Inductions are a hot topic in the labor and delivery world! There is a lot of information floating around, both positive and negative, and it seems like every person has their own, differing opinion.
I would venture to say that a lot of people get a sour taste in their mouth when they hear the word induction. They totally get a bad rap, but I am here to tell you that it’s possible to have a positive and uncomplicated birth experience with an induction. Trust me mama, I see it happen all the time!
In this article, I will spend some time exploring the ARRIVE Trial with you and will also cover the pros and cons of induction vs. spontaneous labor. Without wasting another minute, let’s get down to whether or not you should be induced at 39 weeks!
- What is the ARRIVE Trial?
- What were the findings of the ARRIVE Trial?
- What is ACOG’s stance on 39 week inductions?
- Are inductions at 39 weeks common practice?
- Should I advocate for an induction at 39 weeks?
- Pros and cons of planned inductions
- Pros and cons of spontaneous labor
- Final thoughts on the ARRIVE Trial
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What is the ARRIVE Trial?
Long story short, the ARRIVE Trial was a study that compared elective induction at 39 weeks gestation with expectant management of low-risk, first-time moms. Expectant management is more of a “watch and wait for spontaneous labor” approach as opposed to inducing labor.
The point of the study was to determine whether or not electively inducing women at 39 weeks, without a medical indication, would result in a lower rate of complications. Some examples of these potential complications could include: fetal macrosomia (large baby), shoulder dystocia, need for an episiotomy, or a vacuum or forcep-assisted birth. In addition, it looked at the impact a 39 week elective induction has on the incidence of C-sections.
What were the findings of the ARRIVE Trial?
According to the NIH, the ARRIVE Trial found, “a significantly lower risk of Cesarean birth and no significant difference in composite neonatal complications after elective induction, compared to expectant management.”
To break it down for you, the ARRIVE Trial determined that inducing low-risk, first-time mamas at 39 weeks helped to slightly decrease the C-section rate in those women.
And while it did help to slightly decrease the incidence of C-sections, it did not have any impact on labor and birth complications for mama or baby.
In other words, the chance of needing a C-section was a little bit lower with those mamas induced at 39 weeks but there was not a difference in the two groups when it came to potential complications (large baby, shoulder dystocia, episiotomy, vacuum or forceps, unplanned C-section.)
What is ACOG’s stance on 39 week inductions?
The American College of Obstetricians and Gynecologists (ACOG) is the governing body that oversees and helps obstetricians and gynecologists make decisions that guide their practice.
There are a handful of reasons why a medical induction might be recommended, including:
- Overdue
- Gestational hypertension
- Preeclampsia
- Gestational diabetes
- Growth issues with baby (IUGR/macrosomia)
- Prolonged premature rupture of membranes
- History of third trimester stillbirth
- Advanced maternal age
- Cholestasis
- Oligohydramnios/polyhydramnios
- Placental abruption
Where it becomes a bit more gray is when you get to elective inductions. Different providers have different opinions about elective induction. A lot of these opinions are guided by ACOG. So, what is ACOG’s stance on 39 week inductions after all?
According to ACOG, “In addition to some conditions for which labor induction is recommended, new research suggests that induction for healthy women at 39 weeks in their first full-term pregnancy may reduce the risk of Cesarean birth.”
ACOG basically states that while an induction prior to 39 weeks, without medical indication, should not be performed, an induction at 39 weeks plus might be an option for some women.
Summarizing a bit more
Leaving it ultimately up to the provider and patient, ACOG says that a 39 week elective induction might be up for discussion if:
- It’s the patient’s first full-term pregnancy
- The patient is carrying only one baby
- Both mama and baby are healthy
Even though a baby is considered early term at 37 weeks, a baby born at 39 weeks vs. 37 or 38 weeks has a better chance at healthy outcomes.
Therefore, a healthy mama carrying a healthy baby should not be induced prior to 39 weeks without a medical indication. (source)
Are inductions at 39 weeks common practice?
I think the answer to this truly depends on your provider and your place of delivery. As I previously mentioned, different providers have different opinions and views on 39 week inductions.
To make a general statement saying 39 week inductions are common practice at all facilities would simply not be fair or true. If you look hard enough, and honestly you might not even have to look that hard, you will absolutely find a provider that is supportive of inducing a first-time, healthy mama at 39 weeks.
With that being said, I personally know of several providers that feel strongly about waiting until 40 or 41 weeks to induce healthy first-time mamas. And before you think to yourself, “that’s just cruel and ridiculous”, I encourage you to research the benefits of spontaneous labor!
But you are in luck! I have several resources that discuss the benefits of spontaneous labor and why it’s important to prep your body for labor – you can check them out below!
Related Reading: Natural Ways to Induce Labor: Everything You Need to Know!
Related Listen: EP77: Why It’s Important to Prep Your Body for Labor
Should I advocate for an induction at 39 weeks?
Before I tell you to advocate for (or against) an induction at 39 weeks, let me encourage you to continue doing some research. You are certainly on the right track if you have made it this far along in the article, but I hope you will dive even deeper.
To determine whether a 39 week elective induction is right for you, I want you to first think about your birth wishes and desires. Do you want to birth without an epidural or with one? Are you okay with continuous monitoring or would you prefer intermittent? These decisions should ultimately be what guides whether you ask for a 39 week induction or not. And just hang tight – I’ll get into more of the pros and cons below!
I am not here to say that you can’t have an epidural-free birth if you get induced. I witness it quite frequently actually. All I’m getting at is that you typically will have a greater chance of success minimizing interventions throughout labor and birth if you go into labor spontaneously.
And at the end of the day, no matter what you do to try and send your body into labor, sometimes it’s just not quite ready and needs a little help.
I know inductions can sometimes come with negative feelings, but I see women have beautiful and uncomplicated births following an induction all the time.
So don’t stress if you choose the induction route. Your birth will still be just as amazing as you are, mama!
Pros and cons of planned inductions
If you have taken (or plan on taking) my Birth It Up Online Birthing Courses, you will see that I have an entire bonus section dedicated to induction of labor. In this lesson of the course, I cover all kinds of specifics regarding inductions, including what it is, risk and benefits, elective inductions, and induction methods.
In this article, I want to briefly touch on some of the pros and cons of planned inductions, but just know that my birth classes are here for you if you want to learn even more!
Pros of a planned induction
- Convenience: It might sound silly, but logistically speaking, a planned induction is pretty dang convenient. This especially holds true if it’s not your first baby and you have to coordinate care for older children (can include fur children as well!) It’s also convenient if you live far away from the hospital
- Reduced anxiety: The final weeks of pregnancy can be stressful (for many reasons), but not knowing when baby will come if often one of the biggest ones. Having a planned induction can help minimize some of that anxiety
- Decreased risk of C-section: Don’t forget – the ARRIVE Trial study showed that there is a slight decrease in needing a C-section with a 39 week induction
Potential cons of a planned induction
- Cascade of interventions: This is the theory that one intervention leads to another intervention and so on and so forth
- It doesn’t work: There is such a thing as a “failed induction” where we unsuccessfully try to induce you. This would result in your needing a C-section
- Might be stressful for baby: Some of the medications used to induce labor can cause baby’s heart rate to drop, though most of the time we can quickly intervene to get it back up
- Increased risk of bleeding after delivery: Medications used to induce labor might cause uterine atony after birth, preventing uterine muscles from contracting as strong as we’d like
- Slight increased risk of infection: Certain induction methods can increase your risk for infection
- Can make a non-epidural birth more difficult to achieve: Some mamas report that induction agents can make contractions stronger. In addition, you’ll need to be continuously monitored throughout your induction which can limit your ability to move freely
Pros and cons of spontaneous labor
Just like with an induction, there are also pros and cons to spontaneous labor as well.
Pros of spontaneous labor
- Lower rates of interventions and complications: Spontaneous labor is associated with a lower rate of labor interventions and shorter hospital stays (source)
- Possible decrease in pain: Spontaneous labor might not be as painful for some women (but at the end of the day, labor is pretty painful no matter how you go about it)
- Avoid induction: Avoiding an induction is on a lot of mama’s birth plans. By waiting for spontaneous labor, you’ll be sure to check this wish off
Cons of spontaneous labor
- Not able to get an epidural: Not to say you can’t get an epidural if you go into labor spontaneously, but should your labor progress quickly, you might not have time to get an epidural or for it to work effectively
- Diversion from birth plan: Spontaneous labor might force you to make “on-the-fly” adjustments to your birth plan. This is one reason I always recommend staying flexible with your birth wishes
Final thoughts on the ARRIVE Trial
The bottom line with the ARRIVE Trial is that it might slightly decrease your chances of needing a C-section. Aside from that, there is actually little to no evidence that an elective induction of a healthy, first-time mama at 39 weeks has any impact on complications for mom or baby.
By sifting through the pros and cons of elective induction vs. spontaneous labor and discussing it with your OB provider, I hope you will have all the information you need to determine whether or not one might be a good option for you.
And if you want some additional learning about inductions, labor, and birth, look no further than here:
- An Overview of Induction Methods by an L&D Nurse
- How to Prepare for Labor Induction: Tips From A Labor Nurse!
- EP72: Help! What is an Induction?
- Mommy Labor Nurse Online Birthing Courses
