OB Nurses....Question For Ya

CA CoCoRN, RN · Feb 22, 2005

Depending on the location that the balloon wound up in during pushing/delivery....there could be some urethral injury during the delivery which could be indicated by the blood.

Beyond that...a bit hard to "diagnose" from the ever-so-brief post and the myriad reasons the blood could wind up there.

SmilingBluEyes · Feb 22, 2005

Yes....and no.

how is that for an answer.

yes, you can get frank blood in a foley, particularly during pushing. We empty our ballons during pushing, and then if the foley stays in place, reinflate when delivery is complete. This reduces irritation and/or potential injury to the bladder.

DidiRN · Feb 22, 2005

Just looking for some possible causes. It actually happened to me, and it was a very long time ago. No previous history of anything. First child. I remember watching the urine turn from normal color to bright red blood. I guess I was wondering if your bladder can be injured from child birth.

I didn't provide alot of details I guess because it happened so long ago and really doesn't matter at this point. Just was strictly curious what are some possible reasons.

Depending on the location that the balloon wound up in during pushing/delivery....there could be some urethral injury during the delivery which could be indicated by the blood.
Beyond that...a bit hard to "diagnose" from the ever-so-brief post and the myriad reasons the blood could wind up there.

DidiRN · Feb 22, 2005

Now I do remember the nurse messin' around with my foley from time to time...had no idea why, and I guess I was so focused on the labor I didn't even bother to ask.

Thanks guys for your help. I was reading another thread where someone was talking about blood in the foley, and just reminded me of this and I thought I would ask you guys the experts.

Thanks so much! :)

Yes....and no.
how is that for an answer.
yes, you can get frank blood in a foley, particularly during pushing. We empty our ballons during pushing, and then if the foley stays in place, reinflate when delivery is complete. This reduces irritation and/or potential injury to the bladder.

SmilingBluEyes · Feb 22, 2005

Yes....and no.
how is that for an answer.
yes, you can get frank blood in a foley, particularly during pushing. We empty our ballons during pushing, and then if the foley stays in place, reinflate when delivery is complete. This reduces irritation and/or potential injury to the bladder.

I meant to add, reduces chances of injury to the urethra, too.

I have seen frank blood in urine after a woman has pushed, yes. It usually clears up within a couple hours after delivery. It's not the norm, certainly, and if you have problems w/urination and/or pain you should be seen to be sure there is not some damage there. I wish you best.

BETSRN · Feb 25, 2005

I no nothin' about OB (work in ICU) and was just curious about something. Is it normal to have frank red blood in a Foley during a lady partsl delivery?

Yes, it is possible. There are FEW reasons to have a foley in place for a vag delivery. having an epidural is NOt a reason to have a foley in place.

SmilingBluEyes · Feb 25, 2005

Yes, it is possible. There are FEW reasons to have a foley in place for a vag delivery. having an epidural is NOt a reason to have a foley in place.

Well, that truly depends on the length of time and the overall density of the epidural Are yours very light that patients void on their own? Not ours. Ours are such that ladies can move their legs, but can't feel anything much else, including their bladder fullness/urge to void.

Having an indwelling cath is safer than multiple straight-cathing is as a practice (infection control concerns come to mind). And our patients can't pee voluntarily when they receive epidurals, so what would you suggest we do then? Cath them how many times til they deliver? That would increase chance of infection. Or do you suggest they only be cath'd on delivery? Bad move, also as there can be in excess of 500cc or more of urine in there---- I have emptied in excess of 1500 cc of urine during the labor/delivery of a patient with epidural anesthesia. That is way too much to "let go" til cath time. It's NOT good for the bladder, obviously.

As long as the bulb is emptied at pushing, what is the harm in having a foley in versus letting the bladder distend, or cath more than ONE time?

jrring1019 · Feb 25, 2005

Well, that truly depends on the length of time and the overall density of the epidural Are yours very light that patients void on their own? Not ours. Ours are such that ladies can move their legs, but can't feel anything much else, including their bladder fullness/urge to void.
Having an indwelling cath is safer than multiple straight-cathing is as a practice (infection control concerns come to mind). And our patients can't pee voluntarily when they receive epidurals, so what would you suggest we do then? Cath them how many times til they deliver? That would increase chance of infection. Or do you suggest they only be cath'd on delivery? Bad move, also as there can be in excess of 500cc or more of urine in there---- I have emptied in excess of 1500 cc of urine during the labor/delivery of a patient with epidural anesthesia. That is way too much to "let go" til cath time. It's NOT good for the bladder, obviously.
As long as the bulb is emptied at pushing, what is the harm in having a foley in versus letting the bladder distend, or cath more than ONE time?

If you deflate the bulb, how can you keep her from pushing out the foley? We recently had someone push out a FULL bulb, which caused much damage and I think had to go home with leg bag. We d/c foleys when pt begins pushing and cath later if needed. I have never had a problem doing that and one extra straight cath is better than damage to the bladder.

SmilingBluEyes · Feb 25, 2005

If you deflate the bulb, how can you keep her from pushing out the foley? We recently had someone push out a FULL bulb, which caused much damage and I think had to go home with leg bag. We d/c foleys when pt begins pushing and cath later if needed. I have never had a problem doing that and one extra straight cath is better than damage to the bladder.

Answer is you can't prevent it falling out fully. Just make sure it's taped well to the leg, let it empty passively by attaching a 10cc syringe to it, (leaving the syringe in place), and hope it does not....fact is, 50% of the time, the foley falls out. So obviously, about 50% of the time it stays in. This makes it worth it to try.

If it stays in, we reinflate it. If not, it comes out, IV fluids are slowed, epidural turned off and voiding is urged within 2-3 hours after birth. It works fine where I work doing it this way. I RARELY have to do PP straight caths unless the labia are extremely edematous.

The doctors say they are receiving fewer post partum complaints about bladder problems/infections doing it this way, so they now pretty much order it done. Pushing out a full bulb is definately something we want to avoid, as you illustrate so clearly above.

BETSRN · Feb 25, 2005

Well, that truly depends on the length of time and the overall density of the epidural Are yours very light that patients void on their own? Not ours. Ours are such that ladies can move their legs, but can't feel anything much else, including their bladder fullness/urge to void.
Having an indwelling cath is safer than multiple straight-cathing is as a practice (infection control concerns come to mind). And our patients can't pee voluntarily when they receive epidurals, so what would you suggest we do then? Cath them how many times til they deliver? That would increase chance of infection. Or do you suggest they only be cath'd on delivery? Bad move, also as there can be in excess of 500cc or more of urine in there---- I have emptied in excess of 1500 cc of urine during the labor/delivery of a patient with epidural anesthesia. That is way too much to "let go" til cath time. It's NOT good for the bladder, obviously.
As long as the bulb is emptied at pushing, what is the harm in having a foley in versus letting the bladder distend, or cath more than ONE time?

Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.

other than that, we try to keep labor as "normal" as possible.

SmilingBluEyes · Feb 25, 2005

Well our epidural rates are through the roof, and therefore foleys are warranted and used often. I guess it's a difference of frequency and timing. If our epidural rates were lower and they were done later in labor, I would not place a foley either.