There is lots of conversation about inductions in the birth world. As your midwives, we want you to know our perspective: There are times and situations in which induction is an important recommendation, and we want you to know your options for induction. We do not support blanket policies or practices that encourage inductions at 39 weeks without medical reason.
We also want to clarify that sometimes people talk about natural inductions when they are actually referring to things that are “labor encouragers.” These include things like eating dates, drinking red raspberry leaf tea, going to acupuncture, or doing the Miles circuit. These practices can encourage the cervix to change or soften or stimulate some uterine contractions; these may initiate labor (or not).
On the other hand, there are medical interventions that midwives and OBs can offer to induce labor. The method of induction will depend on the state of your cervix (or the Bishop’s score, which requires a vaginal exam), baby’s position, and your medical history and preferences. This should always be a conversation that includes options, space for questions, and access to more information as needed. Inductions often involve two phrases: 1. Cervical Ripening; 2. Contractions.
In our practice, one option for inducing labor is the Foley bulb. This article offers a brief introduction of that process, as well as the benefits, risks, and evidence.
*Please note that this blog is not a substitute for medical advice, diagnosis, or treatment; Sweet Child O’ Mine is sharing general information about Foley bulbs for labor induction. As always, please consult with your medical provider with any questions you may have regarding this information and/or your medical condition.
What is a Foley Bulb and What Does it Do?
This device is sometimes called a Foley balloon or Foley catheter. This is a catheter (or small, sterile, rubber tube) that is inserted through your cervix and into the uterus. It does not go inside the amniotic sac, so the waters stay intact. In order for the tube to be inserted, your cervix needs to be at least a bit open.
The catheter has a balloon-like end that rests between your baby’s head and your cervix. Once the catheter is in place, your provider will inflate the balloon with saline solution. Thus, the balloon begins to put pressure on your cervix and encourages the cervix to soften and open. The process of placing the device is relatively quick– about 10 minutes.
After the balloon is inflated, contractions may or may not be kickstarted by the cervical change. The catheter will fall out once your cervix has reached 5 centimeters dilated. (Keep in mind that that “complete” or “fully dilated” is approximately 10 centimeters and “paper thin” or 100% effaced.) It usually takes 10-12 hours for the cervix to open to 5 centimeters and for the Foley bulb to fall out. At this point, contractions may have been stimulated on their own (about half the time) or the waters can be broken to help stimulate labor contractions into full gear.
While this is the usual and expected process with Foley bulb inductions, one thing that is true of birth in general and inductions is that we don’t know exactly how it will go.
Benefits and Risks of the Foley Bulb
Some of the benefits include:
- There’s a possibility of going home to rest/labor until the bulb falls out. (This is provider-dependent, and also requires that baby is adjusting well once the balloon is inflated.)
- It does not involve medications. This means you aren’t dealing with systemic medication, which decreases risk hyperstimulation, or excessive uterine activity and fetal distress.
- Foley bulb is typically considered appropriate for folks who have had a previous cesarean birth.
- This procedure does not require anesthesia or analgesia and does not change a natural, unmedicated birth plan.
- In some cases, this options can prevent both maternal and fetal complications associated with a postdates pregnancy.
- Induction can help bring a large baby earlier and prevent dystocias or difficult birth.
- This device can help start labor sooner if a mom’s blood pressure is starting to rise or she has other risk factors indicating a delivery sooner than 40 or 42 weeks.
- Foley bulb inductions can prevent a postdates hospital induction at 42 weeks.
Some of the risks include:
- The birthing person may experience pain. This varies for everyone, of course. Some folks don’t feel much, while others find it quite intense. The insertion feels like a 5-10 minute long vaginal exam with a little increased pressure. There is increased pressure associated with the inflated Foley bulb after the procedure, but most women tolerate the process quite well.
- There is a slightly increased risk of infection because the catheter is inserted internally. However, this is not usually a concern because we do not insert a foley bulb catheter if the waters have already ruptured. The amniotic fluid in the intact amniotic sac creates a protective barrier of bacteria from the baby. Usually, the Foley bulb is discharged before the membranes are ruptured.
- In very rare cases, there can be changes in the baby’s heart rate. Providers will monitor fetal heart rate when the catheter is placed to get data about how baby is doing.
You may also like to dig into the evidence about Bishop’s scores and what makes a cervix “favorable” for an induction here. This information is particularly pertinent for first time birthers.
Per this evidence: “To sum up the advantages and disadvantages of the Foley balloon, the advantages are that it increases the rate of vaginal birth within 24 hours, compared to placebo/sham treatment, and it has similar effectiveness in terms of cervical ripening as the medication Dinoprostone [brand name Cervidil]. However, there is a lower risk of uterine hyperstimulation, which can lead to fetal distress, compared to using synthetic prostaglandins. So, the Foley balloon is safer for the baby than using medications.
The disadvantages of the Foley are that it may be less effective than Cytotec, and it may be less effective alone versus combined with other methods of induction like rupture of membranes or medications. The procedure requires a vaginal exam to assess cervical ripeness, and a period of in-person monitoring before and after device placement.”
Sweet Child O’ Mine is Here to Support You
Your team of midwives is here to support you in navigating options during pregnancy and labor. We want you to be informed and empowered in your choices.
If you are currently building your birth team, we would be honored to be a part of your team; reach out and let us know how we can support you!