What are the risks of refusing a catheter in labor?

[Anonymous]

Anonymous wrote:You could try some of the non-epidural pain relief options, OP. I don't think those require catheters. http://www.babycenter.com/0_systemic-pain-medication-for-labor_1489906.bc

Most of these drugs cannot be administered close to time of birth because of the severe side effects on baby. OP mentioned coming into the hospital well into active labor, which in her situation as a multip, would likely make it impossible to administer narcotics.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can you elaborate what kind of issues with the epidural?

I'm not PP, but I can answer your question in broad terms...

Maternal Risks
Hypotension (Drop in blood pressure) (indication for c-section if not managed)
Urinary Retention and Postpartum Bladder Dysfunction
Uncontrollable Shivering
Itching of the face, neck and throat
Nausea and Vomiting
Postpartum Backache
Maternal Fever (indication for c-section if not managed)
Spinal Headache
Uneven, incomplete or nonexistent pain relief
Feelings of Emotional detachment
Postpartum feelings of regret or loss of autonomy
Inability to move about freely on your own
Loss of perineal sensation and sexual function
Very Serious and rare risks include: Convulsions, Respiratory paralysis, Cardiac arrest, Allergic shock, Nerve injury, Epidural abscess, and Maternal death


Labor Side Effects
Prolonged First Stage of Labor
Increase of malpresentation of baby's head
Increased need for Pitocin augmentation
Prolonged Second Stage of Labor
Decrease in the ability to push effectively
Increased liklihood of forceps or vacuum extraction delivery
Increased likelihood of needing an episiotomy
Increase in cesarean section


Baby Side Effects
Fetal distress; abnormal fetal heart rate
Drowsiness at birth; poor sucking reflex
Poor muscle strength and tone in the first hours

I didn't ask the question but holy cow!!!!

[Anonymous]

Holy cow what?

[Anonymous]

Well I almost did this but it wasn't on purpose. I came in and was already 6 cm and by the time I got my epi I was 8 cm (within an hour of coming in) I probably could have pushed much earlier but it was during a baby boom and nurses were all over the place and by the time my doctor came in for me to push she stated "oh your bladder is about to burst" I had been given two bags of fluid and they never cleared my bladder. she quickly emptied it and then I pushed three times and the baby was out. I did have internal tearing in my uthera but I don't know if that was from labor or from them urgently draining my bladder. This time I might try to go natural but just because I only labor for 3-4 hours and this will be my third.

[Anonymous]

Anonymous wrote:Well I almost did this but it wasn't on purpose. I came in and was already 6 cm and by the time I got my epi I was 8 cm (within an hour of coming in) I probably could have pushed much earlier but it was during a baby boom and nurses were all over the place and by the time my doctor came in for me to push she stated "oh your bladder is about to burst" I had been given two bags of fluid and they never cleared my bladder. she quickly emptied it and then I pushed three times and the baby was out. I did have internal tearing in my uthera but I don't know if that was from labor or from them urgently draining my bladder. This time I might try to go natural but just because I only labor for 3-4 hours and this will be my third.

Yes, the tearing in your urethra was probably from the frantic cath attempt. Sad that had to happen like that.

Third baby with a 3-4 hour labor you could definitely do it without epi if you wanted.

[Anonymous]

If you have the catheter Inserted non emergently, you will be able to have them do it with better sterile technique: when we are in a hurry, sterile is a lot harder. Make sure two RNs put the cath in, one to hold things open so your urethra is visible and the other to insert using sterile technique. If they miss, you or someone with you should request a clean foley and new sterile gloves. It's been almost a year since we have had a catheter related infection using this technique.

The RNs need to clean your peri area with soap and a washcloth at least twice a day: bath wipes or a squirt bottle don't count. Also, if you have stitches, peri bottles are single use items. Make sure the foley is secured to your leg so it doesn't pull on the opening to your bladder.

[Anonymous]

Lots of good advice here, but seriously, why don't you just not have an epidural? It's the simplest solution.

[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.

This. The last few cm are likely to be less pain than UTI plus newborn.

[Anonymous]

Just a note: the straight catheter has been found to increase the risk of infection over the use of the foley cath, because there are more opportunities to push bacteria up into the bladder.

PP Nurse, the process you describe sounds so civilized. I'm a doula and I've never seen nurses double team a foley cath, nor have I seem them do regular cleaning of the area. I hope the practice spreads.

[Anonymous]

Anonymous wrote:Holy cow what?

After reading that how does anyone ask for an epidural.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Holy cow what?

After reading that how does anyone ask for an epidural.

Because those risks are not common. All treatments, meds, surgeries etc carry risks. Have you ever signed a consent form for surgery ? Somewhere in there it will say you can die from the procedure. Doesn't mean you should skip it.

[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?

Yes, intermittent catheterization has a lower infection risk than an indwelling catheter.

[Anonymous]

Anonymous wrote:

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.

Can you provide a source, because this contradicts what is currently accepted as evidence based practice.

[Anonymous]

Two different responses regarding infection risk for intermittent caths? Confused.

[Anonymous]

The hospital seriously lowered our infection rates with that process. Plus, it's nicer for the patient. No digging around in there-----