What is the issue?

We wanted to find out from randomised controlled trials, (RCTs) whether, after induction of labour in a hospital or healthcare facility, women preferred to go home or stay in the facility to await the start of labour. Also, to know if there was any impact on clinical outcomes for either the women or their babies.

Why is this important?

Induction of labour towards the end of pregnancy involves artificially bringing on contractions to start labour. There are risks for mother and baby from induction, but sometimes these are outweighed by the risks of continuing the pregnancy.

However, induction can be a challenging experience for women as they may feel uncomfortable, unsupported and a lack of control. The use of home induction of labour may improve women’s experiences, reduce the length of stay in hospital and lower overall costs. The safety of both the mother and baby are critical factors for consideration. Only certain forms of induction are considered suitable for home induction, for example, vaginal prostaglandins or balloon/Foley catheters.

What evidence did we find?

We searched for evidence on 31 January 2020 and found seven RCTs, six of which provided data on 1610 women and their babies. These studies were all undertaken in income-rich countries. The certainty of the evidence was mostly very low, mainly because of the limited number of studies, some of which were small, and there was lack of clarity in the study design.

The women all received the induction with initial monitoring in hospital. Women in the home induction group were then able to go home to wait for the start of active labour, or for a set period of time. Women in the inpatient group stayed in hospital.

With vaginal prostaglandin (PGE2) for induction, we found two studies with 1022 women and their babies. There may be little or no difference in women's satisfaction between waiting for labour to become active at home or in hospital, although women tended to be more satisfied with going home to wait. For women, there may be no clear differences in the number who had a spontaneous vaginal birth, overstimulation of the uterus or a caesarean birth. For the babies, there may be a similar incidence of infection and admission to neonatal intensive care unit (NICU). The costs may possibly be less in home settings.

For induction with controlled release prostaglandin (PGE2) into the vagina, we found just one study of 299 women and their babies but the findings indicate probably little or no difference.

Using a balloon or Foley catheter for induction, we found three studies providing data on 289 women and their babies. Two studies reported on women’s satisfaction, and showed a tendency to favour home settings, but the way data were collected was unclear. There may be little or no difference in the number of spontaneous vaginal births, overstimulation of uterine contractions and babies admitted to NICU. Home induction may possibly reduce the number of caesarean births but more data are needed.

What does this mean?

The studies did not include sufficient numbers of women and babies to show clear differences in outcomes between home and inpatient induction of labour, and the certainty of the evidence was generally very low. More studies are needed, and further studies are already underway. We need more data on women's experiences and views on their care, as well as on safety and cost.