A better way to Induce - Foley catheter v prostaglandin gel

[gailforce1]

An interesting article in The Lancet (sorry, don't know how to link) suggests that the Foley catheter, a technique first used in1930s, is a better way to induce labour in particular for women having had a previous CS.

Studies in the Netherlands using 824 women showed that both methods were similarly successful in acheiving vaginal births but the catheter led to fewer complications, less distress to the baby and lower infection rates in mothers. Using the catheter reduced the number of operative deliveries caused by foetal distress and significantly fewer babies being admitted to special care, 12% compared to 20%.

The catheter reduced some complications including severe bleeding after delivery and women had less pain because the catheter allowed the cervix to open before contractions started. With the gels both happen simultaneously restricting blood flow to the baby and not helping labour to progress.

Two serious maternal adverse events were recorded both in the prostoglandin goup: one uterine perforation and one uterine rupture.

It was also a more cost effective option so i wonder how long before this is offered to women in this country as an alternative to gels/synto?

Would you try the catheter option it or would you think it too old-fashioned?

Wondered if any midwives had any thoughtd on this?

How does the catheter method differ to prostaglandin pessaries?

The Foley catheter - a balloon is inserted into the uterus and inflated with saline solution to imitate the onset of labour, so no chemicals.

So it inflates just the cervix or higher up into the uterus too? It's like an extreme sweep!?

I was induced by Foley Catheter (not that I knew that was what it was called!).

I was 10 days over with DC2 after having EMC at 28 weeks with DC1. My consultant sold it to me as an option instead of booking straight in for CS when I went over.

It was fine but took a little while to get going - 3 days to get to 6cm!!

How odd! I'm in New Zealand after having my first by c-section 3 years ago in the UK. I've just had my booking in and had a brief discussion with my midwife about options for this pg, mentioning that I'd gone late but did start spontaneously with DS, CS was for failure to progress at 8cms. She said that they wouldn't use chemicals to induce generally, they're not keen on them and outlined exactly this procedure. Have been v impressed with evidence-based sensitive care here generally so maybe they've adopted it for a while? Anyway she did say it's more gentle but less predictable but that's fine by me if the situation arises. I feel much more relaxed knowing it's not 'be on time or c-section' - the chemical-free induction and vbac stays on the table if I go late or look like being v big (high risk of gestational diabetes).

Yes, the article did say that this was safe for VBAC.
Can't understand why it is not being offered in the UK if only because it is more cost effective. And everything else seems to be done on cost!

I've been offered this method if necesary for vbac at Lewisham hospital in South London where apparently there is a team who have been using it sucessfully. I'm not too keen though as I cant find enough about its use in the UK. Also reviews from women in US / Austalia report it as being extremely painful to insert. My consutant said is often used along side syntocinon as will often get you to 4cm but not further so dont see the point if I'm going to have a hormonal drip anyway !!