Foley Bulb Induction for Labor: What to Expect

Your doctor may suggest a labor induction for many reasons. Whether you are overdue or you have pregnancy complications such as preeclampsia or placental problems, there comes a point where your baby may be safer on the outside than staying in. However, sometimes your baby doesn’t know that and needs a nudge to come out, like with a Foley bulb induction. There are many modes of encouraging your baby and your body to start labor. After assessing you, your provider will choose the best one for you, depending on your body’s readiness.

One of these methods of labor induction is called a Foley bulb. A Foley bulb, also called a balloon catheter, can soften, thin, and dilate the cervix. This may also cause labor contractions to start. Even if the Foley bulb does not directly start contractions, a cervix dilated by a Foley balloon is more susceptible to future contractions of active labor. Once your cervix appears ripe for labor, you can move on to other modes of induction.¹

A Foley bulb was initially designed as part of a urinary catheter or a tube that drains urine from the bladder. When used for this purpose, the bulb is threaded through the urethra and into the bladder. Once it is in the bladder, the balloon is inflated with salt water to hold the entire catheter in place to drain urine. You may have a Foley catheter placed during labor and delivery, especially if you have an epidural.^1,2

The balloon part of the Foley catheter can also ripen your cervix to induce labor. Instead of being threaded through your urethra to your bladder, the deflated balloon is inserted through your vagina and cervix. Your cervix must be slightly dilated for insertion to take place.³

The Foley bulb sits under your baby’s head at the bottom of your uterus. Once in place, your provider will inflate it with one to two ounces of water. This inflation holds the balloon in place and puts pressure on your cervix to help it dilate.^1,3

The Foley bulb can remain in your uterus for up to 24 hours. If cervical dilation has not happened by this point, your provider may remove the balloon and try a different method of cervical ripening and induction.^1,4,5

If the Foley bulb is successful, it will fall out on its own, perhaps even less than 12 hours after insertion. Typically, the balloon falls out when your cervix is dilated to 3 centimeters. Sometimes, a Foley bulb can stretch your cervix enough so that your water breaks, and it can sometimes cause contractions to start.¹

A Foley bulb induction may feel like a pelvic or cervical exam, like when your provider checks you for dilation. Some women experience significant pain with the Foley balloon, especially when it is initially inserted and inflated. Others report only pressure. The pressure and pain will likely lessen after insertion and sit in your cervix.¹

A healthcare team member can either insert the Foley bulb using their fingers or a speculum. Studies show the speculum was the more painful method of insertion. If you are planning for a Foley bulb induction, consider asking your provider if they can insert it manually.^6,7

A Foley bulb induction is safe, but there are a few risks. It may fall out and not work, and it may be painful. Reaching the desired dilation from a Foley bulb can also take a long time. Rarely, it can cause infection by introducing germs into the uterus.¹

A Foley bulb induction uses no medications and is a relatively low-cost, effective intervention. A Foley bulb induction dilates the cervix to 3 centimeters about 70 percent of the time. Your provider can remove it at any time if necessary. It is safe for women who have undergone a Cesarean section because it does not pose a risk of an overstimulated uterus. You can combine a Foley bulb induction with medications to ripen the cervix if necessary.¹

Despite the benefits of a Foley bulb induction, there are alternatives to consider for ripening the cervix.

An alternative to a Foley bulb induction is breaking your water. Your provider may suggest this to increase pressure on your cervix and start labor. However, breaking your water may be more effective once your cervix is ripe and is only safe if your baby is already low in your pelvis.³

With your consent, your provider may attempt a membrane sweep using a gloved finger to separate the amniotic sac from your cervix. This causes the release of chemicals that sometimes help labor to start within the next 24 to 48 hours. These natural chemicals are like medications sometimes used to ripen the cervix. However, a membrane sweep avoids induction and is not considered a formal induction technique.³

Instead of a Foley bulb to ripen your cervix in preparation for an induction, medications such as Cervadil or Cytotec (misoprostol) can be used. They can be administered orally, in your cheek, or vaginally.⁴

These medications are slightly more effective at ripening the cervix. Still, they are also more likely to cause uterine hyperstimulation, fetal distress, and the need for instrumental vaginal delivery like forceps or vacuum births. They cannot be used if you have had previous uterine surgery, including a C-section.^3,8

Pitocin through an IV is also an effective induction agent, but it works better on a ripe cervix. Pitocin alone takes a long time to ripen your cervix, and prolonged exposure to Pitocin during labor increases your risk for postpartum hemorrhage. However, Pitocin is the only medication safe for cervical ripening in patients with a history of uterine surgery.³

Inducing labor can be overwhelming and can take a long time. You can take it one step at a time by using the Foley balloon by ripening your cervix without medication. Many people find this a manageable place to start when encouraging their bodies to kickstart labor without medication. Learning your induction options based on your cervical status can help you and your provider determine where to start.