaneously after delivery. But remember, even some patients without anesthesia need to be cathed after delivery. Every single one is different.