What are the risks of refusing a catheter in labor?

[Anonymous]

Looking for nurses or OBs who may be on this board to answer a question: if I refuse a urinary catheter during an epidural (assuming I get the epidural around 6-7 cm), what risks am I assuming?

[Anonymous]

If your bladder is full (or becomes full due to IV fluids being administered in conjunction with epidural), it may impede baby's descent. There is also some belief that pushing with a full bladder increases likelihood of damage to bladder and nearby tissues. If a mechanical delivery (forceps, vacuum, etc) becomes necessary (which is statistically increased with use of epidural anesthesia), they will need to be sure that the bladder is empty as to avoid injury when instrument is inserted.

Have you considered asking to be straight cath'ed? In and out, quick empty rather than the foley which is left in.

[Anonymous]

Don't obsess over this. I hated the idea of a catheter but when the time came it was nothing. When you are 6-7 cm, chances are you won't even feel the catheter go in it is such a nonissue comparatively. You will have other things to think about that are a lot more painful, like the contractions that got you to 7 cm.

I was actually sad when the catheter came out...walking to the bathroom and peeing was very painful after my 4th degree tear. Once the foley is placed you can't feel it.

[Anonymous]

OP here. To PP, I've had a Foley with both deliveries (and am expecting #3). Each time the Foley led to extremely painful, antibiotic resistant UTIs which really affected me the first 2 weeks post-partum. I really want to avoid another UTI this time.

Follow-up question: are IV fluids administered continuously while epidural is in place? Or is it only a certain number of bags that have to be administered and then it is shut off? I just can't remember. If the latter, can I pee right before getting the epidural so bladder is empty for the last 2-3 cm of dilation?

[Anonymous]

Continuous IV fluids once epidural is placed.

[Anonymous]

Anonymous wrote:If your bladder is full (or becomes full due to IV fluids being administered in conjunction with epidural), it may impede baby's descent. There is also some belief that pushing with a full bladder increases likelihood of damage to bladder and nearby tissues. If a mechanical delivery (forceps, vacuum, etc) becomes necessary (which is statistically increased with use of epidural anesthesia), they will need to be sure that the bladder is empty as to avoid injury when instrument is inserted.

Have you considered asking to be straight cath'ed? In and out, quick empty rather than the foley which is left in.

Has this been shown to lead to less UTI risk?

[Anonymous]

Anonymous wrote:

Anonymous wrote:If your bladder is full (or becomes full due to IV fluids being administered in conjunction with epidural), it may impede baby's descent. There is also some belief that pushing with a full bladder increases likelihood of damage to bladder and nearby tissues. If a mechanical delivery (forceps, vacuum, etc) becomes necessary (which is statistically increased with use of epidural anesthesia), they will need to be sure that the bladder is empty as to avoid injury when instrument is inserted.

Have you considered asking to be straight cath'ed? In and out, quick empty rather than the foley which is left in.

Has this been shown to lead to less UTI risk?

No, not at all. Anytime something foreign enters your body in that manner, there is a risk for infection.

You could preemptively start ABX or probiotics, but that's a matter of choice and when it comes to risk/benefit of those treatments, it can get fuzzy as well.

[Anonymous]

Thanks for the replies. Is there a way the nurse or OB can check for bladder distension prior to pushing and then deciding on necessity of cath?

[Anonymous]

Have you considered going unmedicated? Really not looking to start up that debate and definitely think it's a personal decision, but in your case where catheters lead to UTIs, it might be worth reconsidering if that's the only way to avoid the catheter.

[Anonymous]

Anonymous wrote:Thanks for the replies. Is there a way the nurse or OB can check for bladder distension prior to pushing and then deciding on necessity of cath?

I suppose she could, but it's completely subjective and relative to your individual anatomy and baby's size/position. There are too many variables in play to make anything but an educated guess. Not sure how many RNs/OBs would be comfortable with that. Honestly, they'd probably just cath you unless baby popped right out before they had a chance.

[Anonymous]

I didn't have a cath with either delivery, but that was 16+ years ago. One was natural, the other epidural. It's routine now??

[Anonymous]

Skip the epidural. You'll go very fast from 7 to 10 cm with a third labor. And then pushing is pleasant or at least satisfying and takes less time without an epi.

[Anonymous]

Anonymous wrote:I didn't have a cath with either delivery, but that was 16+ years ago. One was natural, the other epidural. It's routine now??

Yes.

[Anonymous]

Anonymous wrote:Skip the epidural. You'll go very fast from 7 to 10 cm with a third labor. And then pushing is pleasant or at least satisfying and takes less time without an epi.

+1

[Anonymous]

OP again. Pushing is pleasant? Isn't it the most painful part (ring of fire?)