Labour Induction in Africans: Why, How, Risks and Outcomes

Author:  Azuka Ezeike, MB.BS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by: O Oni, MD.

A black pregnant woman wearing a white top and brown pants, sitting with her left hand resting on her bulging belly. Image credit: Freepik

Highlights 

• Labour induction is the artificial process of starting labour when continuing the pregnancy poses risks.

• Common reasons include post-date pregnancy, high blood pressure, diabetes, or concerns about the baby.

• Methods include medicines such as prostaglandins and oxytocin, and mechanical options like balloon catheters.

• Doctors assess readiness for induction using the Bishop’s score and monitor the mother and baby closely.

• Benefits include reducing stillbirths, preventing complications, and ensuring safer outcomes.

• Risks, though uncommon, may affect the mother or baby, but are minimised with proper monitoring.

 

Introduction 

What is Induction of Labour?

Your doctor just informed you that you will be admitted for the induction of labour, and you are worried. All your sisters and your mother delivered without needing induction, and you are wondering why. You are also worried about the process and whether it is the best option for you.

Labour is a natural process that usually starts on its own in the last weeks of pregnancy. It is common for doctors to wait for this natural process to occur, but on some occasions, there may be a need to start labour artificially. This is usually a well-thought-out and planned process, and your doctor would carry you along throughout.

Induction of labour is the artificial initiation of labour to achieve vaginal delivery [1]. It is recommended if continuing the pregnancy carries more risk for the mother or baby than inducing labour naturally. Pregnancy is expected to last for 40 weeks, but sometimes induction of labour may be needed before 40 weeks or after 40 weeks if labour does not start on its own.

The number of women being induced is rising, especially in Western countries. This is because doctors now understand pregnancy better, and more women either have health problems before pregnancy or develop them during pregnancy.

Because the reasons for induction of labour differ among countries, the rate of induction also differs. Higher rates are observed in Western countries compared to low-income countries. Evidence shows that about 25 out of 100 pregnancies involve the induction of labour in high-income countries. In Nigeria, however, a study reported the rate to be about 3 out of 100 pregnancies.

This article will provide you with information on why and how induction of labour is performed and what to expect during the process.

 

Who May Need Labour Induction?

Who needs labour induction? Click on image to enlarge.

 

The most common reasons for the labour induction include:

• Post-date pregnancy (pregnancy that has passed the due date)
• Hypertension or diabetes in pregnancy

The World Health Organization World Health Organization recommends that induction of labour should be carried out if the pregnancy has reached 41 weeks [2].  This is because as pregnancy advances, the placenta becomes weaker, the amniotic fluid reduces, and this may affect the baby.

You may also require induction of labour if you have:

• Heart, kidney, or certain autoimmune diseases
• Intrahepatic cholestasis of pregnancy
• Isoimmunisation (a mismatch between your blood group and that of the baby)
• Risk of rapid labour (precipitous labour)

Induction of labour may also be needed if your baby:

• Is not growing well in the womb
• Has a major congenital anomaly that makes continuation of the pregnancy unnecessary
• Has reduced amniotic fluid (oligohydramnios)
• Has died (stillbirth)

Sometimes induction of labour can be done for social reasons, such as: [1]

• Living a long distance from the hospital
• Social reasons, such as an upcoming examination

While induction for a pregnancy that has passed its due date typically occurs around 41 weeks, induction for other reasons may take place earlier, usually between 37 and 39 weeks, depending on the specific condition.

 

What are the Methods of Induction of Labour?

A vial of oxytocin solution, placed beside three white misoprostol tablets and a balloon catheter on a light gray surface. Image credit: ChatGpt

 

Induction of labour is done using two major methods:

• Pharmacological (Drugs)
• Mechanical methods
   

A. Pharmacological (Drugs) 

There are two classes of drugs used for the induction of labour. They are: 

• Prostaglandins
• Oxytocin

I. Prostaglandins 

These are natural substances produced by the body, but they can also be artificially manufactured. 

There are two main types:

 Prostaglandin E1

Also known as misoprostol. It was originally developed for the treatment of stomach ulcers, but was later found to affect the womb as well. It helps to soften the cervix (the mouth of the womb) and can also induce contractions.

• It usually comes in tablets of 200 mcg, but doses of 25 and 50 mcg are also available.
• For induction of labour, it is either given by mouth or inserted into the vagina.
• The World Health Organization recommends oral misoprostol 25 mcg every 2 hours or vaginal misoprostol 25 mcg every 6 hours for the induction of labour.

 Prostaglandin E2
 Also known as dinoprostone. It may come in the form of:

• A slow-release pessary containing 10 mg of dinoprostone
• A vaginal tablet containing 3 mg of dinoprostone
• A gel containing 1 or 2 mg of dinoprostone

Because they are expensive, prostaglandin preparations other than misoprostol may not be a good option in low-resource settings due to cost and limited access.

II. Oxytocin

Oxytocin is a natural hormone produced in the brain. It can also be produced artificially and is very important in the induction of labour. It helps the muscles of the womb contract. It is usually given as an injection, which is added to an intravenous drip, and administered in drops.

B. Mechanical Methods

Mechanical methods involve the use of devices or procedures to help soften and open the cervix. They also stimulate the release of prostaglandins, which play an important role in initiating labour.

I. Transcervical Balloon Catheter

Transcervical balloon catheter method of labour induction. Image credit:  TVASurg

 

This method uses catheters that contain a balloon. The most commonly used one in Africa is the Foley catheter [3].  Originally designed for use in the bladder, it has been adapted for the induction of labour. 

Other specialised catheters, such as the Cook’s catheter and double-balloon catheter, exist but are not always available in many African countries.

The procedure involves passing the catheter through the vagina and into the cervix. The balloon is then inflated with water and left in place for about 12 hours. The pressure from the balloon helps soften and dilate the cervix.

 II. Hygroscopic Dilators

Dilapan-S progressive cervical osmotic dilators. Image credit: AJOG-MFM

These dilatators work by absorbing fluid from the cervix, causing them to swell and exert pressure that leads to cervical dilatation. They are also known as osmotic dilators.

They include: 

• Laminaria, a type of seaweed (dried and sterilised before use).
• Dilapan, an artificial version, which is available in the United States of America (USA)

III. Membrane Sweeping

Labour induction by membrane sweeping. Image credit: AJOG-MFM

This procedure is usually performed by a healthcare provider. The doctor inserts a finger into the cervix and gently separates the amniotic sac (bag of water) from the wall of the lower uterus. This process releases prostaglandins, which can help initiate labour.

IV. Amniotomy

Labour induction through artificial rupture of membrane (Amniotomy). Image credit: TVASurg

 

Amniotomy is the deliberate rupture of the membranes by the doctor. It is usually done once the cervix has opened sufficiently to make the membranes accessible.

It can be performed:

• Before starting oxytocin infusion, or
• After oxytocin has already been started.

Amniotomy is rarely used alone for the induction of labour [4].

 

How Is Labour Induction Done?

A. Clinical Assessment:

1. Before Labour Induction

• Before the induction of labour, your doctor would have discussed the procedure with you at the antenatal clinic, and you must have given your consent.
• To prepare for the procedure, you may be asked to make arrangements for blood to be available for you at the blood bank. This is because sometimes induction may fail, and a caesarean section could be required. It is important to be ready.
• Your doctor will also request some tests, such as a full blood count, to make sure you have enough blood and are prepared in case a caesarean section becomes necessary. 
• Your doctor also confirms your due date to avoid delivering the baby too early
• You are usually admitted to the ward a day before the procedure.

II. On Admission for Labour Induction

Your doctor will carry out a quick assessment to confirm you are a good candidate for induction of labour. 

This involves:

• Reconfirming the reason for induction to ensure it is still valid.
• Checking the cervix to assess whether it is soft and open enough to begin the process. This is done using a scoring system called the Bishop’s score, derived from findings on vaginal examination [5].
  • A score of 9/13 or more suggests a high chance of successful induction [6].
  • A lower score means the cervix is not yet ready, and a procedure called cervical ripening will be done to prepare it.
• Checking your baby’s wellbeing to be sure the baby can tolerate the induction process. This is often done using a non-stress test (cardiotocography) to monitor the baby’s heart rate pattern. This procedure is usually called CTG by the health workers.  Some doctors may also request a biophysical profile (special ultrasound) in addition to the non-stress test.

III. On the day of Labour Induction

• If your cervix is sufficiently ripened, induction is started the following morning.
• If your cervix is not ready, your doctor will prepare it using:
  • Drugs such as misoprostol or dinoprostone, or
  • Mechanical methods (balloon catheter, dilators, etc.).
    The choice depends on your history and examination findings.

Cervical ripening is usually started in the evening.

If you have had a previous operation on your womb, such as a caesarean section or fibroid surgery, your doctor will avoid prostaglandins, and in some cases, induction of labour may be avoided altogether.

B. The Process of Labour Induction

Induction is usually done using oxytocin.

• It is started in the morning to allow for adequate monitoring.
• The drug is added to a drip and begun at a low dose, then gradually increased until you establish good contractions.
• Once contractions are adequate, the oxytocin drip is maintained at that rate.
• Amniotomy may be started before or after starting the oxytocin drip. Sometimes, active labour may begin after cervical ripening, and there may be no need to use oxytocin.

C. Monitoring During the Process of Labour Induction

Throughout the induction, your doctor and midwives will monitor:

• Your contractions
• Your baby’s heart rate
• The state of your cervix

This ensures that both you and your baby remain safe during the process.      

 

Benefits of Labour Induction

When induction of labour is properly planned and carried out under medical supervision, it can lead to:          

• A reduction in stillbirths
• A reduction in newborn admissions and  deaths
• Prevention of complications when the mother has medical conditions such as high blood pressure, diabetes, or ruptured membranes without labour starting on its own
   

Risks of Labour Induction

Labour induction is generally safe when closely monitored, but there are some risks. These risks may result from the drugs used (such as oxytocin or prostaglandins) or from mechanical methods [1].

Labour induction risks for mother and baby. Click on image to enlarge.

 

Risks for the Mother

• Failed induction of labour, which may require a caesarean section
• Excessive contractions of the womb (uterine tachysystole) which can reduce oxygen supply to the baby
• Fluid retention, a possible side effect of oxytocin
• More painful contractions compared to natural labour
• Postpartum bleeding (postpartum haemorrhage) due to over-stimulation of the womb
• Infections in the mother (Chorioamnionitis)
• Uterine rupture (this is rare)

Risks for the Baby

• Fetal distress, often detected as an abnormal heart rate pattern
• Umbilical cord prolapse (the cord slips into the birth canal ahead of the baby, which can cut off oxygen supply)
• Stillbirth (rare when induction is properly managed)
• Jaundice (sometimes associated with oxytocin use and prolonged labour)
   

 

Conclusion

Labour induction is usually recommended when your doctor believes that continuing the pregnancy may carry more risks than benefits for you or your baby. With proper assessment and close monitoring, induction is generally safe and effective. While there are possible risks, your healthcare team is trained to manage them and keep you and your baby safe. 

 

Frequently Asked Questions (FAQs)

Is labour induction safe for the baby?

Induction of labour involves the use of medicines or mechanical methods that may sometimes carry risks for your baby. However, with close monitoring by your doctor and midwives, it is usually safe.

How long does induced labour take?

The duration of induced labour can be hard to predict because it depends on how your body responds to the medicines. In most cases, it does not last longer than 48 hours.

Does labour induction hurt more than natural labour?

The contractions caused by the medicines used for induction may feel more painful than natural labour. However, pain relief options are available during labour to help make you more comfortable.

 

References

1.  Jenkins SM, Van Hook JW. Induction of labour. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [Cited 2025 Sep 23]. Available from here.

2. WHO recommendations on induction of labour, at or beyond term. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO Available from here.

3.   Alu F, Nwachukwu CND, Igbinovia I, Abdulkareem RB, Mai AM, Otubu JAM. Patterns and obstetric outcomes of induction of labour in a public district hospital in Abuja, North Central Nigeria: a five-year review: induced labours and obstetric outcomes in a district hospital. Tropical Journal of Obstetrics and Gynaecology 2024 Jun 19;42(3):195–201. Available from here.

4.  Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev. 2000;2000(4):CD002862. doi: 10.1002/14651858.CD002862. Available from here.

5.  Wormer KC, Bauer A, Williford AE. Bishop score. [Updated 2024 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [Cited 2025 Sep 25]. Available from here.

6.  Wheeler V, Hoffman A, Bybel M. Cervical ripening and induction of labour. Am Fam Physician. 2022 Feb;105(2):177–86. Available from here.

 

Related: 

Essential Guide to Labour for African Women and Men

How to Boost Positive Childbirth Experience in African Women

Oxytocic Drugs in Pregnancy and Labour: An Explainer for Africans

 

 

Published: October 21, 2025
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