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Am J Perinatol
DOI: 10.1055/a-2298-5166
Original Article

Patient Perspectives on Outpatient versus Inpatient Cervical Ripening for Induction of Labor

Amber Watters 
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Etoroabasi Ekpe 
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2   Department of Obstetrics and Gynecology, University of Toronto, Toronto, Illinois
,
Annette Okafor
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3   University of Illinois College of Medicine, Chicago, Illinois
,
Emily Donelan
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
4   Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
› Author Affiliations Funding None.
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Abstract

Objective Our objective was to compare patient perceived control and experience with outpatient versus inpatient cervical ripening.

Study Design This is a retrospective mixed-methods analysis of a quality improvement initiative focused on the impact to patients of incorporating outpatient cervical ripening into routine practice. Postpartum inpatients who had elected for outpatient cervical ripening (outpatients) and those who met criteria for outpatient cervical ripening but opted for an inpatient setting (inpatients) were invited to participate in the study. Patients completed the Perceived Control in Childbirth Scale, and scores were compared between outpatient and inpatient groups using Mann–Whitney U test. In addition, semistructured questions elicited feedback prior to hospital discharge, and these qualitative data were analyzed using iterative thematic analysis.

Results The study population consisted of 36 outpatients and 38 inpatients. The median score on the Perceived Control in Childbirth Scale was 69 for outpatients and 67 for inpatients (p-value = 0.49), out of a maximum score of 72 (representing the highest level of perceived control). Both groups reported similarly high levels of perceived control, regardless of cervical ripening setting. In the qualitative analysis, pain was the most common theme in both groups. Inpatients reported more distress despite access to stronger pain medications. Outpatients utilized a variety of distraction techniques and expressed gratitude for their setting more than inpatients.

Conclusion Outpatient cervical ripening can be a patient-centered solution to obstetric throughput challenges arising from increased numbers of inductions. Those who underwent outpatient cervical ripening had similar perceived control to those who underwent inpatient cervical ripening, suggesting that individual patient preferences are most important in determining the optimal setting for care. The patients' reported experiences identified focus areas for process improvement efforts and future research, including improving patient education regarding expectations and innovating new pain management strategies for cervical ripening.

Key Points

  • Patient experiences must inform patient-centered care.

  • Perceived control with cervical ripening was high.

  • Pain with cervical ripening was the most cited theme.

Keywords

cervical ripening - labor induction - patient-centered care - quality improvement

Note

Prior presentation as a poster at the 11th Annual Meeting, Society for Academic Specialists in General Obstetrics and Gynecology, Baltimore, MD, held on May 18, 2023.


Supplementary Material



Publication History

Received: 11 December 2023

Accepted: 24 March 2024

Accepted Manuscript online:
03 April 2024

Article published online:
23 April 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2021. Natl Vital Stat Rep 2023; 72 (01) 1-53
    PubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397
    CrossrefPubMedGoogle Scholar
  • 3 Manizheh P, Leila P. Perceived environmental stressors and pain perception during labor among primiparous and multiparous women. J Reprod Infertil 2009; 10 (03) 217-223
    PubMedGoogle Scholar
  • 4 Alfirevic Z, Gyte GML, Nogueira Pileggi V, Plachcinski R, Osoti AO, Finucane EM. Home versus inpatient induction of labour for improving birth outcomes. Cochrane Database Syst Rev 2020; 8 (08) CD007372
    PubMedGoogle Scholar
  • 5 Policiano C, Pimenta M, Martins D, Clode N. Outpatient versus inpatient cervix priming with Foley catheter: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2017; 210: 1-6
    CrossrefPubMedGoogle Scholar
  • 6 Sciscione AC, Muench M, Pollock M, Jenkins TM, Tildon-Burton J, Colmorgen GH. Transcervical Foley catheter for preinduction cervical ripening in an outpatient versus inpatient setting. Obstet Gynecol 2001; 98 (5 Pt 1): 751-756
    PubMedGoogle Scholar
  • 7 Wilkinson C, Adelson P, Turnbull D. Outpatient compared to inpatient cervical ripening with a double balloon catheter: a pilot randomised controlled trial. Int J Obstet Gy 2015; 122 (Supp S1): 231
    PubMedGoogle Scholar
  • 8 Ausbeck EB, Jauk VC, Xue Y. et al. Outpatient Foley catheter for induction of labor in nulliparous women: a randomized controlled trial. Obstet Gynecol 2020; 136 (03) 597-606
    CrossrefPubMedGoogle Scholar
  • 9 Diederen M, Gommers J, Wilkinson C, Turnbull D, Mol B. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG 2018; 125 (09) 1086-1095
    CrossrefPubMedGoogle Scholar
  • 10 Kruit H, Heikinheimo O, Ulander VM. et al. Foley catheter induction of labor as an outpatient procedure. J Perinatol 2016; 36 (08) 618-622
    CrossrefPubMedGoogle Scholar
  • 11 Lamar R, Mengesha B, Little S. The case for outpatient cervical ripening for IOL at term for low-risk pregnancies. OBG Manag 2019; 31 (09) 41-48 , 52
    PubMedGoogle Scholar
  • 12 Pierce-Williams R, Lesser H, Saccone G. et al. Outpatient cervical ripening with balloon catheters: a systematic review and meta-analysis. Obstet Gynecol 2022; 139 (02) 255-268
    CrossrefPubMedGoogle Scholar
  • 13 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
    CrossrefPubMedGoogle Scholar
  • 14 Amiri P, Mirghafourvand M, Esmaeilpour K, Kamalifard M, Ivanbagha R. The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial. BMC Pregnancy Childbirth 2019; 19 (01) 534
    CrossrefPubMedGoogle Scholar
  • 15 Söderquist J, Wijma K, Wijma B. Traumatic stress after childbirth: the role of obstetric variables. J Psychosom Obstet Gynaecol 2002; 23 (01) 31-39
    CrossrefPubMedGoogle Scholar
  • 16 Falk M, Nelson M, Blomberg M. The impact of obstetric interventions and complications on women's satisfaction with childbirth a population based cohort study including 16,000 women. BMC Pregnancy Childbirth 2019; 19 (01) 494
    CrossrefPubMedGoogle Scholar
  • 17 Adler K, Rahkonen L, Kruit H. Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two-year cohort study. BMC Pregnancy Childbirth 2020; 20 (01) 415
    CrossrefPubMedGoogle Scholar
  • 18 Blanc-Petitjean P, Dupont C, Carbonne B, Salomé M, Goffinet F, Ray CL. MEDIP study group. Methods of induction of labor and women's experience: a population-based cohort study with mediation analyses. BMC Pregnancy Childbirth 2021; 21 (01) 621
    CrossrefPubMedGoogle Scholar
  • 19 Henderson J, Redshaw M. Women's experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand 2013; 92 (10) 1159-1167
    CrossrefPubMedGoogle Scholar
  • 20 Stevens NR, Wallston KA, Hamilton NA. Perceived control and maternal satisfaction with childbirth: a measure development study. J Psychosom Obstet Gynaecol 2012; 33 (01) 15-24
    CrossrefPubMedGoogle Scholar
  • 21 Beckmann M, Acreman M, Schmidt E, Merollini KMD, Miller Y. Women's experience of induction of labor using PGE2 as an inpatient versus balloon catheter as an outpatient. Eur J Obstet Gynecol Reprod Biol 2020; 249: 1-6
    CrossrefPubMedGoogle Scholar
  • 22 Wang MJ, Jauk VC, George DM. et al. Patient satisfaction with outpatient cervical ripening in parous women. Am J Perinatol 2021; 38 (S 01): e71-e76
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Dupuis N, Loussert L, de Vries PLM, Parant O, Vayssière C, Guerby P. Offering women a choice in induction of labour: a prospective cohort study. Arch Gynecol Obstet 2023; 307 (06) 1781-1788
    CrossrefPubMedGoogle Scholar
  • 24 Turnbull D, Adelson P, Oster C, Bryce R, Fereday J, Wilkinson C. Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for induction of labor. Birth 2013; 40 (02) 75-80
    CrossrefPubMedGoogle Scholar
  • 25 Haavisto H, Polo-Kantola P, Anttila E, Kolari T, Ojala E, Rinne K. Experiences of induction of labor with a catheter - A prospective randomized controlled trial comparing the outpatient and inpatient setting. Acta Obstet Gynecol Scand 2021; 100 (03) 410-417
    CrossrefPubMedGoogle Scholar
  • 26 Mäkelä K, Palomäki O, Korpiharju H, Helminen M, Uotila J. Satisfaction and dissatisfaction with pain relief and birth experience among induced and spontaneous-onset labours ending in vaginal birth: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2023; 18: 100185
    CrossrefPubMedGoogle Scholar
  • 27 Coates R, Cupples G, Scamell A, McCourt C, Bhide A. Women's experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: a qualitative study. Women Birth 2021; 34 (04) e406-e415
    CrossrefPubMedGoogle Scholar