Nurse-Midwifery M.S.

Number of Pages


Year Approved


First Advisor

Smith, Rebecca

Second Reader

Julie Ann Vingers


Induction of labor (IOL) is common practice in the United States, with a rate of 25.7% in 2018. IOL can be a lengthy process, placing undue strain on the healthcare system, increasing healthcare costs, and decreasing patient satisfaction. The purpose of this integrative review is to determine how outpatient mechanical cervical ripening with a cervical ripening balloon (CRB) correlates with a change in hospital length of stay, patient satisfaction, and cost. A keyword search strategy was utilized in PubMed, CINAHL, and Scopus databases. The inclusion criteria included original research published in the last 10 years, available in the English language, focusing on women undergoing outpatient cervical ripening with a CRB. A journal hand search was performed for articles published in the last 5 years in three publications. Finally, a citation search of the selected articles was completed. This search process yielded 24 articles for analysis. The social-ecological model was used to organize the findings according to areas of impact: individual, interpersonal, organizational, community, and public policy. Among these 24 articles, the total number of participants was 14,376. Findings revealed that overall patient satisfaction was high with CRB use. Most studies demonstrated a shorter hospital stay in outpatient CRB groups and indicated that CRB was not associated with adverse maternal or neonatal outcomes. Moderate cost savings were noted in three studies. This review reaffirms the evidence that outpatient use of CRB demonstrated safety and effectiveness. Patients have reported satisfaction with CRB, especially in the outpatient setting. Outpatient CRB demonstrated a reduction in inpatient hospital time which could result in reducing strain on healthcare systems and associated costs of hospitalization. Future research opportunities exist for a large randomized controlled trial (RCT) measuring time admitted to the hospital, costs, and patient satisfaction of CRB in the inpatient versus outpatient setting.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis