Pros And Cons Of Inducing Labor At 40 Weeks – This article was first published in 2015 and last updated on February 24, 2020 by Rebecca Dekker, PhD, RN, and Anna Bertone, MPH. Read our Disclaimer and Terms of Use. To get a printable PDF file, become a pro member and get access to our full library.
Over the past 30 years, admissions for nonmedical reasons have been increasing in the United States and worldwide (Little, 2017). More and more pregnant people are planning to give birth – because they have reached the expected “date” of 40 weeks or even when they have reached 39 weeks.
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Pros And Cons Of Inducing Labor At 40 Weeks
Are you past your due date – is there a point when the risk of continuing the pregnancy increases significantly? Do a person’s goals and preferences at birth matter?
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For deadlines. To read our separate signed article, all about the evidence on due dates (including accuracy of dates, risk of stillbirth at different stages of pregnancy, and risk factors that increase the risk of stillbirth for some people), click here.
This signature article focuses on proof of deadline compliance. To read our separate signed article, all about the evidence on due dates (including accuracy of dates, risk of stillbirth at different stages of pregnancy, and risk factors that increase the risk of stillbirth for some people), click here.
According to the Listening to Mothers III survey in 2013, more than four in ten mothers (41%) in the US reported that their health care provider had tried to induce labor (Declercq et al., 2013). The researchers asked the mothers to choose the reasons for which they were called.
In the US, the Centers for Disease Control (CDC) reported that in 2018, 27% of pregnant women were induced (Martin et al. 2019). But this figure is probably low. Induction of labor is likely to be underreported in federal vital statistics (Declercq et al. 2013).
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In general, inductions are considered medically indicated if there are recognized health problems or pregnancy complications that make it less safe to continue the pregnancy. Induction of labor for which there is no clear medical reason (or indication) is considered a “planned” induction.
Elective inductions can be for social reasons, such as a provider wanting the birth to happen before she leaves town, or for other nonmedical reasons, such as a mother wanting to get over an unpleasant pregnancy.
But the difference between planned induction and medically indicated induction is not always clear. Some health professionals consider only late-term pregnancy induction and pregnancy after miscarriage to be medically indicated due to the increased risk of complications associated with longer pregnancies (Little, 2017). In this article, we present induction without medical indications as planned induction regardless of gestational age.
For years, it was widely believed that elective inductions doubled the number of C-sections, especially among primiparous women.
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However, in 2010, some researchers began to question whether elective induction doubled the risk of C-section. They argued that previous studies where elective inductions showed a doubling of caesarean sections were flawed.
Previous studies have only compared elective induction with spontaneous labor: people who were induced at will versus people who went into spontaneous labor. People who did not meet the requirements were excluded from these two groups
They initially induced but waited for labor and later ended up with inductions, some of which were medically necessary (and therefore associated with a higher caesarean section rate). For an example of this earlier flawed study, see this article by Yeast et al. 1999 year.
The new researchers said that we need to compare people who have planned births with a whole group of those who are waiting for a spontaneous birth, regardless of whether they have a spontaneous birth or not.
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It’s a subtle difference, but an important one because not everyone who is expecting will actually go into spontaneous labor; some develop complications that lead to induction and increase the risk of cesarean delivery. The researchers argued that the comparison group should also include these people.
Thus, with this new understanding, someone in the labor waiting group who was induced late in pregnancy would not be considered an inappropriate crossover between the groups. This is because induction late in pregnancy is a possible outcome of expectant management, as is spontaneous labor.
This figure shows how you look at two groups: the elective induction group versus the entire group of people who didn’t have an elective induction at the time – some of whom would actually have been induced later in the pregnancy.
The researchers argued that because of this flaw in previous studies, these studies do not give us a true picture of the risks and benefits of elective induction between 39-41 weeks versus waiting to go into labor on your own (the “presumptive treatment”). Basically, when they started using a matching comparison group in the studies, they no longer saw an increase in elective induction C-sections.
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As the due date approaches or ends, the question of whether to induce labor or wait for labor to begin on its own often arises.
Many researchers have attempted to compare the risks and benefits of induction and wait-and-see tactics for pregnant women between 39 and 42 weeks of gestation.
Before we discuss the evidence, it is important to note that the evidence we currently have regarding induction versus waiting for labor to begin has several serious weaknesses:
In 2018, researchers published the results of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, which was conducted to determine whether planned induction of labor at 39 weeks of pregnancy would reduce infant mortality and serious complications. compared to waiting at least 40 weeks and 5 days for planned induction (Grobman et al., 2018). They also wanted to see if induction affected the risk of caesarean section.
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This was a large-scale study that took place in 41 hospitals in the United States. Researchers surveyed more than 50,000 people to see if they could participate in the study. People had to give birth to an only child upside down for the first time, be sure of the date of their last period and have no serious health problems.
They found 22,533 people who could participate in the study, but only 6,106 of them (27%) agreed to participate. Researchers believe that such a high rejection rate means it may exist
, where research findings among study participants do not reflect the general relevant population (Carmichael and Snowden, 2019).
The researchers randomly assigned (like a coin toss) 3,062 people to be called after 39 weeks and 3,044 to follow-up. Carrying a pregnancy meant that you could wait until labor started on your own if you were in labor for 42 weeks and 2 days, or you could be induced for medical reasons at any time or if you wanted after 40 weeks and 5 days. In other words, people in the expectation management group experienced a combination of spontaneous, medically induced, and elective births.
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Some people may wonder why the researchers didn’t just compare elective induction with spontaneous labor. As we discussed, they couldn’t compare the two groups because spontaneous labor isn’t a certainty—someone might have changed their mind and wanted an induction or needed an induction for medical reasons.
They found that induction of labor at 39 weeks did not improve the primary outcome of death or serious complications in the children. Because stillbirth and neonatal death are very rare at 39 and 40 weeks, the ARRIVE study (with 6,000 participants) was too small to say whether elective induction affected this outcome. More children received respiratory support after treatment during pregnancy (4.2% vs. 3%) and had a longer hospital stay, which may have been related to a higher cesarean delivery rate with treatment during pregnancy.
In mothers, induction at 39 weeks was associated with a lower caesarean section rate compared to those assigned to expectant management (19% cesarean rate vs. 22%) and lower odds of pregnancy-induced hypertension (9% vs. 14%). .
Of note, the participants in this study developed extremely high blood pressure after 38 weeks of pregnancy, and the researchers wondered whether the reduction in cesarean delivery rates after 39-week induction was largely due to the mothers’ high blood pressure during pregnancy. . for deliveries after 39 weeks (Carmichael and Snowden, 2019). Hopefully, the researchers will publish another study based on the ARRIVE data (called a secondary analysis) that will allow us to better understand why the 39-week induction resulted in a lower caesarean section rate.
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Mothers in the early induction group spent more time in the hospital during labor but less time in the hospital after delivery. There was no difference in breastfeeding outcomes between groups. In both groups, 33% of children were exclusively breastfed for 4-8 weeks after birth, and 31% were formula fed.
Although this research can be useful for information
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