Foley Balloons for cervical ripening?

Specialties Ob/Gyn

Published

Anyone out there have a policy/protocol to share?

Specializes in N/A.

The differences I see so far are:

1. Do you use pit concurently with the foley balloon or not?

2. Is the balloon inflated 30, 40, 50 or 60 cc?

3. Traction or no traction?

4. Saline or no saline?

Is there some standard guideline somewhere? Razie what "most recent" studies are you referring to? Can you provide a link/source?

Thanks,

PattonD

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I've seen foleys used. I personaly dont like them for several reasons.

#1 they hurt

#2 if it not okay to manualy dialate a cervix with your fingers, then whey weould it be okay to do it with a peice of rubber? - what kind of damge is it cuseing?

#3 yes it dilates the cervix but it does not put the patient in labor (labor = cervical change + regular contactions)

#4 if your gunna have to pit them anyway what good does the ballon do? it does not ripen (soften or thin) it only dilates.

I think people get excited by the cervical dilation achived with this method but i dont see any real benifit to it.

Our residents offten sugest a ballon but I have never allowed one on my patients. sure it changes their cervix but it doesnt put them into labor or ripen the cervix so why do it?

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I've seen foleys used. I personaly dont like them for several reasons.

#1 they hurt

#2 if it not okay to manualy dialate a cervix with your fingers, then whey weould it be okay to do it with a peice of rubber? - what kind of damge is it cuseing?

#3 yes it dilates the cervix but it does not put the patient in labor (labor = cervical change + regular contactions)

#4 if your gunna have to pit them anyway what good does the ballon do? it does not ripen (soften or thin) it only dilates.

I think people get excited by the cervical dilation achived with this method but i dont see any real benifit to it.

Our residents offten sugest a ballon but I have never allowed one on my patients. sure it changes their cervix but it doesnt put them into labor or ripen the cervix so why do it?

This was exactly my thought and part of my conversation with the doc.

steph

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This is really interesting - I had no idea this thread was still active as I haven't gotten an e-mail about new responses since 2/14!

I have skimmed all your messages and will have a response for you soon.

Raizie

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OK - here I go.

Please, nobody be offended by what I am about to say.

It is SO important in nursing that we practice evidence based care, when it exists. Thank you to the person who asked for a reference. I used these, and others, in writing my hospital's policy - which goes to committee today.

AWHONN. (2001) Perinatal Nursing (2nd Ed). Mechanical methods of cervical ripening. Pp335-336.

Karjane, N. W., Brock, E.L., and Walsh, S. W. (2006). Induction of labor using a foley balloon, with and without extra-amniotic saline infusion. Obstetrics and Gynecology

There is a lot of opinion and misinformation that sometimes appears on these threads. I believe it is important to differentiate opinion from evidence when practicing/teaching etc.

A couple of examples: according to the literature, the foley balloon DOES ripen the cervix through mechanical pressure and release of prostaglandins. The change in Bishop scores is measurable. It is used to increase the effectiveness of a pitocin induction (unless mom spontaneously goes into labor!) so it does not follow to say, if you're going to use pit, why bother with a foley. Also, most of the literature indicates that this is NOT a painful procedure (unless mom spontaneously goes into labor!). I hope you get my point.

Anyway, I can only encourage us, as professionals, to review the literature when a new practice is proposed - Cochrane data base can be VERY helpful. If you are a staff nurse and don't have the time, ask your CNS or educator to review the new practice. And when something new is introduced, it may be important to do some type of performance improvement monitoring for a while to make sure the new policy is being followed and that it achieves the outcomes we anticipated.

I'll get off my soapbox now. Have a great day everyone.

Raizie

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Thanks, Karen, for yet another reference!

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Cool thanks for the info. I wont be so resistant to peopel useing them now that I have seen some studies on them.

the only point I still argue is that they do in fact hurt =) but prostin placment is no picnic either.

Also ty for the link to web MD, I had no idea that site was so in depth with its explainations.

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Cool thanks for the info. I wont be so resistant to peopel useing them now that I have seen some studies on them.

the only point I still argue is that they do in fact hurt =) but prostin placment is no picnic either.

Also ty for the link to web MD, I had no idea that site was so in depth with its explainations.

Mine didn't hurt at all and I went from 1 cm to 4. Is is the placement or the whole time it is in that bothers people? Just curious, thanks.

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Specializes in Nurse Manager, Labor and Delivery.
OK - here I go.

Please, nobody be offended by what I am about to say.

It is SO important in nursing that we practice evidence based care, when it exists. Thank you to the person who asked for a reference. I used these, and others, in writing my hospital's policy - which goes to committee today.

AWHONN. (2001) Perinatal Nursing (2nd Ed). Mechanical methods of cervical ripening. Pp335-336.

Karjane, N. W., Brock, E.L., and Walsh, S. W. (2006). Induction of labor using a foley balloon, with and without extra-amniotic saline infusion. Obstetrics and Gynecology

There is a lot of opinion and misinformation that sometimes appears on these threads. I believe it is important to differentiate opinion from evidence when practicing/teaching etc.

A couple of examples: according to the literature, the foley balloon DOES ripen the cervix through mechanical pressure and release of prostaglandins. The change in Bishop scores is measurable. It is used to increase the effectiveness of a pitocin induction (unless mom spontaneously goes into labor!) so it does not follow to say, if you're going to use pit, why bother with a foley. Also, most of the literature indicates that this is NOT a painful procedure (unless mom spontaneously goes into labor!). I hope you get my point.

Anyway, I can only encourage us, as professionals, to review the literature when a new practice is proposed - Cochrane data base can be VERY helpful. If you are a staff nurse and don't have the time, ask your CNS or educator to review the new practice. And when something new is introduced, it may be important to do some type of performance improvement monitoring for a while to make sure the new policy is being followed and that it achieves the outcomes we anticipated.

I'll get off my soapbox now. Have a great day everyone.

Raizie

I like how you think!!!!!! :yeahthat:

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Specializes in L0-high risk OB, PP/NBN, Med/Surg.

Thanks to RAIZIE and NRSKarenRN for reminding us of evidence based practice. As a CNM I placed many foley catheters as a prefered choice for women who wanted to avoid oxytocin if at all possible. The level of discomfort with placement was nil to mild cramps, certainly less than with gel, misoprostol or oxytocin. My OB partner had used this method at UCLA for years & had the nurses tie a 6 pack of soda to the catheter & when you heard the cans clunk, the cervix was dilated. I had huge doubts about this until a mom wanted to try it to move the process along. No complaints of pain, no bleeding & a 3-4 cm cervix within a few hours. It isn't for everyone, but it is an EVP that could be another option for women if the nurses & care providers would give it a fair try. Now as a CNS I recommend EBP & write policies. You can bet I'm suggesting this as an option.

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Specializes in OB, lactation.

The only thing we use for ripening is Cytotec so it's nice to read about this or I wouldn't know a thing about it!

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