Expert: Catherine Beier MS CBE - 9/6/2009

Question
Hi, I would line to find out the benefits and risks associated with inserting a Foley catheter after receiving the epidural. How long should a person push with the catheter when the moment comes after one is ready to push.

Answer
RJ,


Typically, catheterization after epidural becomes standard procedure, as you may not feel the sensation of needing to urinate or be unable to move your legs to use a bed pan.  Even with a "walking epidural", you still may not be able to get to the bathroom with assistance.


Since the sensation of needing to urinate may be diminished or absent, a catheter is typically inserted to prevent the bladder from blocking the baby's head from descending into the birth canal and to prevent bladder distension from being unable to voluntarily urinate.


So, if you accept an epidural, it's extremely likely that you will also require a catheter.  In some hospitals, it is removed before pushing begins.  In others, it is removed after the full effects of the epidural have worn off as the perineal area is the last to gain full sensation after birth; thus delaying removal of the catheter helps prevent needing another one inserted or having bladder distension postpartum because the catheter was removed before full urinary control was restored.


Typically, time limits for pushing with an epidural are 3 hours. If the baby hasn't been born by that time, most doctors want to do a c-section.  How long you push will depend upon many factors, including the position you are in, the baby's station, how much sensation you have left, if any, etc.




Best,
Catherine