Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines


  • Matthew Olukayode Abiodun Benedict Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
  • Hanneke Brits Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein



induction of labour, practices, institution guidelines, setting-adapted


Induction of labour (IOL) is defined as an artificial stimulation administered to initiate the delivery process before the onset of spontaneous labour. Setting-adapted guidelines need to be developed to promote safe maternal and neonatal care in line with the needs of a specific institution. This study aimed to describe and assess the current IOL practices at Botshabelo District Hospital, focusing on incidence, indications, induction methods, complications, and outcomes. A retrospective-descriptive study included all relevant data from IOL cases over six months between July and December 2017. From 168 attempted inductions of labour, 153 files were retrieved. The majority of cases (69.7%) were for post-dates. Normal vaginal delivery (NVD) was achieved in most patients (69.3%), while one patient had an assisted delivery. Thus, 30.1% of inductions failed and required caesarean sections. The incidence, indications, methods of induction, complications, and outcomes of IOL in BDH are in line with international guidelines; however, including the sweeping of membranes at term and balloon catheters as methods could improve the current guidelines.

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Ryan R, McCarthy F. Induction of labour. Obstet Gynaecol Reprod Med. 2016;26(10):304–310. DOI:

WHO recommendations: Induction of labour at or beyond term. 2011. [cited 30 September 2020] Available from:

NICE Pathways – 2019 Induction of labour. Available from:

Tarimo CS, Mahande MJ, Obure J. Prevalence and risk factors for caesarean delivery following labor induction at a tertiary hospital in North Tanzania: a retrospective cohort study (2000–2015). BMC Pregnancy Childbirth. 2020;20(1):a173.

Leduc D, Biringer A, Lee L, et al. Induction of labour. J Obstet Gynaecol Can. 2013;35(9):840–857. DOI:

World Health Organization. WHO recommendations: induction of labour at or beyond term. World Health Organization; 2018. [cited 30 September 2020] Available at:

NICE. Clinical Guideline 70. Issue date July 2008 Updated 2017. [cited 30 September 2020] Available from:

Coates D, Homer C, Wilson A, et al. Induction of labour indications and timing: A systematic analysis of clinical guidelines. Women Birth. 2020; 33(3):219–230. DOI:

World Health Organisation. WHO Handbook for guideline development. Geneva: WHO; 2012. [cited 30 September 2020] Available from:

Vogel JP, Souza JP, Gülmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: A secondary analysis of the WHO Global Survey on maternal and neonatal health. PLoS One. 2013;8(6):e65612.

Boshomane JM, Sebitloane HM. Factors associated with successful induction of labour with oral misoprostol in term or post-term pregnancies. Obstet Gynaecol Forum. 2019;29(3):25–28.

Ndovie L. Maternal and fetal outcomes of induction of labour using oral misoprostol at New Somerset Hospital (Doctoral dissertation, University of Cape Town). 2018. [cited 30 September 2020] Available from:

AIHW. Australia’s mothers and babies 2016 – in brief. Canberra: Australian Institute of Health and Welfare; 2018. [cited 30 September 2020] Available from:

Kjerulff KH, Attanasio LB, Edmonds JK, et al. Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA. Birth. 2017;44(3):252–261. DOI:

Tydeman-Edwards R, Van Rooyen FC, Walsh CM. Obesity, undernutrition and the double burden of malnutrition in the urban and rural southern Free State, South Africa. Heliyon. 2018;4(12):e00983.

Narayani BH, Shalini B. First trimester maternal BMI and pregnancy outcome. Int J Clin Obstet Gynaecol. 2018;2(4):72–75.

Ding XX, Xu SJ, Hao JH, et al. Maternal pre-pregnancy BMI and adverse pregnancy outcomes among Chinese women: results from the C-ABCS. J Obstet Gynaecol. 2016;36(3):328–332. DOI:

Deshmukh VL, Jadhav M, Yelikar K. Impact of HIGH BMI on pregnancy: maternal and foetal outcome. J Obstet Gynaecol India. 2016;66(1):192–197. DOI:

Yousuf F, Naru T, Sheikh S. Effect of body mass index on outcome of labour induction. J Pak Med Assoc. 2016;66(5):598–601.

Audette MC, Kingdom JC. Screening for fetal growth restriction and placental insufficiency. Semin Fetal Neonatal Med. 2018;23(2):119–125. DOI:

Acharya T, Devkota R, Bhattarai B, Acharya R. Outcome of misoprostol and oxytocin in induction of labour. SAGE Open Med. 2017;5: 2050312117700809–2050312117700809. DOI:

Leigh S, Granby P, Haycox A, et al. Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost-consequence analysis alongside a clinical trial. BJOG. 2018;125(13):1734–1742. DOI:

Alfirevic Z, Keeney E, Dowswell T, et al. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG. 2016;123(9):1462–1470 DOI:

Chatsis V, Frey N. Misoprostol for Cervical Ripening and Induction of Labour: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018.

Liljestrom L, Wikstrom AK, Agren J, Jonsson M. Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study. Acta Obstet Gynecol Scand. 2018;97(5):615–623. DOI:

Kim SS, Zhu Y, Grantz KL, et al. Obstetric and neonatal risks among obese women without chronic disease. Obstet Gynecol. 2016;128(1):104–112. DOI:

Pimentel VM, Arabkhazaeli M, Moon JY, et al. Induction of labor using one dose vs multiple doses of misoprostol: a randomized controlled trial. Am J Obstet Gynecol. 2018;218(6):614.e1-614.e8.




How to Cite

Benedict, M. O. A., & Brits, H. (2022). Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines. Journal of Public Health in Africa, 13(2).



Original Articles