Heterogenous use of misoprostol for induction of labour: results of an online survey among midwives in German-speaking countries

Arch Gynecol Obstet. 2021 May 3. doi: 10.1007/s00404-021-06079-7. Online ahead of print.

Abstract

Purpose: This online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol.

Methods: We published an online questionnaire with 24 questions in German on midwives' experiences and perceptions of different methods of induction of labour.

Results: The online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour.

Conclusion: Misoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians.

Keywords: Castor oil; Induction of labour; Midwife; Misoprostol; Survey.