Globally the rates of induction of labour (IOL) are on the rise. The availability of prostaglandins, which act as both cervical ripening as well as inducing agent, has improved the success rates of IOL in the presence of an unfavourable cervix. Mechanical methods such as intracervical balloon catheters appear to be equally effective as compared to pharmacological agents and have fewer adverse effects. The process of IOL is associated with significant risks such as uterine hyperstimulation, fetal compromise, increased risk of operative deliveries and rarely rupture of the uterus. Hence, there should be a clear indication for IOL based on best available evidence, with benefits to either mother or fetus, which outweigh the perceived risks. The World Health Organization, the National Institute for Health and Clinical Care Excellence and various professional organisations have produced guidelines to assist clinicians in decision-making regarding IOL in various obstetric situations. The process of IOL should be tailored to meet the expectations and preferences of women in their unique circumstances.

Labor induction is common and frequently recommended based on maternal or fetal indications. It may also be chosen by a patient with a term pregnancy after 39 weeks’ gestation. When compared with expectant management, labor induction at term is associated with a reduced risk of cesarean delivery (CD) and the associated maternal and neonatal morbidities in current and subsequent pregnancies. In patients with unfavorable cervices undergoing induction, cervical ripening should be performed prior to administration of oxytocin to reduce the risk of CD and decrease time to delivery. Expected durations of the latent phase of spontaneous labor cannot be applied to induced labor. There are not widely accepted criteria for the diagnosis of a prolonged latent phase of induced labor, or a “failed induction.” The metrics described to diagnose arrest of dilation in the active phase of labor should also not be applied to the latent phase. Cesarean delivery can be avoided by requiring membrane rupture and oxytocin administration for at least 12–18 hours prior to diagnosing a failed induction for nonprogression to the active phase. Consideration should be given to allowing 24 hours or more of induction to enter the active phase if maternal and fetal statuses permit.