A C-section, also known as a Cesarean section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. It is one of the most common surgeries performed on women in the United States, with over 30% of babies being born this way.
During a C-section, a catheter may be used for several reasons. A catheter is a thin, flexible tube that can be inserted into the bladder to drain urine. Understanding whether a catheter is necessary and why it may be used can help women know what to expect during and after their C-section.
Why a Catheter May Be Used
There are several reasons why a catheter may be placed during a C-section:
To Empty the Bladder
Before any major abdominal surgery, the bladder is emptied to get it out of the way of the surgical area. A catheter provides a quick and easy way to drain the bladder before the start of a C-section. An empty bladder reduces the risk of injury during the surgery.
To Monitor Fluid Output
During and after the C-section, doctors want to closely monitor how much fluid is being produced by the body, including urine output. A catheter allows urine to drain freely from the bladder into a collection bag where output can be measured. This helps assess kidney function and ensure excess fluid buildup is not occurring.
To Prevent Urinary Retention
After a C-section, some women may have trouble urinating on their own due to discomfort, pain medications, anesthesia, and the trauma of surgery. A catheter can stay in place to continue draining urine until normal bladder function returns. This prevents urine retention in the bladder, which can lead to complications.
For Epidural Anesthesia
An epidural is often used for anesthesia during a C-section. This type of regional anesthesia can sometimes interfere with bladder control and urine retention. Inserting a catheter helps keep the bladder empty while an epidural is in place.
When a Catheter is Placed
The catheter is most often placed just before or soon after the start of a C-section. Here is a look at the typical catheter timeline:
Before Surgery Starts
The catheter will usually be inserted after anesthesia has been administered but prior to making the surgical incision. This ensures the bladder is empty from the beginning.
Shortly After Delivery
Alternatively, the catheter may be placed immediately after the baby is delivered via C-section. This gets the catheter in place to monitor postpartum urine output.
In the Operating Room
Placement of the catheter generally occurs in the operating room while the woman is under anesthesia. The process only takes a few minutes to complete.
Postpartum
The catheter may remain in place for several hours or days after the C-section until the woman is mobile and able to urinate on her own again. This prevents bladder distension and urinary retention.
The Catheter Insertion Process
Inserting a urinary catheter is a simple process that involves the following steps:
Cleaning
The urethral opening where the catheter will be inserted is cleaned with an antiseptic solution to reduce the risk of infection.
Anesthetic Gel
A local anesthetic gel is often applied to numb the urethra prior to catheter insertion. This minimizes discomfort.
Inserting the Catheter
The catheter tube is threaded through the urethra and into the bladder. This may feel uncomfortable but should not be painful due to anesthesia.
Inflating the Balloon
Once in the bladder, a small balloon at the end of the catheter is inflated with sterile water to hold it in place.
Urine Drainage
A drainage bag is connected to the catheter to collect urine output. Proper urine flow confirms correct catheter placement.
The catheter is then secured in place with tape and can remain inserted until no longer needed.
Types of Catheters Used
There are a few different types of catheters that may be used during a C-section:
Foley Catheter
This is the most common type used. It has a balloon on the end that inflates inside the bladder to hold it in place. Foley catheters are inserted for longer-term drainage.
Straight Catheter
This is a thin, flexible tube with no inflatable balloon. It is inserted briefly to drain urine, then removed.
External Catheter
This condom-like device is placed over the urethral opening in women to passively drain urine from the bladder.
Coude Catheter
This catheter has a curved tip to help guide it through the urethra more easily. It may be used if insertion is difficult.
The doctor will select the most appropriate catheter type based on the individual clinical scenario.
Recovery After Catheter Removal
The urinary catheter is generally removed before a woman is discharged from the hospital after her delivery. Here is what to expect as the bladder returns to normal function:
Urine Retention
It is common to experience incomplete bladder emptying or urine retention initially after catheter removal. This usually resolves within a few days as the bladder muscles regain strength.
Burning Urination
Some mild burning with urination is normal and will improve quickly. Increased pain or burning may be a sign of a urinary tract infection.
Frequent Urination
The bladder may be overly sensitive at first, causing a frequent urge to urinate. This hypersensitivity should fade over days to weeks.
Leaking Urine
Temporary leaking with coughing, laughing, or picking up heavy items is not uncommon after catheter use and childbirth. Pelvic floor exercises can help improve bladder control.
Staying well-hydrated and avoiding straining with bowel movements can help minimize discomfort during the transition after catheter removal.
Infection Risk
One concern with urinary catheters is the increased risk of developing an infection. Bacteria can enter the urinary tract when the catheter is inserted. Longer catheter use raises infection risk.
Signs of a urinary tract infection after catheter removal include:
– Fever or chills
– Painful urination
– Frequent need to urinate
– Cloudy, bloody, or foul-smelling urine
– Pelvic pain or abdominal discomfort
Seeking prompt medical treatment is important if any symptoms of infection develop. A urine culture can confirm a UTI diagnosis, and antibiotic medications will be prescribed.
Preventing Infections
Doctors and nurses take steps to minimize the infection risk associated with catheter use:
– Using sterile technique for insertion
– Securing the catheter properly to prevent movement
– Keeping the drainage bag below the level of the bladder
– Emptying the drainage bag regularly
– Removing catheters as soon as no longer needed
– Monitoring for early signs of infection
Even with precautions taken, infections may still occur. Staying aware of any concerning symptoms after catheter removal is advised.
Considerations for Vaginal Birth After C-Section (VBAC)
For women planning a VBAC, or vaginal delivery after a past C-section, bladder management also needs to be considered. Here are a few key points:
Higher Risk of Urine Retention
Women attempting a VBAC have an increased risk of temporary urine retention after delivery. A catheter may be recommended proactively.
Avoiding Unnecessary Interventions
However, catheter use could potentially impact efforts to labor naturally. Talk with your provider about benefits and risks.
Intermittent Catheterization
This involves straight catheter insertion to drain the bladder periodically instead of leaving one in place. It avoids constant catheter use.
Monitoring Fluid Intake and Output
Closely tracking fluid intake and urine output can help assess any urinary retention issues promptly if a catheter is not used.
Thoroughly discussing catheter use preferences with your OB provider is advised when planning a VBAC.
Frequently Asked Questions
Is catheter use mandatory during a C-section?
No, catheter insertion is not absolutely mandatory. But it is recommended for most C-sections to help empty and monitor bladder function. Some women may wish to decline catheter placement if the benefits do not outweigh personal preferences.
Can a C-section be done without a catheter?
It is technically possible to undergo a C-section without having a urinary catheter placed. However, the surgeon may have difficulty accessing the lower uterus without a empty bladder. Lack of bladder monitoring could also increase risks after surgery.
How long after a C-section is the catheter removed?
The catheter is typically removed within 24-48 hours after a C-section. It may be taken out as soon as the effects of anesthesia and pain medicine allow regular urination. Prolonged use raises risks of discomfort and infection.
Is catheter insertion during C-section painful?
Catheter placement during a C-section is generally not painful. Any discomfort is minimized since it is performed after anesthesia has numbed the area. Some women may experience mild stinging when urinating initially after catheter removal.
Can a C-section be done with an epidural only?
It is possible but uncommon to have a C-section with only epidural anesthesia and no urinary catheter. However, medications in an epidural can make urinating difficult, so a catheter is almost always placed to empty the bladder during surgery.
Conclusion
While not necessarily mandatory, catheter use is very common during a Cesarean delivery. Inserting a urinary catheter provides several benefits in terms of emptying the bladder before surgery, monitoring urine output, and preventing retention after the procedure. Catheters are generally placed right before or shortly after the start of a C-section. Despite proper precautions, catheters also carry a small risk of causing urinary tract infections. Being educated about the indications for catheter use and what to expect with its insertion and removal can help mothers feel better prepared for this aspect of a C-section.