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Why has offering induction at 39 weeks become something we are talking about?

Having been on a number of forums, and in professional discussions with colleagues, it seems that care providers are starting to offer induction at 39 weeks. Why you ask? Well the ARRIVE trial might have something to do with this. The ARRIVE trial was a large American randomized trial of induction vs expectant management during the 39th week of pregnancy of first-time pregnant women, with baby in cephalic (head down) position with no major medical conditions (Grobman et al.2018). What does that mean?


First time pregnant women who met the criteria were randomly allocated to two groups:

Group 1- induction at 39 weeks

Group 2- allowing labour to commence naturally, induction for medical reasons or induction after 40 weeks and 5 days


What did they find??

Induction at 39 weeks did not improve death or serious injury outcomes for newborns (this means that the chance of death or serious injury for Group 1 was no different to Group 2, or induction did not improve on these outcomes for newborns).


What they did find was that induction at 39 week did lower the rate of cesarean birth (19% vs 22%) and lowered the chance of developing pregnancy induced hypertension (9% vs 14%) BUT remember the chances of finding complications increases the longer a pregnancy progresses so this might have influenced this outcome. There were also several other interesting outcomes in relation to time spent in hospital overall which you can find here: https://evidencebasedbirth.com/arrive/


So should every woman be induced at 39 weeks?

There are risks associated with induction of labour, including that induction may fail and you may need more interventions and be in for a long hospital stay. If we are talking induction to reduce the risk of cesarean birth, there are several other approaches that are equally effective, including minimising unnecessary interventions (CTG when not indicated being one), and increasing non-clinical interventions, such as childbirth training and preparation (WHO has guidelines here: https://www.who.int/reproductivehealth/guidance-to-reduce-unnecessary-caesarean-sections/en/).


Final thoughts

It does not appear that the ARRIVE trial has made a strong argument for routine induction at 39 weeks and neither RANZCOG or the Australian College of Midwives has endorsed induction at 39 weeks. I personally think that at this point the answer should be to discuss the benefits, risks and alternatives with your care provider if they are offering induction at 39 weeks, and ask for time to think, research and discuss this with your birth partner before making a decision.


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