Outpatient cervical ripening: discomfort/pain during speculum and Foley catheter insertion

Abstract

ObjectiveTo examine discomfort/pain associated with the Foley catheter insertion process and explore factors affecting discomfort/pain. DesignThis cohort study conducted in the context of larger randomised clinical trial comparing silicone and latex Foley catheters. SettingA tertiary hospital in Western Sydney. ParticipantsOutpatient pregnant women (eligible participants in the main study). InterventionsWe asked about the discomfort/pain expectations and experience during the digital vaginal examination and insertion of the speculum, insertion of the Foley catheter and while the catheter was in situ. MeasurementsWe used visual analog scale and a purposefully designed questionnaire to measure outcomes. FindingsWe found digital vaginal examination and speculum insertion (mean pain score = 4.6–4.7/10) to be significantly more uncomfortable than Foley catheter insertion (mean pain score = 3/10), while having the catheter in situ for a median of 14 h was mid-way in discomfort (mean pain score = 3.7/10). Only 12–13% of women experienced no discomfort during digital vaginal examination and speculum insertion, while about 40% experienced no discomfort during Foley catheter insertion. We identified no factors that influenced the experience of discomfort during speculum insertion. However, being overseas-born (odds ratio = 1.91, 95% = 1.10, 3.33) and experiencing discomfort during the speculum insertion (odds ratio = 8.15, 95% = 3.19, 20.79) increased the chance of discomfort on catheter insertion. Women's discomfort was not influenced by inserter designation or experience. Key conclusionsDigital vaginal examination and speculum insertion were moderately uncomfortable while insertion of a Foley catheter and having the catheter in situ for several hours were less uncomfortable procedures. Implications for practiceOnly 8% of insertions were rated as difficult by staff while 70% were rated easy. This, together with the fact that the inserter's level of experience had no influence on women's discomfort, are reassuring for midwives who wish to teach and learn this common procedure.