Is it recommended to remove a Foley (indwelling urinary) catheter during the pushing stage of labor?

Foley Catheter Removal During the Pushing Stage of Labor

Foley catheters should be removed at the earliest opportunity following delivery to reduce the risk of accidental overdose and infectious complications, but there is insufficient specific evidence to support routine removal during the pushing stage of labor. 1

Timing of Foley Catheter Removal in Labor

• Foley catheters are traditionally placed prior to major procedures to avoid urinary retention, improve patient comfort, and monitor urine output, though there is limited evidence supporting this practice 1
• Prolonged catheterization increases the risk of urinary tract infection (UTI), which is the fourth leading cause of hospital-acquired infections 1
• Current guidelines recommend that Foley catheters should be removed within 24 hours after surgery in most cases 1
• For obstetric patients specifically, the timing should be individualized based on the clinical situation, with removal as soon as feasible 2

Risks of Prolonged Catheterization

• Indwelling catheters are associated with higher rates of urinary tract infections 1
• Other complications include hematuria, catheter blockage, patient discomfort, and delayed mobilization 1
• The risk of infectious complications increases with the duration of catheter placement 1
• Accidental disconnection of catheters can create a route for microorganisms to enter, increasing infection risk 1

Considerations for Catheter Management During Labor

• There is no specific evidence in the literature addressing the optimal timing of Foley catheter removal during the pushing stage of labor 2, 3
• For patients with intrathecal catheters (a different but related scenario), guidelines recommend removal at the earliest opportunity following delivery to reduce infection risk 1
• Early mobilization after delivery is recommended as part of enhanced recovery protocols, which may be facilitated by earlier catheter removal 1
• The optimal timing for catheter removal after cesarean delivery appears to be 12-16 hours postoperatively to minimize urinary retention 4

Algorithm for Decision-Making Regarding Foley Catheter Removal

1. Assess the clinical situation:

   • If the patient has an epidural with dense motor block, consider maintaining the catheter until motor function returns 1
   • If the patient has normal motor function and sensation, removal during the pushing stage may be reasonable 2

2. Consider the expected duration of pushing:

   • For multiparous women with a history of rapid second stage, removal before pushing may be appropriate 2
   • For nulliparous women or those with anticipated prolonged second stage, the catheter may help prevent bladder distension 2

3. Monitor for complications:

   • After catheter removal, ensure the patient voids within 4-6 hours 3
   • Monitor for signs of urinary retention or infection 3

Special Considerations

• Urinary retention is uncommon but more likely in patients who received epidural anesthesia compared to spinal anesthesia 4
• Patients who pushed for longer durations may have higher rates of urinary retention after catheter removal 4
• If the catheter is removed during pushing, ensure the patient has adequate bladder emptying after delivery 3
• Consider intermittent catheterization rather than indwelling catheter replacement if urinary retention occurs 3

Conclusion Based on Available Evidence

While there is no direct evidence specifically addressing Foley catheter removal during the pushing stage of labor, the principles of minimizing catheterization time to reduce infection risk suggest that earlier removal when clinically appropriate is reasonable. The decision should balance the benefits of earlier removal (reduced infection risk, earlier mobilization) against the risks (potential bladder distension during pushing, urinary retention). Given the lack of specific evidence, clinical judgment based on the individual patient's situation remains important.