Foley Balloons for cervical ripening? - page 2
Anyone out there have a policy/protocol to share?... Read More
Feb 14, '07Joined: Aug '04; Posts: 872; Likes: 534Quote from RAIZIEBTW, I jsut noticed you're in NY. My foley induction was in NY. Maybe it's a regional thing.Yet another example of how the "same" labor process varies infinitely from woman to woman - and from pregnancy to pregnancy!
Can't get bored, even after 30+ years!!
Feb 14, '07Joined: Dec '02; Posts: 41,781; Likes: 48,177Quote from CEGI googled it and read from different sites . . .seems like a midwife thing.BTW, I jsut noticed you're in NY. My foley induction was in NY. Maybe it's a regional thing.
I'm going to ask the ER doc today - He is also the OB doc.
Feb 14, '07Specialty: CNM ; Joined: Jul '05; Posts: 189; Likes: 61I like foley bulbs - I've had good outcomes with them. I've never used CFM with them. Intermittent monitoring is fine.
Feb 15, '07Occupation: Nursery I & II Specialty: 20+ year(s) of experience ; Joined: Oct '06; Posts: 441; Likes: 100All I can say is OWWWWWW. Do these mothers find insertion painful?
I'm in TX and have never heard of this until now. Maybe it IS a regional thing. I'll have to ask my friends over in L&D about it.
It's nice to see folks are coming up with ways to avoid dangerous drugs for induction, though.
Feb 15, '07Joined: Apr '02; Posts: 38,776; Likes: 16,413Foley balloon cervical ripening is not a new thing. I knew the military docs did them in my last state. We "downtown" at the county hospital did not.
No one around here where I am now, does these at all, including midwives.
From those who underwent it, I heard it was very crampy, uncomfortable and felt cumbersome. The consensus was it either worked or not, just like any other artificial means to induce labor.
Feb 15, '07Occupation: High School Teacher, Oh My! Joined: May '05; Posts: 19; Likes: 1Quote from 33-weekerI'm in Texas, and foley balloons are definitely used here. My OB places them in her office, so she can monitor everything herself. She inflates with 30cc and sends you off for a long, brisk walk. She has you come back every hour to check in until the catheter falls out. She uses this form of ripening with her VBAC patients (like me) who need a little help getting started. I went in to have it done at 39 weeks. Fortunately, my cervix had changed dramatically overnight, so she sent me home. I went into labor on my own and delivered two days later.I'm in TX and have never heard of this until now. Maybe it IS a regional thing. I'll have to ask my friends over in L&D about it.
Feb 15, '07Joined: Aug '04; Posts: 872; Likes: 534Interesting SBE, it was a military CNM who did mine.
Also to the PP, it was not at all painful. The worst part was the tape on my leg.
Feb 15, '07Occupation: NP-C Specialty: 15 year(s) of experience in Family NP, OB Nursing ; From: US ; Joined: Jan '04; Posts: 377; Likes: 383At my small community hospital (380 deliveries/yr) we have 1 OB and 5 family docs. We use foleys for postdates.
The OB has his girls come in at noon, NST, then places the bulb, inflates to 40ml, applies traction by taping to leg, monitors for 1 hour then sends them home with an Rx for ambien to be taken at bed time. His pt's come back for SROM, UCs q 5, if they feel they need checked or 6am, which ever comes first.
The family docs do NST in office then place bulbs in office usually inflated to 30-40mls. Then they send them home with the same instructions as the OB. They come in at 6am if they don't show up sooner.
If the bulb comes out, they are instructed to throw it away and unless they are contracting regularly or have SROM they stay home until morning. Usually the foley is out by the AM and AROM or AROM + pit is started. Most of these girls do well, haven't ever seen any problems from one, though having had one these things are uncomfortable and most girls show up long before 6am.
Mine was done at 42 wks. Placed in addition to cervidil (which we don't use anymore...now we use cytotec). I walked the halls after 2 hours in bed. Mine was placed at 7am, and was out by noon (3cms), followed by AROM. I ended up with thick mec, amnio-infusion and eventually at 0100 an emergent c/s for fetal distress (I had refused a c/s at 2000 for FTP as I was only 7cms). I had a healthy 7# 12oz, brow presentation boy who is now 10yrs old.
Feb 15, '07Joined: Apr '02; Posts: 38,776; Likes: 16,413The base hospital did not have CNMs, just OB's. This was Oklahoma several years and CNMs were not very plentiful anywhere near where I was. Our hospital only had OBs and FP docs, no midwives, either.
None of our CNMs around here that I know of, do this. (I live in WA State). It's very interesting to read the varying practices around the country.
Feb 15, '07Occupation: Doula Joined: Dec '03; Posts: 55; Likes: 3We do Foley bulbs in OR and from my experience they can be painful for the placement. Many times we will give them fentanyl prior, vistaril and morphine sulfate or nubain. Just another perspective.
Feb 16, '07Joined: Dec '02; Posts: 41,781; Likes: 48,177I did talk to one of our docs. He had heard of it. Usually used as an abortifacient, like lamineria.
He said stripping the membranes is the same kind of idea.
I still think it sounds weird. I wouldn't do it. And Ambien? hmmm . . .
Things are so different depending where you live. . . .
Feb 18, '07Occupation: Construction Specialty: N/A ; Joined: Jan '07; Posts: 61The 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?
PattonDLast edit by PattonD on Feb 18, '07
Feb 19, '07Occupation: RN in L&D Joined: Nov '01; Posts: 720; Likes: 185I'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?