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Abstract

Background
In the United Kingdom, induction of labour rates are rapidly rising, and around a third of pregnant women undergo the procedure. The first stage, cervical ripening, traditionally carried out in hospital, is increasingly offered outpatient – or ‘at home’. The current induction of labour rates place considerable demand on maternity services and impact women’s experiences of care, and at home cervical ripening has been suggested as potential solution for alleviating these. However, there is a lack of evidence on both women’s and birth partners’ experiences and acceptability of at home cervical ripening informing its practice.

Methods
We undertook a qualitative study of women and their birth partners’ experiences of cervical ripening at home and in hospital. Semi-structured interviews explored experiences, acceptability and consequences of cervical ripening.

Results
We identified six key themes: ‘Information and choice’; ‘Physical and sensorial environments’; ‘Pain’; ‘Uncertainty’; ‘Care during induction’; ‘Lasting effects’. Women and birth partners experienced limited choice about cervical ripening. Many reported that shared hospital spaces contributed to negative experiences, while home environments were comforting. Women were unprepared for cervical ripening-associated pain, and delays and uncertainty during induction caused anxiety. Supportive care contributed to more positive experiences; however, some reported difficult or traumatic experiences related to induction.

Conclusions
Most participants were positive about home cervical ripening, yet our study highlights the lack of information and genuine choice regarding cervical ripening and induction. Privacy, presence of birth partners and supportive care contributed to more positive experiences among women. Home cervical ripening may be acceptable to some women and birth partners in the context of informed choice and personalised care.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords:	Home cervical ripening, Induction of labour, Outpatient induction of labour, Informed choice, Experience, Acceptability
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Psychological Sciences School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:	Symplectic Administrator

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