Impact of Standardization on Outcomes Following Cervical Ripening

The goal of this study is to evaluate the impact of standardization of cervical ripening on labor outcomes as well as to evaluate whether different methods of cervical ripening influence labor outcomes The primary outcome will be SVD rate. Secondary outcomes will include time from admission to delivery, total duration of hospitalization (admission to discharge), operative vaginal delivery rate, incidence of delivery within 24 hours of admission, maximal dose of oxytocin (in mU/min), incidence of tachysystole requiring intervention, incidence of intervention for fetal bradycardia or "non-reassuring fetal status", maternal morbidity (endometritis, 3rd or 4th degree lacerations, hemorrhage >1000mL, blood transfusion, wound separation or infection or readmission), neonatal length of stay>3 days, NICU admission.

Inclusion criteria

• Patients who are scheduled for medically indicated or elective induction of labor with gestational age ≥37 weeks at Eskenazi hospital
• Willing and able to provide informed consent
• Age ≥18 years old
• Able to read, speak and understand English, Spanish or Haitian Creole

Exclusion criteria

• Premature rupture of membranes
• Known chorioamnionitis
• Fetal malpresentation
• Placenta previa
• Category 3 fetal heart rate tracing -- only at the time of screening and enrollment. If a Category III tracing develops later in labor, this will prompt standard obstetric management, not removal from the study.
• Prior uterine scar (cesarean delivery or other contraindication to use of prostaglandins)
• Major fetal anomalies known at the time of enrollment that are expected to meaningfully impact labor management
• Multiple gestation
• Allergy to misoprostol or other contraindication to induction of labor or use of misoprostol or cook cervical ripening balloon
• Patient does not require cervical ripening (SBS ≥ 6 or dilation ≥ 4cm)
• Significant acute or chronic medical, neurologic, or illness in the patient that, in the judgment of the Principal Investigator, could compromise subject safety, limit the ability to complete the study, and/or compromise the objectives of the study