Cervical ripening balloon (balloon catheter method)

If you are suitable, you can return home following the balloon insertion.

This method of induction involves a catheter (a soft silicone tube) being inserted into your cervix during a Vaginal Examination (VE) performed by the midwife. The catheter has a balloon near the tip and when it is in place the balloon is filled with a sterile saline (salt water solution). The catheter stays in place for 24 hours, with the balloon putting gentle pressure on your cervix. This pressure should soften and open (dilate) your cervix enough to either start labour or to enable the waters around the baby to be broken artificially (ARM).  

The procedure can be uncomfortable but it should not be painful. Any initial discomfort should settle following the procedure. There is a small risk of infection and if this is suspected you will be re-assessed and your plan of care will change.

What to expect

Step 1

On arrival to the hospital you will be cared for by a midwife who will:

• discuss and explain the process for induction and answer any questions you may have
• review your notes and make sure that outpatient induction is still an appropriate option for you
• check your blood pressure, pulse, temperature and test your urine
• examine your tummy to check the baby’s size and position. A presentation scan may be performed to check that your baby’s head is presenting (head first position). Induction will not continue if your baby is breech (bottom first position) or unstable lie (any other position)
• observe if your baby is well by monitoring your baby’s heart beat using a Cardiotocograph (CTG) machine for a minimum of 20 minutes, sometimes longer if necessary

Once the midwife is satisfied with your observations and with the monitoring of your baby’s heartbeat, she will ask if you are happy for her to proceed to an internal examination. This involves a vaginal examination (VE) to feel how ‘ready’ the cervix (neck of the womb) is for labour

Step 2

If you are happy to proceed, a vaginal examination will be performed by the midwife to assess your cervix and carry out the procedure. Depending on the findings, the midwife may offer to perform a membrane sweep and will only proceed with your consent.

The balloon catheter is put in place by the midwife. The catheter will be either secured to the inside of your thigh or folded into your groin area and held in place with two pairs of pants.

Step 3

If you are suitable for outpatient induction, you will be able to go home once the balloon is inserted and the midwife is satisfied with the procedure and findings.

During the time you are at home, you can do things as you would normally do, for example showering, bathing or walking. However, please avoid intercourse.

After going to the toilet please wash your hands and make sure the catheter is clean and change underwear/sanitary pads regularly. If you have any of the following, you must ring the Maternity Assessment Unit on 01226 432249 and speak to a midwife who will advise you of what you need to do:

• bleeding
• contractions
• concerns about the baby’s movements
• you feel unwell
• your waters break
• the balloon falls out
• any other concerns

If you are not suitable for outpatient induction, you will be offered admission to the Antenatal/Postnatal ward which is located on level 2 of Women’s Services at Barnsley Hospital.

Step 4

As mentioned above the balloon may fall out by itself, if this happens please contact the Maternity Assessment Unit. If this does not happen you will have already been given an appointment time to return the following day. When you return the balloon will be removed and you will have a vaginal examination to assess your cervix. Depending on the findings, you will either be ready for your waters to be broken (ARM) or you will require further induction methods to open/dilate your cervix.

If we are able to break your waters you will be transferred to the Birthing Centre at the earliest opportunity, however this depends on your individual circumstances and the number of women already in labour. You will be either offered admission to the ANPN ward to await transfer to the Birthing Centre or you will be offered to go home with a time to return later that day.

If we are unable to break your waters, you will be offered further options for induction or delivery. This will most likely involve using vaginal dinoprostone to soften and open the cervix (neck of the womb). After this, if suitable you will be able to go home or be offered admission to the Antenatal ward.