Outpatient Cervical Ripening as a Method to Support Vaginal Birth

Abstract

To develop an evidenced-based approach for outpatient cervical ripening for medically indicated induction of labor. Women who require induction because the cervix is unfavorable are more likely to have cesarean births. Cervical ripening may take hours or days before an adequate Bishop's score is achieved before use of oxytocin, particularly in nulliparous women. Additionally, interventions increase workload and costs. Evidence demonstrates that outpatient cervical ripening improves patient satisfaction. To implement an outpatient cervical ripening program for qualified women in a tertiary care facility that has 7,000 births a year. Cesarean birth occurred in an average of 11 women per month who were nulliparous and had term, singleton, fetuses in vertex positions (NTSV) and required cervical ripening. The goal was to reduce this rate. A mutidisciplinary team of registered nurses, obstetricians, pharmacists, and risk managers reviewed the research. The team developed a process, policy, order set, and patient discharge form. The charge nurses began the staff education. Unexpected neonatal complication from the California Maternal Quality Care Collaborative (CMQCC) was used as a balance measure for neonatal outcomes. Maternal intensive care unit admission for sepsis and NTSV cesarean birth rates from the CMQCC were used as balance measures for maternal outcomes. After the implementation of this program, the NTSV cesarean birth rate in this population decreased by one half, and there was no increase in the balance measures. Nursing assessments and patient education were essential in implementing this program. Nurses were given the knowledge to make a difference in the outcomes of these patients.