Background
The process of induction of labour (IOL) commonly involves cervical ripening, using mechanical or pharmacological methods. However, the optimum protocol of IOL remains undetermined.

Aims
To report the maternal, neonatal and process outcomes for women being induced with a balloon catheter or prostaglandin E2 gel (PGE2).

Materials and methods
Matched retrospective cohort study of women requiring IOL at term with a modified Bishop’s score (MBS) <7. Those who underwent cervical ripening with a double balloon catheter were matched 1:1 for parity, indication and MBS score to those using PGE2 gel. The primary outcome measure was mode of birth. Results After exclusions, data from 427 women induced with a balloon catheter were able to be matched to 427 women induced with PGE2 gel. Compared to women receiving PGE2 gel, those induced using a balloon catheter were more likely to have an unassisted vaginal birth (50.4% vs 42.9%; P = 0.028), a lower mean estimated blood loss (420 vs 481 mL; P = 0.028), a reduction in fetal acidaemia (2.4% vs 8.8%; P = 0.003) and a greater likelihood experiencing vaginal delivery within 24 h (33.7% vs 25.8%; P = 0.011). Conclusion Similar to findings in randomised controlled trials and meta‐analyses of IOL methods, we observed more unassisted vaginal births, less blood loss, decreased fetal acidaemia, and a greater likelihood of vaginal delivery within 24 h, with use of balloon catheter as compared to PGE2 vaginal gel.