Cervical balloon catheter induction of labour

Introduction

This leaflet is for women and birthing people who have previously had a caesarean birth, and have been recommended an induction of labour with a cervical balloon catheter (also known as a ‘cervical ripening balloon’).

We recommend that you also read Induction of Labour leaflet. We will also talk to you about your induction of labour choices, but we hope these leaflets will be a starting point for discussion.

What is induction of labour?

In order for a baby to be born, the neck of the womb (cervix) has to shorten, soften and open and there must be contractions. Your womb (uterus) has a powerful muscular wall that tightens and then relaxes; these contractions gradually open the neck of the womb. In most pregnancies this normally starts on its own between 37 and 42 weeks and is called ‘spontaneous labour’. Induction of labour is a process used to encourage labour to start artificially.

Benefits

The cervical balloon catheter method of induction is recommended to some women and birthing people with a scar on their womb (uterus), as it has been shown to reduce the risk of some complications, in particular the risk of your womb tearing during labour. It is also known as a ‘mechanical’ method of induction, used instead of medical methods which involve medications being inserted into the vagina.

• Significantly lower chance of contracting too often (uterine hyperstimulation): 5% of those having cervical balloon catheter versus 17% of those having medication to start labour.
• Significantly lower chance of having fetal heart rate concerns: 2% of those having cervical balloon catheter versus 15% of those having medication to start labour.
• You may be able to go home during the first part of the induction process as less monitoring is needed compared to when medication is given.

What are the complications or risks?

The procedure can be uncomfortable but it should not be painful. There is a very small risk of infection.

On the day of your induction

On the day your induction is booked, you will be asked to call delivery unit on 01223 217648 at 09:00. You will speak to the coordinator to discuss when you should come to the hospital. There are times when this will be delayed, for example, when the delivery unit it unexpectedly busy. All delays are discussed with the on-call obstetric consultant and midwife manager of the day and are prioritised on a clinical basis. You will be kept updated and additional monitoring will be offered if you have any concerns during delays.

You should continue to eat and drink as normal, unless advised otherwise. When you come to the hospital, a midwife will perform a full check on you and your baby, this includes checking your blood pressure, pulse, breathing rate and temperature, as well as testing a wee sample (urine) and undertaking monitoring of your baby’s heart rate. A maternity support worker may help with these checks.

The insertion of the cervical catheter balloon is usually carried out by a midwife or obstetric-trained doctor. A vaginal examination is offered before the procedure. If during this examination it is noted that the neck of your womb is already open and soft enough to break your waters, then a cervical balloon catheter won’t be needed and you will be offered artificial breaking of your waters instead. This will be discussed with you at the time.

To insert the cervical catheter balloon, first a speculum is inserted into your vagina (like at a smear test). This enables us to insert a soft tube (the catheter) into the opening of the neck of your womb. The catheter has a balloon near the tip and when it is in the right place it is filled with sterile water. The bottom of the balloon catheter will then be secured to your leg to apply gentle downward pressure on the balloon. The balloon catheter stays in place for 24 hours, with the balloon putting gentle pressure on the neck of your womb. The pressure should soften and open the neck of your womb enough to start labour or to be able to break the waters around your baby.

The procedure can be uncomfortable and we can provide pain relief if needed.

Going home with the cervical balloon catheter

Your midwife or doctor will assess if it is safe for you to be offered an outpatient induction of labour and will discuss this with you. Outpatient induction of labour reduces the amount of time you need to stay in hospital before your labour begins. This makes the process of induction as close as possible to going into labour naturally and means you can relax at home in a familiar environment.

During the time you are at home, you can do things as you would normally, for example, showering, having a bath or walking. However, please avoid having sex. After going to the toilet please wash your hands, make sure the catheter is clean and change underwear regularly.

It is very important to phone the delivery unit 01223 217648 if you have any of the following so that a midwife can give you advice on what to do next:

• Bleeding from the vagina
• Contractions
• Concerns about the baby’s movements
• You feel unwell
• The waters around the baby break
• The cervical balloon catheter falls out

What happens when the cervical balloon catheter is removed?

The cervical balloon catheter may fall out by itself as the neck of the womb softens and opens or if you go into labour. Alternatively, it will be taken out the next day. The midwife will remove the water inside the balloon using a syringe at the outside end of the catheter, and then gently pull the tube out. After this, the midwife will break your waters and then if your contractions do not start by themselves, a hormone ‘drip’ will be used to start your labour.

What are the alternatives?

If you have had a previous caesarean birth then the risks of induction of labour with medication will be discussed with you. It is usually recommended to either await spontaneous labour or book a planned repeat caesarean. You should discuss these options with your midwife and obstetrician.

Unlicensed use

You need to be aware that although cervical balloon catheters are widely used all around the world to induce labour, the company have not sought a license for this. There have been many research trials that have shown that this is a safe, effective method of induction. If you would prefer not to have this treatment, please discuss this with your midwife or obstetrician. The person inserting the cervical balloon catheter may be undergoing training to insert this, but will always be supervised by someone trained in the procedure.

What happens if induction of labour is unsuccessful?

In a small number of people, induction of labour is not successful even after repeated attempts. You can discuss your management with the consultant obstetrician so that a plan for birth can be put into place.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Please tell the ward staff about all of the medicines you use. During your stay if you wish to take your medication yourself (self-medicate) please speak with your midwife. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

Speak to your midwife or more information is available on the MyChart section on our website.