Women may be more comfortable waiting for labour to start at home, and outpatient care may be less costly for providers of health services. Induction of labour (where labour is started artificially) is carried out for a variety of reasons including when women have passed their due dates or on an individual basis, such as having diabetes. A range of different drugs (including vaginal and cervical prostaglandin E2, vaginal and oral misoprostol and isosorbide mononitrate) and other methods (including acupuncture) have been used to induce labour. Induction of labour has been carried out in hospital, but some methods may be suitable for use in outpatient settings. Women may be able to administer treatment themselves at home, or to be discharged home after treatment in hospital. This review examined the feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information was available, safety of outpatient induction of labour.
We have included 28 controlled studies with 2616 women randomised to induction or who received placebo or no treatment. In all studies women received treatment at home or were discharged home after initial treatment and monitoring in hospital. There was some evidence that the induction agents used in outpatient settings reduced the need for further drugs such as oxytocin to induce labour, and shortened the time from the beginning of treatment to the birth of the baby. Induction agents used in this way did not appear to increase the likelihood of the need for caesarean section or other interventions in labour. Only two studies provided information on women's views about the induction process. Overall there was very little information on the costs to health services of different methods. Induction of labour in outpatient settings appears feasible and safe to use. We do not know which methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings.