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Is inducing labor at 39 weeks really safer?

A new study has been making the rounds on the news and social media outlets that you may have heard about, especially if you are pregnant. This study, called the ARRIVE trial, found that in low-risk women having their first baby, being induced in the 39th week of pregnancy decreased their risk of needing a C-section than if they let nature take its course.

It sounds great. Looks like what all we need to do to decrease our C-section rate is to just induce everyone at 39 weeks, right?

If you answered, “No! Wrong!” then you are correct. Let’s breakdown this study to understand it a bit better and determine if it should really change what we do when it comes to managing pregnancy and delivery.

 

Why was this study done?

The C-section rate continues to climb in the United States—currently 32 percent of all babies are born this way—and obstetric providers counsel patients that an induction of labor increases a woman’s chance of needing a C-section. The point of this study was to see if that holds true in this group of women, as a way of identifying ways to decrease our C-section rate. In other words, will inducing these low-risk first-time moms make a vaginal delivery more likely?

 

Who this study looked at

This study included a total of about 6,000 women. It only included low-risk women who were having their first baby. In addition, the women they studied were around the age of 24—rather young in today’s birthing population. These women delivered at academic hospitals only.

 

Who this study didn’t look at

It didn’t include women with any high-risk issues (think obesity, diabetes, high blood pressure), nor did it include women who had given birth before. Women delivering at community hospitals not associated with a university were not in this study.

 

What they did in the study

This was a randomized control trial, which means the women were split into either group before they gave birth. Of the women who agreed to participate once they heard about the study, half were induced between 39 weeks 0 days and 39 weeks 4 days gestation and the other half were expectantly managed (meaning they waited for labor to start on its own). For the induction group, labor was induced using strict protocols that were the same at all the hospitals where this study took place.

 

What the study showed

This study showed a difference in C-section rate. Women who were induced at 39 weeks had an 18.6 percent C-section rate, while women who waited for labor to start on its own had a 22.2 percent C-section rate. It may not seem like a huge difference, but it was statistically significant, which means it is a real difference and not just based on chance alone.

 

What the study didn’t show

There were no differences in harm to the babies (the scientific words are morbidity and mortality) between the groups. There were also no differences in maternal outcomes (or problems) in either group.

 

Shortcomings of the study we need to consider

The nuances of this study are very important and can’t be glossed over. First of all, 75 percent of all women asked to participate in this trial refused. That means the women who signed up were very accepting of an induction of labor. This is not all women! Also, this study took place at 41 hospitals that were associated with universities. They all used very strict protocols for induction and labor management, and more importantly for when they said an induction just wasn’t working and a C-section was needed. It is doubtful the majority of the hospitals in this country use these strict criteria (which likely explains why the “higher” C-section rate of 22.2 percent is still well-below the national average of 32 percent).

 

Does this apply to me? Should I request an induction of labor at 39 weeks?

That’s a great question, and the answer is “maybe” (don’t you love the vagueness of that?!). If you happen to fall into the category of being a low-risk woman having her first baby, and you plan to deliver at a hospital that follows strict induction of labor guidelines, that at this time already has a lower-than-average C-section rate in first-time moms, and you want an induction of labor—well, then maybe this is relevant to you. But if all those don’t apply to you, then no, this study is not a ticket into an induction of labor so you can be done with pregnancy at 39 weeks.

 

The take-home message

This study is very interesting, but it is not a game-changer. Definitely discuss it with your doctor or midwife, but don’t expect sweeping changes from it. If you are being pressured to change how you deliver based on this study, take pause and ask questions.

Let’s also keep in mind that an induction of labor is no small feat—it takes longer (usually) than spontaneous labor, it costs more, and it does away with letting your body do its own thing. This might sound fluffy, but a woman needs to not only be OK with how she gave birth, but also how she labored. And if she feels her doctor is forcing her into an induction based on this study for a small decreased risk of delivering by C-section, that isn’t OK and she has the potential to be traumatized by the process.

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