Induction of Labor Quality Improvement Initiative


Intervention by:


Project Aim

The Induction of Labor Quality Improvement Initiative seeks to reduce failed induction of labor (IOL), and to improve the overall process surrounding IOL. More specifically, this project aims to help participating hospitals improve the overall process surrounding IOL, and ultimately, reduce primary cesarean delivery. 

Over one-third of all births (34.4%) in Texas were delivered by cesarean section in 2015.

Learning Collaborative

Currently there are three hospitals participating in the project, with potential for more hospitals to join. This learning collaborative is designed to enable teams to share, test, and implement an evidence-based protocol for labor induction, with the primary objective of decreasing rates of failed induction of labor. This project will require that teams engage with energy and acceptance of novel IOL practices to adopt and successfully implement the protocol.

This learning collaborative is working to
reduce failed IOL through implementation of a standard, evidence-based protocol for IOL
with principles adopted from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). In addition, hospitals may choose other action steps to help reduce primary cesarean deliveries, focusing on readiness, recognition and prevention, response, and reporting and learning. Monthly calls are convened to discuss progress, and data on five core metrics are collected and reported on a quarterly basis.

Elements of the IOL Protocol

  • Non-medically indicated IOL should not be scheduled until ≥39 0/7 weeks of gestation and favorable cervix

  • IOL involves the following steps:

    • Cervical ripening for unfavorable cervix

    • If cervix is favorable, administer oxytocin per protocol

    • Perform amniotomy within 24 hours of starting oxytocin

    • Titrate oxytocin to achieve adequate contractions with the assistance of an intrauterine pressure catheter

    • Administer oxytocin for at least 12-18 hours after membrane rupture before diagnosing failed IOL

  • Once cervix is 4cm dilated and 90% effaced, or cervix is 5cm dilated (regardless of effacement), continue labor (may take up to 10 hours to dilate from 4cm to 6cm)

  • Once cervix reaches 6cm dilation, continue 2nd stage of labor following current guidelines



Project Lead

Divya Patel, PhD, UT Health Northeast, Affiliate of The University of Texas System


Christina Davidson, MD, Baylor College of Medicine
Carla Ortique, MD, Texas Children's Hospital