One method that is used to assist with the induction of labor is via use of the mechanical dilatation of the cervix using a foley catheter.
An 18 french foley catheter is inserted through the cervix, near the fetal head, and is inflated with 30 cc saline. Gentle traction is applied to the foley bulb, and the foley tubing is taped to the woman's leg, keeping gentle traction.
The whole idea with a foley bulb is to provide manual traction to an unfavorable cervix, also releasing natural prostaglandins by separating the amnion from the uterine wall where the foley bulb has been placed.
Sometimes, IV pitocin is added to the induction process, to help stimulate uterine contractions.
The foley bulb is left in place until it falls out on it's own, or can be removed with gentle traction. At this time, the woman's cervix is usually about 3-4 cm dilated, and has also become more effaced (thinned out) from the prostaglandin effect.
Some doctors I work with never use mechanical dilatation. Others use this method frequently. I've personally seen it used on 3 of my patients this week, and for the most part, it works very nicely. The only time it didn't work too well was when a latex-free foley was used (which doesn't inflate to 30 cc, only to 20cc), and the woman was only about 1cm when the foley bulb came out.
Yes, we are still messing with mother nature by inducing - using any method of induction - however, this seems to work very well, with minimal side effects to the mother and fetus. Side effects that I have noticed tend to be increased cramping, nausea from the vagal response of manipulating the cervix, and cervical irritation leading to small amounts of vaginal bleeding.
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I enjoyed this bit of information; I hope to VBAC with my next baby but being diabetic (T1) I'll most likely be induced (again). I'll definitely be asking my OB if they can use this if it comes down to it.
How would you rate the side effects of mechanical vs. chemical induction?
I love foley bulbs! I think some docs forget studies have shown foley bulbs are equivalent to pharmacologic agents for cervical ripening.
I definitely prefer them because you don't have to worry about the hyperstimulation you might get with miso etc...though explaining them to patients can be somewhat tricky ;) "You're putting a balloon *where*??"
As for side effects, FBs have way less. They are not a drug, and can be easily removed if needed. Drugs like miso can be associated with hyperstim and once in the cervix can't be removed as they dissolve away. I would say the main side effect I see w/ FBs are some discomfort with insertion...but most people tolerate it well.
Very interesting. I've never seen this before, but I also work on a tele floor! ha! Anyway, good info for the future maybe.
Since you are on the subject of cervical dilation, how long/often would one have to have intercourse for it to produce enough prostaglandin to start ripening the cervix? Like, should one start at say 30 weeks every day? Or something like that.
You wouldn't happen to have a policy and procedure for this? I did this for a couple of patients when I was doing intergration as a student. but forbid the hospital doesn't have a policy and procedure therefore i can't do it in my practice.
I'll have to copy our P&P when I work again, and get it to you TRB310.
And to amommiex2 - I have no idea how much or how often you would need to have intercourse with your partner to kick start your labor. Even if I did know the answer, it would be construed as giving medical advice without a license. Sorry!
Can you or Jen explain to me what miso is, unless it's the soup, and if so, how does that stimulate the uterus? I feel kinda silly here, like I'm the only one who doesn't know this. Thanks!
Miso is misoprostil (cytotec). We just abbreviate it.
Cytotec is used as an induction agent, given orally or vaginally, to stimulate contractions. It can also be given rectally in larger doses to help treat postpartum hemorrhage.
I will never ever ever agree to a foley induction ever again. The pain from it was worse than having the baby come out and labor. With my first daughter I had severe pe and partial hellp syndrome. I was very sick and she needed to come out. Csection was ruled out as they told me I would seize/stroke out and hemmorage on the table. So induction was the safest method. Problem was my cervix was like Ft knox and not the least bit happy at having to open. So they tried two rounds of gel. It did absolutely nothing. Meantime I was getting sicker, swelled up like the michelin man and started bruising everywhere. My dh left at 9pm and I had one iv in. When he arrived the next morning at 6am, I was very very very sick. I had tubes and wires everywhere. I had ivs in both arms. I'm sure you have seen these patients. Anyway,after two rounds of gel that did not work and a very posterior very unripe cervix, they told me no way to a csection because of the risks above. They did tell me if my daughter went downhill they could have her out in less than 5minutes because then it would be a crash section and they would worry about the rest later. I was just the one that very sick. Anyway, the dr came in and said he was going to manually dialate my cervix. They took me to a procedure room and it hurt like hell. I was literally crying and screaming and begging them to stop. My dh had to leave the floor because he couldn't take it. They got it in and inflated it. Then they shot me up with fentanyl and stadol. I slept the entire afternoon. At 4 pm, the bulb fell out. The dr came in and said time to start labor. Gave me an epidural and started pit. My daughter was born 7 hours later.
Oh and if you were wondering about my pain tolerance, my epidural didn't work with my second and she was induced with broken water and pit at 35 weeks 5 days. I didn't cry one bit or scream or any of that. I wasn't happy that my epi didn't work, but that was much easier than the foley induction that I had with my first at 36 weeks. With my second, I was a fingertip dialated and 50% effaced when I had an emergency induction with her. They were prepared to do an emergency csection with her that night if I hadn't of gone into labor so fast with her. She was 3 hours 7 minutes.
amommiex2: Unfortunately sex has not been proven to actually kick start labor (neither has walking), but heck I say why not do it (or both) to distraction?? ;)
pe mommy: I'm sorry your labor was so hard. Sounds like you were quite sick. Fortunately, most people tolerate FB's way better than that, but still it's no fun when it's you. Glad to hear everything worked out in the end...
Jen, labor and delivery was the EASY part with that foley induction and I went really fast once I got started both times. Once I go9t fentanyl and stadol, there was no pain. They started the epi before they started the labor. It was just the foley part that sucked. Fortunately with the second, there was no gel or and no foley. It was admit and pit asap. I think they really thought they were going to end up doing a csection because she had decels on the monitor at the peri's and I was getting really sick again. The peri told me not to eat much in case of a csection. The nurse said that baby was coming out one way or another that night and they had the csection room ready. It just so happened that this time, all I needed was a little pit and once they broke my water I went super fast again. Maybe it was because something had started to happen with her and nothing was happening with the first. Both babies were born healthy and just fine.
We are expecting again. I am already being watched like a hawk. :)
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