The CHOICE study is a non-commercial study, sponsored by the University of Edinburgh and funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme.
Induction of labour (IOL) is the most common obstetric intervention, offered to women when risks of continuing the pregnancy are thought to outweigh risks of delivery. Rates of IOL were above 40% in the 1970s, but halved over the next decade, before increasing again from the late 1990s. Current IOL rates mean that 30.6% of pregnant women in the UK have their labour induced.
Cervical ripening is a key component of IOL, whereby application of a drug or mechanical method over a number of hours, causes softening, shortening, and opening of the cervix in preparation for labour. Traditionally cervical ripening has been performed entirely in-hospital, to allow monitoring of mother and baby, and to recognise complications. However, an increasing number of maternity units offer home cervical ripening, whereby women attend hospital for initial assessment and administration of cervical ripening agent; and then return home for a period of time (usually 24 hours), before reassessment in hospital. Home cervical ripening has the potential to reduce hospital stay during IOL, reducing costs to health services, and maybe more acceptable to women. However, this has not been fully evaluated, and possible benefits could be offset by increased costs of any additional morbidity resulting from home cervical ripening, costs to parents may be increased; and acceptability of home cervical ripening is unknown. Health services need to balance the full resource impact of IOL with the need to provide safe and acceptable care.