Labour induction poses risk of maternal, neonatal deaths, Gynaecologists warn

Maternal health experts have warned against not taking all necessary precautions before engaging in labour induction during child delivery, noting that the procedure can cause serious complications and fatality.

They also stressed that private health facilities without skilled birth attendants should not carry out a caesarean section or perform labour induction.

According to the experts, labour induction is never an emergency procedure, noting that it can lead to maternal and neonatal deaths when poorly performed.

The maternal health experts stated that labour induction is usually planned and also done based on certain reasons and indications.

Speaking in an interview with PUNCH HealthWise, the gynaecologists warned traditional birth attendants and private hospitals without safe CS delivery facilities to desist from carrying out labour induction.

One of the experts, a Consultant Obstetrician and Gynaecologist at the Lagos University Teaching Hospital, Idi-Araba, Dr. Babasola Okusanya, says labour induction is not what anybody can do.

Okusanya explained, “There are indications for labour induction. The most common indication is for a prolonged pregnancy. Other indications could be hypertensive disorders in pregnancy, intrauterine growth restriction and diabetes mellitus in pregnancy.

“Induction of labour has reasons and when the reasons have been met, it is usually planned. It is never an emergency procedure. The main reason for labour induction is to achieve vaginal delivery.

“Before you start it, you must be sure that there is nothing in that woman that will prevent her from delivering vaginally. You must make sure that the baby is lying straight and not lying across the woman’s abdomen. You must make sure that nothing is blocking the birth canal. You must be sure that the baby is of normal size.”

The gynaecologist noted that labour induction should not be performed on pregnant women with big babies, warning that it could lead to the rupture of the uterus.

“You don’t do induction on a woman whose baby has been assessed to be very big and may not be able to pass through the birth canal of the woman.

“In any place where labour induction should be done, that facility should be able to perform safe caesarean delivery. While we hope and plan that induction of labour will succeed, there are instances where you have to have a very good and quick recourse to CS.

“For instance, all has been well with the baby while induction of labour has started, then the foetal heart rate of the baby shows that the baby cannot tolerate the induction anymore, you have to go for CS. Again, maybe you have started the induction and the woman is bleeding, you have to go for CS”, he said.

Okusanya urged pregnant women not to put their lives and the lives of their unborn babies at risk by patronising health facilities without skilled birth attendants and by allowing themselves to be induced by quacks.

The gynaecologist cautioned, “TBAs should not even think of labour induction. Private health facilities that don’t have skilled birth attendants and cannot do CS should not induce labour. Women should patronise qualified hospitals where they can get quality care. If labour induction is poorly managed, it can lead to maternal and neonatal deaths.”

According to the World Health Organisation, induction of labour is the process of artificially stimulating the uterus to start labour. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes.

WHO says induction of labour should be performed only when there is a clear medical indication for it and the expected benefits outweigh its potential harms.

The United Nations health agency recommends induction of labour for women who are known with certainty to have reached 41 weeks of gestation.

“Induction of labour should be performed with caution since the procedure carries the risk of uterine hyperstimulation and rupture and foetal distress. Wherever induction of labour is carried out, facilities should be available for assessing maternal and foetal well-being.

“Failed induction of labour does not necessarily indicate caesarean section. Wherever possible, induction of labour should be carried out in facilities where caesarean section can be performed”, WHO says.

The American College of Obstetricians and Gynaecologists says sometimes, labour induction does not work.

“A failed attempt at induction may mean that you will need to try another induction or have a caesarean delivery. The chance of having a caesarean delivery is greatly increased for first-time mothers who have labour induction, especially if the cervix is not ready for labour.

“There are risks associated with labour induction. With some methods, the uterus can be overstimulated, causing it to contract too frequently. Too many contractions may lead to changes in the foetal heart rate, umbilical cord problems, and other problems,” ACOG says.

Also speaking, another Consultant Obstetrician and Gynaecologist at LUTH, Dr. Ephraim Ohazurike, says labour that is being induced is high risk and should be managed by experts.

“The commonest risk that we see around here is the rupture of the uterus. The baby can die. Injudicious use of drugs for induction can cause rupture of the uterus and the woman can die from it.

“Labour that is being induced is high risk. It is not even a labour that you do without the presence of a gynaecologist or an obstetrician because it is a high risk labour. Once you start inducing labour, that labour can go in any direction.

“So, it is something that an obstetrician should do or somebody who is skilled in CS and all kinds of surgeries so that when an issue comes up, it can be effectively handled. Labour induction is not something you do where there is no obstetrician”, Ohazurike said.

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