Aim: To compare effectiveness and safety of double balloon catheter and prostaglandins for induction of labor. Methods: an observational ambidirectional cohort study was conducted at a tertiary care university hospital. A total of 666 women with a Bishop score ≤6 requiring labor induction were included. A cohort of 418 patients with double balloon catheter were compared with a retrospective cohort of 248 women induced with prostaglandins, either misoprostol or dinoprostone. Perinatal outcomes were compared between groups, with a p<0.05 considered statistically significant. Results: The cesarean-section rate was 27% in the double balloon group, compared with 27.8% in the prostaglandin group (p=0.352). The mean induction time-to-delivery was longer in the double balloon group as compared to the prostaglandin group (26.6±9.3 hrs vs 19.1±8.6 hrs, p<0.001). Hyperdynamia and umbilical-cord arterial pH<7.1 rates were significantly lower with the mechanical method compared to prostaglandins (p<0.001 and p=0.043, respectively). Other maternal and neonatal outcomes were similar between the groups. Conclusions: Double balloon catheter has similar effectiveness in terms of cesarean-section rate compared to prostaglandins, but with a better safety profile. However, the balloon catheter is associated with a longer time-to-delivery compared to prostaglandins.