Labor Inductions - New Evidence

After several studies over the last seven years, culminating with the largest, The ARRIVE trial, which was published in 2018, experts and leader in obstetrics in the U.S have generally agreed that elective induction of labor at 39 weeks gestation in low-risk nulliparous women results in a significantly lower risk of cesarean delivery compared to expectant management. This is a new development from years past. Interestingly, other outcomes such as hemorrhage and stillbirth, as well as preeclampsia, were lower in most of the studies.

Since the publication of the ARRIVE trial, there has been some debate about the implications of its findings. Some experts have argued that the study provides strong evidence that elective induction of labor at 39 weeks should be the standard of care for all low-risk nulliparous women. Others have argued that the study's findings are not generalizable to all women and that the decision of whether or not to induce labor should be made on a case-by-case basis.

The American College of Obstetricians and Gynecologists (ACOG) has not yet made a recommendation on whether or not to offer elective induction of labor at 39 weeks to all low-risk nulliparous women. However, the organization has stated that the ARRIVE trial findings "should be considered when making decisions about labor induction."

If you are pregnant and your doctor is considering inducing your labor at 39 weeks, it is important to discuss the risks and benefits of this procedure with them. You should also ask about your individual risk factors for cesarean delivery and other complications. Ultimately, the decision of whether or not to induce labor is a personal one.

Here are some of the potential risks and benefits of labor induction at 39 weeks:

Risks:

• Increased risk of infection
• Longer labor
• Increased risk of needing pain medication

Benefits:

• Reduced risk of stillbirth
• Reduced risk of maternal death
• Reduced risk of shoulder dystocia (a complication during childbirth in which the baby's shoulders get stuck)
• Reduced risk of neonatal jaundice
• Increased chance of having a vaginal delivery
• Reduced risk of hemorrhage
• Reduced risk of pre-eclampsia

If you are considering labor induction at 39 weeks, it is important to weigh the risks and benefits carefully with your doctor.

At Special Care for Women, Dr. Braden Richmond encourages elective induction at 39 weeks based on the expert opinions, but explains the pros and cons so the patient can decide how they would like to proceed.  Make an appointment by calling 256-435-2229 and have Dr. Richmond take care of your obstetric needs.