Woman-centred induction of labour (the WOCIL project)

Abstract

Induction of labour (IOL) is a common obstetric intervention. 32% of women are induced per year in our obstetric unit. We were experiencing delays in starting IOLs due to unit activity, protracted inpatient stay and dissatisfaction among staff and service users. We used quality improvement (QI) methodology to identify inefficiencies and root causes and used a bottom-up approach in planning improvements. After optimising our IOL processes, we introduced misoprostol vaginal insert (MVI) as it was faster acting than traditional dinoprostone. We compared 207 women who had MVI with 172 women who had dinoprostone prior to MVI introduction. There was a reduction of IOL start to delivery time, from a mean of 30 hours to 21 hours. Fewer women required oxytocin and of those who did, required oxytocin for fewer hours. We also found a reduction in caesarean section rates in women undergoing IOL, statistically significant in nulliparous women (41%-25%, p=0.03). There was a higher uterine tachysystole and hyperstimulation rate with MVI use and introduction should be accompanied by education of staff. We did not find any increase in neonatal admissions, maternal haemorrhage or other serious adverse events. In summary, MVI is a useful drug in helping high volume units with high IOL rates, reduced bed occupancy and improved flow of women. We would recommend a holistic QI approach to change management, as safe use of the drug requires optimisation of the IOL processes as well as staff engagement, due to rapid flow of women through the IOL pathway and increased hyperstimulation rates.