Going home with a catheter after operative birth (Caesarean section and instrumental vaginal delivery)

Many patients are not able to pass urine after delivery of their baby. The midwives will teach you how to manage a catheter. This leaflet provides information about care of your catheter at home after caesarean section and instrumental vaginal delivery.

A catheter is a small flexible tube that drains urine from your bladder. It is held in your bladder by a small water filled balloon that prevents it falling out. The urine drains from your bladder into a bag.

About one in seven women may need to go home with a catheter after giving birth. This may be due to overdistension of bladder during a prolonged labour. Sometimes the effect of the anesthesia slows down bladder function. The catheter will help to drain your urine until your bladder function returns to normal. This is usually within one to two weeks.

You will either be sent home with a free drainage leg bag or flip flow valve attached to your catheter. This will be discussed with you and will depend on both your medical history and what you prefer.

• If you are sent home with a leg bag attached to your catheter this can be worn on your calf or thigh. You may be asked to empty your catheter intermittently (every 4 hours) by opening a tap at the end of legbag. You can attach a bigger bag to use at night to avoid having to get up to empty it. You will need to change your leg bag weekly.
• If you are sent home with a flip flow valve attached to your catheter then you would need to open the valve to empty the urine from your bladder. You would need to ensure that you empty it regularly to avoid overstretching your bladder.
• It is important to wash your hands before and after touching the catheter and when changing the bag or flow valve. You should shower daily and clean the area where the catheter enters your body with soap and water.
• You should ensure that you have a good fluid intake with a catheter and aim to drink 1.5 to 2 litres of fluid a day. This will help prevent infection and constipation. A healthy diet with fibre is recommended to maintain regular bowel pattern.

You will be provided with enough catheter supplies to last you until you have it removed. This will include:

• Spare leg bag or flip flow valve.
• Leg straps.
• Night bag.
• Catheter stand.

It is not uncommon to have bladder spasms with a catheter. This will feel like tummy cramps. If this bothers you, contact your GP.

• Leakage. You can sometimes experience leakage around the catheter; this is also called by passing. It can happen with bladder spasms or when you open your bowel. If this happens continuously, your catheter may be blocked.
• Blockage. This can cause pain and discomfort. Check that the drainage bag is below the level of your bladder and that the catheter tube is not twisted. If no urine is draining contact Bolney ward at Princess Royal Hospital or Level 12 Royal Sussex County Hospital.
• Blood in your urine. If you see blood coming through your catheter contact Bolney Ward or Level 12.
• Your catheter falls out. If your catheter falls out contact Bolney Ward or Level 12.
• Infection. You are at more risk of urine infection with a catheter. Symptoms of this may include discomfort, smelly or cloudy urine. If you suspect you have an infection contact Bolney Ward or Level 12 who may prescribe you antibiotics.

Your catheter will be removed at the Trial without catheter (TWOC) clinic at Bolney ward / Lewes Victoria Hospital (to confirm at discharge).

Once we remove your catheter, you will be asked to drink and wait to fill your bladder. You will need to pass urine three times and we will check bladder is emptying with a scanner. If you are passing urine and emptying your bladder adequately then you can be discharged home.

If you are unable to pass urine or continue to retain high volumes of urine then you will be given the option to have another catheter inserted to allow more time, or to learn how to self catheterise.

Your TWOC appointment may take several hours so please be prepared for this and make sure you bring any medication or pain relief you may need.