Ripening Approaches for Prompt Induction and Delivery - Sequential Versus Concurrent Dilapan-S and Misoprostol to Achieve Vaginal Delivery (RAPID-DS)

Inclusion Criteria: * Nulliparous patients with singleton pregnancies with vertex lie at term receiving prenatal care that are eligible for outpatient cervical ripening will be eligible Exclusion Criteria: * age less than 18, * suspected major fetal anomalies (including suspected or proven chromosome anomalies, congenital cardiac disease expected to require neonatal intervention, and multiple anomalies suggestive of a complex syndrome), * fetal growth restriction * oligohydramnios * prior full thickness * uterine scar * placenta previa, * low-lying placenta, * premature rupture of amniotic membranes, * cervical dilation \> 2 cm * modified Bishop score \> 4 * residence greater than 60 minutes from the hospital