Published Feb 13, 2007
Anyone out there have a policy/protocol to share?
nursejohio, ASN, RN
Foley is placed by the doc, inflated with 40-60cc. It's usually with low dose pit (4-6mu) and EASI @ 60cc/hr
jenrninmi, MSN, RN
Where I work, foley is placed by the doc, inflated with 30cc. Baby is monitored during this time. A few hours later when the foley falls out, mom is usually able to rest, and if no ctx are felt then efm can be removed until 6:00 am when physician performs AROM. I don't have the policy in front of me but this is basicly how it goes.
babyktchr, BSN, RN
Oh how I love foley bulb inductions. 30cc foley is inserted by provider, with NST prior to insertion. After that, monitoring is not necessary..patient may ambulate prn, shower, whatever. Catheter should be plugged, and taped to leg with a bit of traction. Every 2 hours you should give catheter a slight tug, and every 4 hours an exam to see if catheter is out. Once catheter has come out (around 3 cms), pit is started.
Continuous EFM is not required for foley bulb inductions. It is important to place traction, since your mechanical stimulation of prostiglandin is what you are looking for. If this works, you should reach 3cms (on average) in 6 hours or less. You don't get the incidents of hyperstim with this procedure, like you would with cervidil etc. Patients can move around more and they seem to be much happier. I think the pit works better also. Just my two cents.
Thanks for your responses.
It's so interesting how all 3 of you do things slightly differently.
Saline infusion vs. traction; monitoring/no monitoring; followed by AROM vs. pit.;
I am currently writing the policy for my hospital and have seen so many variations in the literature. The most recent studies have pit infusing concurrently with the Foley balloon.....with or without the saline infusion; no traction because it is hard to quantify etc!
Next question: are midwives inserting the catheters or just docs?
And are nurses inflating the balloon or is that done by the person inserting the Foley?
My midwife inserted mine and inflated it once it was in place while I was in labour with my first child. Afterwards, she asked me to get up and walk around as soon as I could. I walked around for about two hours and then started the dreaded pitocin. Delivered my son about 5 hours after getting it placed.
With my first child I had a foley cath placed, filled with saline by my CNM. Was 4 cm a couple of hours later, AROM. No pitocin at that time- started it later.
So, the plot thickens.
May I ask the 2 last posters the reasons for their inductions (by the midwives)?
Granted, the foley balloon is non-pharmacologic and does not seem to cause hyperstimulation / fetal distress. But I am still concerned about whether this will make for even more elective inductions,,,,
Your labor was really short for a primip, BouBou. what happened to you CEG?
So, the plot thickens.May I ask the 2 last posters the reasons for their inductions (by the midwives)?what happened to you CEG?
what happened to you CEG?
I was 42.1 weeks. 1 cm. Induced for postdates obviously:) (the real postdates, not the on the due date postdates we see so much) I had the foley placed along with cytotec around 10 am. Around 2 pm I was 4 cm. AROM around 5pm. Mild contractions lead into several hours of major contractions. Around midinight was 5-6 cm. Started pit and got an intrathecal. Baby was born at 0559. My midwife knew I was trying for a Bradley birth and was conservative (although in hindsight I probably would have done better on pitocin right away, it was exhausting! also would probably avoid the cytotec now but I do trust my midwife's opinions).
I think I am also just a long laboring person. With my second child at 40.2 weeks. Started having painful contractions at midnight 3-5 minutes apart, son was born at 8:05 pm the following day after AROM at about 4:00 pm. The foley/ cytotec induction seemed to be very efficient though.
Thanks for sharing your experience! Those WERE long labors! Enjoy those "fruits of your labor"!
Another thing that interests me is that my sister (also an L&D nurse) says they used the foley balloons at her hospital for a while and then stopped. She doesn't know why - just that they're using cytotec and cervidil now.....anyone else start, then stop, using balloon inductions?
At the time I was 41 weeks and went to the hospital to have an ultrasound to make sure everything was still okay for me to go another week. During the ultrasound, it was discover that I had low amniotic fluid. The doctors immediately wanted to give me a ceasarian. Started talking about cords wrapping around the baby's body and stuff like that. I refused and immediately called my midwife, who zoomed to the hospital at the speed of light. The doctors agreed to give me 24 hours and then they would proceed. This all led to my foley experience.
A side note. With my second child I went in because I felt like labor was starting got all hooked up to the machines then contractions stopped. An ultrasound was done, and Viola, I had low aminiotic fluid again I was only 40.5 weeks. No foley. Started pitocin, made it to complete with no pain medcines. Felt like I wanted to push and the nurse couldn't believe I was ready and wanted to check me. I refused and insisted she summon my midwife. While I was alone began pushing with all my might, and baby was crowning by the time the midwife came in. My labour was about four hours. I think I am just one of the few women who are blessed to have short labours.
Yet another example of how the "same" labor process varies infinitely from woman to woman - and from pregnancy to pregnancy!
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