Different methods for the induction of labour in outpatient settings

Abstract

Background Induction of labour is carried out for a variety of indications and using a range of pharmacological, mechanical and other methods. For women at low risk, some methods of induction of labour may be suitable for use in outpatient settings. Objectives To examine pharmacological and mechanical interventions to induce labour in outpatient settings in terms of feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information is available, safety. The review complements existing reviews on labour induction examining effectiveness and safety. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (December 2009) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Data collection and analysis Two authors independently extracted data and assessed eligible papers for risk of bias. We checked all data after entry into review manager software. Main results We included 28 studies with 2616 women examining different methods of induction of labour where women received treatment at home or were sent home after initial treatment and monitoring in hospital. Studies examined vaginal and intracervical PGE2, vaginal and oral misoprostol, isosorbide mononitrate, mifepristone, oestrogens, and acupuncture. Overall, the results demonstrate that outpatient induction of labour is feasible and that important adverse events are rare. There was no strong evidence that agents used to induce labour in outpatient settings had an impact (positive or negative) on maternal or neonatal health. There was some evidence that, compared to placebo or no treatment, induction agents reduced the need for further interventions to induce labour, and shortened the interval from intervention to birth. We were unable to pool results on outcomes relating to progress in labour as studies tended to measure a very broad range of outcomes. There was no evidence that induction agents increased interventions in labour such as operative deliveries. Only two studies provided information on women’s views about the induction process, and overall there was very little information on the costs to health service providers of different methods of labour induction in outpatient settings. Authors’ conclusions Induction of labour in outpatient settings appears feasible. We do not have sufficient evidence to know which induction methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings.

Psychosocial Outcomes of a Randomized Controlled Trial of Outpatient Cervical Priming for Induction of Labor

“…An important objective of outpatient priming is to improve maternal satisfaction (2,3). Our findings support the results of previous research on women's expe- riences of outpatient priming, which indicated that women were satisfied with the experience (14,15,17).…”

Psychosocial Outcomes of a Randomized Controlled Trial of Outpatient Cervical Priming for Induction of Labor

“…An important objective of outpatient priming is to improve maternal satisfaction (2,3). Our findings support the results of previous research on women's expe- riences of outpatient priming, which indicated that women were satisfied with the experience (14,15,17).…”

Women’s experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study

“…Almost half the women who had the balloon in our study found it was still painful or uncomfortable when in place, and some research suggests that the single balloon is significantly less painful when in place than the double balloon which in turn is less painful than prostaglandin gel / pessary (10,11). Kehl et al (12) found that 25% of women were still 'quite-' or 'very bothered' by the balloon once in place, and 51% in the study by Wilkinson et al (45) found wearing the balloon 'physically uncomfortable'. However, in line with our findings, significantly more women who received the balloon in the study by Kehl et al (12) were likely to recommend the method, than women who had a pharmacologic intervention (oral misoprostol in that case).…”

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

“…The included systematic reviews highlight the problem of health systems not eliciting information about users’ perception of care with regard to the provision and costs of healthcare as well as lack of standard tools to measure patient satisfaction. Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive 25 68. Women's satisfaction with healthcare influences utilisation of health services22 and their ability to be in control of their own health 55…”

“…Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive. 25 68 Women's satisfaction with healthcare influences utilisation of health services 22 and their ability to be in control of their own health. 55 …”

“…It was observed that settings other than the clinics and hospitals, such as the home, maternity waiting facilities and outpatient setting, were relatively more successful in improving user satisfaction and at least as effective as the hospitals in terms of effectiveness. 61 68 69 82 87 88 However, the safety of such settings could not be ascertained, particularly safety related to planned home birth/abortion 59 82 89 90 and induction of labour in the home or community setting. 68 …”

Psychosocial Outcomes of a Randomized Controlled Trial of Outpatient Cervical Priming for Induction of Labor

“…An important objective of outpatient priming is to improve maternal satisfaction (2,3). Our findings support the results of previous research on women's expe- riences of outpatient priming, which indicated that women were satisfied with the experience (14,15,17).…”

Women’s experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study

“…Almost half the women who had the balloon in our study found it was still painful or uncomfortable when in place, and some research suggests that the single balloon is significantly less painful when in place than the double balloon which in turn is less painful than prostaglandin gel / pessary (10,11). Kehl et al (12) found that 25% of women were still 'quite-' or 'very bothered' by the balloon once in place, and 51% in the study by Wilkinson et al (45) found wearing the balloon 'physically uncomfortable'. However, in line with our findings, significantly more women who received the balloon in the study by Kehl et al (12) were likely to recommend the method, than women who had a pharmacologic intervention (oral misoprostol in that case).…”

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

“…The included systematic reviews highlight the problem of health systems not eliciting information about users’ perception of care with regard to the provision and costs of healthcare as well as lack of standard tools to measure patient satisfaction. Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive 25 68. Women's satisfaction with healthcare influences utilisation of health services22 and their ability to be in control of their own health 55…”

“…Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive. 25 68 Women's satisfaction with healthcare influences utilisation of health services 22 and their ability to be in control of their own health. 55 …”

“…It was observed that settings other than the clinics and hospitals, such as the home, maternity waiting facilities and outpatient setting, were relatively more successful in improving user satisfaction and at least as effective as the hospitals in terms of effectiveness. 61 68 69 82 87 88 However, the safety of such settings could not be ascertained, particularly safety related to planned home birth/abortion 59 82 89 90 and induction of labour in the home or community setting. 68 …”

Psychosocial Outcomes of a Randomized Controlled Trial of Outpatient Cervical Priming for Induction of Labor

“…An important objective of outpatient priming is to improve maternal satisfaction (2,3). Our findings support the results of previous research on women's expe- riences of outpatient priming, which indicated that women were satisfied with the experience (14,15,17).…”

Women’s experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study

“…Almost half the women who had the balloon in our study found it was still painful or uncomfortable when in place, and some research suggests that the single balloon is significantly less painful when in place than the double balloon which in turn is less painful than prostaglandin gel / pessary (10,11). Kehl et al (12) found that 25% of women were still 'quite-' or 'very bothered' by the balloon once in place, and 51% in the study by Wilkinson et al (45) found wearing the balloon 'physically uncomfortable'. However, in line with our findings, significantly more women who received the balloon in the study by Kehl et al (12) were likely to recommend the method, than women who had a pharmacologic intervention (oral misoprostol in that case).…”

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

“…The included systematic reviews highlight the problem of health systems not eliciting information about users’ perception of care with regard to the provision and costs of healthcare as well as lack of standard tools to measure patient satisfaction. Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive 25 68. Women's satisfaction with healthcare influences utilisation of health services22 and their ability to be in control of their own health 55…”

“…Health systems often do not account for users’, particularly women's, perception and their opinion about the care that they receive. 25 68 Women's satisfaction with healthcare influences utilisation of health services 22 and their ability to be in control of their own health. 55 …”

“…It was observed that settings other than the clinics and hospitals, such as the home, maternity waiting facilities and outpatient setting, were relatively more successful in improving user satisfaction and at least as effective as the hospitals in terms of effectiveness. 61 68 69 82 87 88 However, the safety of such settings could not be ascertained, particularly safety related to planned home birth/abortion 59 82 89 90 and induction of labour in the home or community setting. 68 …”