If labor doesn’t start on its own, doctors and midwives can use different techniques to get it started so you can give birth. This is called inducing labor, and there are different reasons for doing it.
One of the techniques your doctor or midwife might suggest to get your labor started is using a Foley bulb catheter. It’s sometimes called a cervical ripening catheter. This is a tube with a balloon attached that puts pressure on your cervix, the opening of your uterus (womb).
How Are Foley Bulbs Used in Labor Induction?
A Foley bulb is a soft silicone tube, or catheter, with a balloon near the top. Your doctor or midwife will put the tip of the catheter into your cervix. Then, they will fill the balloon with sterile salt water.
Once the balloon is filled, its gentle pressure helps your cervix dilate (open) so your baby can be born. Touching your cervix also causes your body to make hormones that can help start contractions. Using a Foley bulb catheter “gives you a little mechanical dilation and a little stimulation to your cervix to get labor started,” says Wendy Shaw, a nurse midwife at Alabama Birth Center, in Huntsville, Alabama.
Sometimes, your health care provider will put the Foley bulb in and then have you go home. Or you might stay in the hospital or birth center during the process. Both options are safe.
Once your cervix opens enough, the Foley bulb will fall out. Then, contractions open your cervix the rest of the way so you can deliver the baby.
Inducing labor works best if your cervix is already soft and a little bit open, says Yashica Robinson, MD, an OB/GYN who is the founder and executive director of Alabama Birth Center.
What’s the procedure for inserting a Foley bulb?
If you know you’ll be induced using a Foley bulb, get a good night’s sleep beforehand. Make sure you’re eating and drinking enough to keep up your energy.
You’ll go to a hospital, birth center, or your health care provider’s office for the procedure. Your doctor or midwife should first explain what will happen and get your permission to go ahead. Make sure you understand your options and ask them any questions you have.
Then, you’ll undress and lie on your back on the exam table. Your provider will check to make sure the baby is OK. You might have a monitor on your belly, or your provider might listen to your baby’s heartbeat every few minutes with a machine.
They’ll do a vaginal exam to check how soft your cervix is. You might find out that you’re already dilated. If you’re dilated more than 3 or 4 centimeters, you won’t be able to use the Foley. Instead, you’ll make a different plan with your provider.
Some providers put a small tool called a speculum into your vagina to help them see your cervix. “It’s like when you get your Pap smear, only it might be more uncomfortable because you’re pregnant,” Shaw says.
They’ll slip the tip of the Foley catheter into your cervix and slowly fill the balloon with salt water.
Putting the catheter in is usually the most uncomfortable part, but it doesn’t take long. You might have contractions during this time.
“There’s going to be cramping, such as period cramps, and you’ll feel some pressure. Once that balloon is in place, it’s going to ease up soon,” Shaw says.
You can ask your provider to stop and let the contraction pass. Tell them when you’re ready to continue.
This is a good time to use coping tools such as breathing, visualization, meditation, imagining being somewhere that makes you feel safe, or anything else that helps you relax. Bringing a support person with you during the procedure can help, too. This can be a partner, a family member, a friend, a doula, or anyone you feel comfortable with.
Once it’s in your cervix, the other end of the Foley catheter will be taped to your leg. After that, you’ll either go home or relax in your hospital or birth center room. If you get the procedure at night, you can ask for medicine to help you sleep and to get through the early part of labor.
Tashina Bowman, a doula, childbirth educator, and home birth midwife in Amherst, Massachusetts, recommends advocating for a Foley bulb catheter if you need to be induced.
“They blow up the Foley balloon and then they tape it to your leg. You can go about doing what you’re doing,” Bowman says. “And it gives you a good alternative to let you get open to a point where your body says, ‘Oh, we’re not going back.’”
How long does a Foley bulb stay in place?
It’s safe to have a Foley bulb in for as long as 12 hours. But they usually fall out sooner than that once your cervix starts to open. “Generally, in the birth center, we put them in in the morning, and you’ll be in active labor by midnight,” Shaw says. It tends to go faster for people who are further along in their pregnancies and for those who have already had children before.
It’s not common, but the Foley bulb can fall out of your cervix and stay in your vagina. This doesn’t hurt you or your baby. The bulb usually falls out later, when the baby moves down.
If the Foley bulb hasn’t fallen out and labor hasn’t started after about 12 hours, go over your options with your provider. Sometimes, they can take out the Foley bulb and try again with a new one the next day after you get some rest.
What Are the Risks of Using a Foley Bulb?
Foley bulbs can be safer than some other ways of starting labor. There are some possible risks, though. These include:
- If it isn’t inserted correctly, the Foley bulb can fall out before it has a chance to work.
- You don’t need to be as closely monitored as with other procedures since a Foley bulb is so low-risk.
- You could get an infection. If this happens, your baby might need to be born as quickly as possible. You could end up needing more interventions or a C-section.
- It might not work.
- It can be uncomfortable or even painful.
Who shouldn’t get a Foley bulb induction?
Your health care provider usually won’t induce labor with a Foley bulb or any other method when you have certain health conditions. These include:
- When your placenta is covering your cervix, called placenta previa
- When you have an active genital herpes outbreak
- If a doctor has told you labor won’t be safe for you because of the location of a C-section scar
- If the baby isn’t in the right position
- When you’ve had certain types of surgery
Risks of Inducing Labor
If you and your baby are healthy and you’re not overdue, it’s usually best to let your body go into labor on its own because there can be risks to inducing labor. These may include:
- Changes in your baby’s heart rate
- Contractions that are too strong
- Umbilical cord problems
- Newborn death
- Uterine rupture
What Are the Benefits of Using a Foley Bulb for Labor Induction?
It’s generally safe to use a Foley bulb if your doctor or midwife does the procedure. Using a Foley bulb to help induce labor also has some benefits, such as:
- In most cases, it’ll dilate your cervix within 12 hours.
- It’s usually a safe option if you’ve had a C-section in the past.
- You don’t need medication (although you can use it).
- Compared to other ways to induce labor, it has lower rates of complications.
Plus, you can always ask your doctor to take out the Foley bulb if you change your mind.
When Is a Foley Bulb Recommended for Inducing Labor?
Foley bulbs are a good option if you want to have an outpatient procedure and go home (and if your doctor agrees to this). Induced labor may be a good idea if you have certain health conditions, including:
- High blood pressure before pregnancy
- Preeclampsia or eclampsia (high blood pressure during pregnancy)
- Chorioamnionitis, in which your placenta and the amniotic fluid around it get infected
- Your baby isn’t thriving or growing
- Your water broke on its own, and labor hasn’t started after 24 hours
- Your pregnancy lasts longer than 42 weeks
In these cases, it may be safer for your baby to be born and treated than to remain in your uterus.
Sometimes, people might feel that their heath care provider is pressuring them to get induced without really understanding the reason. Ask for an explanation if this is the case.
“People can be afraid to speak up, but you have a right to understand everything,” Bowman says.
Elective induction. If you live far away from your hospital, you might decide to have your labor induced. This is called elective induction. A Foley bulb could be helpful if you are healthy and able to stay somewhere nearby.
What’s it like to have a Foley bulb?
The procedure might feel uncomfortable, but it usually isn’t painful.
You might have some contractions for about an hour right after your provider inserts the Foley bulb. Having these contractions doesn’t necessarily mean that your labor is starting. Contractions will get stronger and more regular when labor starts.
It’s important to rest, eat, and drink water. Having a support partner, friend, relative, or doula with you can help, too.
If you’re at home, you can do what you need to do, Bowman says. “You can come in and out of the house as you need to. You can go to the store. You can do things that distract you,” she says. “And a lot of the time, those distractions make the hardest part of labor easier to manage.” She says it is a good idea to have a supportive partner, friend, relative, or doula with you, if you want.
You can do your regular daily activities like showering, bathing, using the toilet, and walking. You shouldn’t have sex while you have a Foley bulb in place, though.
Make sure to clean the catheter tubing after you use the toilet and wash your hands well. It’s normal to have some spotting or discharge when you have a Foley in. You may want to change your underwear regularly to stay clean and dry.
Sometimes, Foley bulbs may fall out. If yours comes out, don’t try to reinsert it. If it stays in place, don’t try to take it out yourself. Let your doctor or midwife remove it properly. This will help stop you from getting hurt or getting germs in your vagina.
Your doctor will want to see you the next day. Make sure you return to your appointment and let your doctor or midwife know how you’re feeling. Talk to your doctor before your appointment if you have any of the following symptoms:
- Bleeding
- Contractions
- Your baby isn’t moving
- You feel sick
- Your water breaks
What happens if the Foley bulb doesn’t work?
Sometimes, Foley bulbs don’t work. If your labor hasn’t started 12-24 hours after you get a Foley bulb put in, your doctor or midwife will take it out. You can ask them if it’s OK to try it again later with a new Foley catheter.
Adding medications to start labor, along with the Foley bulb, can be an option for some people. Using medication and a Foley bulb together can give you a better chance of going into labor, Robinson says.
You can also choose to try a different way of inducing labor, or you can decide to wait and see if labor will start on its own.
Are there alternatives to the Foley bulb for inducing labor?
There’s not much scientific evidence that any home remedies aside from nipple stimulation can help get labor started. Touching your nipples or using a breast pump makes your body release hormones that cause contractions and help kickstart labor.
But some people try generally safe methods such as:
- Walking
- Doing squats
- Eating certain foods
- Doing sexual activities that you enjoy, as long as you don’t have any medical reasons to avoid sex
Stress can sometimes get in the way of labor, so Bowman recommends talking to a friend, relative, doula, or loved one about anything that’s bothering you. “Do calming things,” she says. “There’s acupuncture. There’s acupressure. There’s massage therapy to help you go into labor, and also help relax your body, too.”
Your provider might also try methods such as:
- Membrane sweeping, where they try to loosen the bag of water
- Putting small rods inside your cervix to help it open
- Using a tool to make your water break
Some medications can help open your cervix, cause contractions, or make labor start. Your midwife or doctor can tell you about their risks and benefits, what it would feel like to get them, and what your options are. Some are put into your vagina, some are pills you swallow, and some are given to you through an IV. You usually need to be in the hospital or birth center to get them, because they can have side effects for you and your baby.
If you and your baby are doing well, there’s also the option of just continuing to wait, Shaw says.
Remember, it’s your choice. Your doctor or midwife is there to support you and empower you to make decisions that are right for you and your family.
Takeaways
A Foley bulb catheter is a thin tube with a balloon attached that your doctor or midwife puts inside your cervix. Your provider fills the balloon with sterile salt water to put pressure on your cervix. This helps it open and start contractions.
Foley bulbs are a low-risk way to help get labor started. Many doctors, midwives, and doulas think they’re a good option for most people. Be sure to ask your doctor or midwife why they think your labor should be induced to make an informed decision.
FAQs About Using a Foley Bulb
Below are some commonly asked questions about using a Foley bulb for labor induction.
How long does it take for a Foley balloon catheter to induce labor?
It’s different for everyone, but you might start having regular contractions right away after they put the Foley in. Or it might take several hours or more. While you wait to see if labor starts, eat, rest, and drink water. If you’re not in labor after 12 hours, your doctor or midwife may take out the Foley bulb and talk to you about other options.
Is a Foley balloon painful?
You might feel pain or discomfort when your provider puts in the Foley catheter and when they fill the balloon. But this part of the process usually takes only under a minute. How much discomfort you feel depends on several things, including:
- Where your cervix is
- Whether you’ve had a baby before
- How relaxed you are
- How ready your body is for labor
If you’ve experienced some types of trauma before, that can make it more painful. You can ask your provider to stop for a minute if you’re in too much pain.
Once the Foley balloon is in, most people don’t really feel it. You might feel some pressure, or the tape on your leg might feel irritating. When contractions get started, they might be uncomfortable or painful.
What is the success rate of Foley balloons?
A Foley balloon helps start labor in about 7 out of 10 cases. It’s more likely to work if your cervix is soft and starting to get thin, which means it’s more ready for labor. It also works better if you’re further along in your pregnancy. Ask your doctor or midwife how well they think the Foley will work for you.
