A catheter is a thin flexible tube that is inserted into the bladder to drain urine. Catheters are routinely used during cesarean sections (also called C-sections) for several reasons:
- To keep the bladder empty – A full bladder can get in the way during the surgery and increase the risk of injury.
- To monitor urine output – This allows the medical team to track how well the kidneys are functioning during and after surgery.
- For ease of use – Women undergoing C-sections have epidurals or spinal anesthesia which numb the lower body. This makes it difficult to urinate voluntarily after surgery until the anesthesia wears off.
While catheters are standard practice with C-sections, some women may wish to refuse the catheter or have concerns about needing one. This article provides an overview of the use of catheters for C-sections and whether it is possible to refuse a catheter during the procedure.
Why Are Catheters Used for C-Sections?
There are three main reasons that nearly all women having a C-section will have a urinary catheter placed:
1. Keep the Bladder Empty
During a cesarean delivery, the surgeon will make an incision through the abdominal wall and uterus to deliver the baby. The bladder sits right in front of the uterus in the pelvis. If the bladder is full during the surgery, it can obstruct the surgeon’s access to the uterus.
An empty bladder reduces the risk of:
- Accidental injury or laceration to the bladder
- Increased bleeding due to a distorted surgical field
It is crucial that surgeons have a clear view during the procedure to avoid complications and safely deliver the baby.
2. Monitor Urine Output
The medical team closely monitors urine output during and after a C-section. The urine draining into the catheter collection bag allows them to easily measure the volume and watch for changes.
Increased urine output can indicate:
- Good blood flow to the kidneys
- Well-hydrated state
Decreased output may be a sign of:
- Low blood pressure
- Dehydration
- Kidney problems
If urine output becomes a concern during or after the surgery, the medical team can take steps like giving IV fluids to support kidney function.
3. Assistance After Anesthesia
A C-section is done under regional anesthesia, either an epidural or spinal block. This numbs the lower half of the body to prevent pain during the surgery.
The numbing effect makes it difficult or impossible for a woman to walk or urinate on her own until it wears off. This typically takes several hours.
A catheter allows the bladder to stay empty without the need to get up to go to the bathroom. Once sensation returns, the catheter is removed and women can urinate normally again.
Are There Risks With a Catheter?
As with any medical procedure, there are some risks associated with the use of a urinary catheter:
- Infection – Bacteria can be introduced into the urinary tract during catheter insertion. However, the risk is low when sterile technique is used for insertion and the catheter remains in place for a short time.
- Bladder injury – There is a small risk of injury to the urethra or bladder with improper catheter insertion.
- Urethral injury – In rare cases, the catheter can cause trauma to the urethra, especially if the catheter is left in place for a prolonged period.
- Discomfort – Some women may experience bladder spasms or discomfort with the catheter.
Despite these risks, the benefits typically outweigh any downsides for most women undergoing a C-section. Proper sterile procedures minimize the chance of any complications.
Can I Refuse a Catheter for My C-Section?
While catheters are routine with cesarean deliveries, a woman’s preferences are still an important consideration. Refusing medical procedures should be discussed with your obstetrician prior to the surgery date.
There are a few key points to consider if you wish to decline a urinary catheter:
- Your provider may advise against refusing the catheter due to safety or difficulty performing the surgery without it.
- You may need to sign a waiver or release form due to increased risks associated with not using a catheter.
- The anesthesiologist may be unwilling to proceed with a spinal or epidural anesthetic if you do not have a catheter placed, due to risks of bladder distention.
- After surgery, you will likely need assistance to ambulate and use the restroom until the anesthesia wears off completely.
- Your medical team will need to monitor your fluid status and urine output through alternative means, such as regular abdominal ultrasounds.
While it may be possible to refuse the urinary catheter, your health care providers will weigh whether the risks of doing so outweigh the benefits. Ultimately the final decision may depend on their clinical judgment regarding the safest options for both you and your baby.
Are There Alternatives to an Indwelling Catheter?
If you wish to avoid an indwelling urinary catheter placed prior to surgery, there are a few alternatives that you can discuss with your OB:
Intermittent straight catheterization
Rather than an indwelling catheter that stays in place, the nurse intermittently empties the bladder by inserting a single-use catheter when needed. This reduces the risk of infection. However, it can become labor intensive for the nursing staff.
External catheter
This is a condom-like device that adheres to the area around the urethral opening to passively drain urine from the bladder into a collection bag. It avoids inserting a tube into the urethra. However, external catheters may not empty the bladder as effectively.
In and out catheterization
A catheter is inserted prior to the surgery start time in order to empty the bladder. It is removed once the bladder is empty. A new catheter may be placed again later to drain urine if needed.
More frequent ultrasounds
Rather than relying on a catheter to monitor fluid status, your medical team may opt for more frequent bladder scans by ultrasound. This allows visualization of urine volume in the bladder non-invasively.
Delayed spinal anesthesia
Rather than doing the epidural or spinal anesthesia early to allow placement of a catheter, the anesthesia may be placed after the bladder is emptied just prior to surgery start time.
Your OB can help determine if any of these alternatives are appropriate options for your C-section. However, they may still advise that the standard indwelling catheter is the safest choice.
Key Points to Discuss With Your OB Before Surgery
If you do not want a urinary catheter for your upcoming C-section, be sure to:
- Mention this preference to your OB well in advance of the surgery date.
- Ask your OB if it would be possible to avoid a catheter and have an informed discussion of the risks versus benefits.
- Discuss any alternative options, like intermittent catheterization, that may allow your preference to be accommodated.
- Inquire about any additional forms or waivers needed if declining standard catheter placement.
- Talk to the anesthesiologist prior to surgery to agree on a pain management plan if a catheter will not be used.
- Make a plan for assistance with ambulation and using the restroom after surgery until sensation returns.
- Agree to additional monitoring methods if a catheter will not be utilized, like frequent bladder scans.
While refusing a urinary catheter is not recommended, you and your OB can determine if there are any safe alternatives that could work for your particular situation. Keep an open line of communication about your concerns and preferences.
Frequently Asked Questions
Is it possible to avoid getting a catheter for a C-section?
It is generally recommended to have a urinary catheter placed for a C-section for safety reasons. However, in some cases, it may be possible to avoid an indwelling catheter if alternatives like intermittent catheterization are used instead. Discuss options with your OB.
What if I don’t want a catheter during my C-section?
Speak with your OB about your concerns beforehand. They can explain the risks versus benefits and see if options like intermittent catheterization are appropriate. However, they will advise against refusing a catheter if they feel it is necessary for the safety of the procedure.
Can I ask for the catheter to be removed early?
The catheter is usually kept in place for the duration of the surgery and for a few hours afterwards in the recovery room until sensation returns. This ensures the bladder stays empty while you are unable to urinate on your own. Early removal is not typical as it could lead to a distended bladder before you are able to walk to the restroom.
What problems can occur without a catheter for C-section?
Potential risks include injury to the bladder during surgery, inability to measure urine output to monitor kidney function, fluid overload, bladder distention, and prolonged difficulty urinating if epidural anesthesia is used.
Can I still get an epidural without having a catheter?
The anesthesiologist may want a catheter placed prior to administering an epidural or spinal anesthetic to help avoid bladder distention. Discuss your options, but the anesthesiologist may decline to proceed without a catheter in place.
Conclusion
In summary, urinary catheters are routinely utilized during cesarean deliveries to keep the bladder empty, monitor fluid status, and allow urine drainage after numbness from anesthesia. While it may be possible to decline a catheter, this is generally not recommended due to increased risks to both the mother and baby. A woman’s preferences should be discussed with the OB well before the scheduled surgery date in order to determine if alternatives like intermittent catheterization are appropriate options in any individual case. With open communication and proper planning, a safe compromise may be reached regarding the use of catheterization for a C-section procedure.