Bladder Care Post Vaginal Delivery: How Two Hour Recovery Decreased Bladder Catheterization

Objective:  Many women in labor who have had epidural anesthesia undergo unnecessary bladder catheterizations (BC) which render them at risk for infection as well as undue discomfort. Recent guidelines have promoted voiding trials and reserving BC for those who fail to void on the bedpan. We devised a program of staff education and reminders to reduce the number of BC at our institution. At the same time, standards for post partum recovery changed from 1 to 2 hours of monitoring. The purpose of this study was to determine if this education program would reduce peri-partal BC. In addition, we now had longer time in recovery which might promote voiding post delivery.

Design: This study used a quasi-experimental design.

Setting: This study was conducted at an LDR tertiary care community hospital with Magnet distinction performing 3100 deliveries/year.

Patients/Participants: Subjects included all consecutive patients with epidural anesthesia and a vaginal delivery. A retrospective chart review (n=147) was conducted to obtain pre-intervention data and a prospective (n=150) group was studied post-intervention for 6 months.

Methods: After IRB approval chart reviews were conducted for a 6 month period pre and post intervention.

Results:  Mean gestation was 39.2 weeks with no significant difference between groups. Most vaginal repairs were 2^nd degree and there was no difference in the overall number or types of vaginal repair. Weight was 185 pounds in the pre and 174 pounds in the post groups (p=.006). In the pre-intervention group 97% were BC after delivery and none were offered a bedpan post epidural administration. Post-intervention 66% were BC once during labor and 27% had >1 or indwelling BC.  The post-intervention group had 2 hours of recovery and 85% were able to void with the added time. Of the 88/150 that were offered a bedpan, 33% were able to void at least once after epidural placement. These differences were statistically significant (p<.001).

Conclusion/Implications for nursing practice: Practice changes regarding bladder care can be successfully instituted in a busy labor and delivery unit. Prior to the intervention, BC was routinely performed and accepted as standard care despite national efforts to decrease BC. Staff education plus the 2 hour recovery resulted in a practice change that promoted patient comfort and safety. Results of this intervention can be adopted in other institutions.

Keywords:  Bladder catherterization, Epidural voiding, 2 hour recovery