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Woman-Centred Induction of Labour (the WOCIL project)
  1. Sabrina O’Dwyer,
  2. Anna Clark,
  3. Hayley Taggart,
  4. Muna Noori
  1. Maternity Department, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Sabrina O’Dwyer; sabrina.o%E2%80%99dwyer{at}


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.

  • healthcare quality improvement
  • obstetrics and gynecology
  • patient-centred care
  • women’s health

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  • Contributors All authors contributed substantially to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SO, AC and HT received educational grants from Ferring Pharmaceuticals. SO and HT are members of the Mysodelle User Group, which is operated by Ferring Pharmaceuticals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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