Why I like the Balloon Catheter for Cervical Ripening
If you’re headed for an induction, and your cervix isn’t “ripe” you have two main choices to make it more favorable for induction. The traditional method is a topical postaglandin (Cervidil usually). You report to the hospital the night before your induction and have this gel on your cervix for 12 hours before starting other induction drugs.
Or, you could opt for the foley balloon. In this option, your OB would insert a balloon next to your cervix, and would pump it up with saline so it’s putting pressure, also stimulating natural prostaglandins to promote opening and softening. There are two clear advantages of going this route. The first is that you can go home! How nice to be able to sleep at home the night before you have your baby, laboring when you’re not well rested is a real bummer. And sleeping in the hospital is tough, because you have to be monitored, blood pressured, poked, prodded, bugged, it’s not a great sleep. Another advantage is that sinces it’s mechanical in nature, it’s “natural”. No drug has entered your body, and you can continue to labor using other natural methods.
There are only two doctors that I work with in Austin that do the foley routinely as their preferred method of ripening, probably because of my two points above, becuase they support a more mother friendly apporoach (Nurture and OBGYN-North). Why don’t the rest of doctors do it? I have my doula clients request this option many times, and there is always some excuse as to why the balloon is inferior to the drugs.
But low and behold the study in the American Journal of Obstetrics and Gynecology this month. The foley balloon actually does better by having more women delivering babies within 24 hours of its use than of traditional prostaglandins. Now science favors mother-friendly care too. Ladies – ask your doctors about your options!
A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter
Objective
We sought to compare the efficacy of a double-balloon transcervical catheter to that of a prostaglandin (PG) vaginal insert among women undergoing labor induction.
Study Design
In all, 210 women with a Bishop score ≤6 were assigned randomly to cervical ripening with either a double-balloon device or a PGE2 sustained-release vaginal insert. Primary outcome was vaginal delivery within 24 hours.
Results
The proportion of women who achieved vaginal delivery in 24 hours was higher in the double-balloon group than in the PGE2 group (68.6% vs 49.5%; odds ratio, 2.22; 95% confidence interval, 1.26–3.91). There was no difference in cesarean delivery rates (23.8% vs 26.2%; odds ratio, 0.88; 95% confidence interval, 0.47–1.65). Oxytocin and epidural analgesia were administered more frequently when a double-balloon device was used. Uterine tachysystole or hypertonus occurred more frequently in the PGE2 arm (9.7% vs 0%, P = .0007).
Conclusion
The use of a double-balloon catheter for cervical ripening is associated with a higher rate of vaginal birth within 24 hours compared with a PGE2 vaginal insert.
