Early induction versus 40-week induction: Why early induction may not be for you

By Casey Newman

If you’re pregnant with your first baby and considering elective induction, you may have heard of the ARRIVE study. This study — A Randomized Trial of Induction Versus Expectant Management (ARRIVE) — was conducted because researchers wanted to see if elective induction of labor at 39 weeks would result in lower rates of serious complications or death for babies and lower rates of cesareans compared to the induction of labor at 40 weeks 5 days and beyond.

Researchers followed 6,106 people pregnant with their first child who gave birth in 41 hospitals throughout the United States. Half of the people would be induced at 39 weeks and the other half would be assigned expectant management and either wait for labor to begin on its own or be induced after 40 weeks and 5 days. 

Here’s What They Found

Induction of labor at 39 weeks did not lower the risk of death or serious complications for babies, however, it did reduce the c-section rate for mothers (19% compared to 22% in the expectant management group). It also lowered the risk of developing pregnancy-induced high blood pressure (9% versus 14% in the expectant management group). Researchers also found that those in the early induction group spent less time in the hospital postpartum but more time in the hospital in labor. 

On the surface, these results sound intriguing, don’t they? Why not get induced early if your provider suggests it and you want to? You’ll allegedly have a lower risk of cesarean, hypertension and spend less time in the hospital. But there’s more to it than that. Induction at 39 weeks doesn’t lower the risk of cesarean for every person, and professional organizations like the American College of Obstetricians and Gynecologists (ACOG) have yet to officially recommend induction at 39 weeks for first-time parents. If you and your provider are considering a 39-week induction, ACOG urges providers to keep in mind the values and preferences of the pregnant person, the staffing and availability of the hospital, and the protocols for a failed induction.

It’s also important to note that participating hospitals used the latest, progressive, long induction protocols, which have a significantly lower risk of cesarean. Not all hospitals use these protocols. 

Why Early Induction May Not be Best for You

Some people may not benefit from early induction. It might not be for you if:

You want to go into labor naturally: The ARRIVE study didn’t compare people who were induced with people who went into labor naturally. While the study had an expectant management group, people in this group were still induced if they did not go into labor by 40 weeks and 5 days. 

You wouldn’t normally choose an elective induction: If the only reason you’d choose an elective induction is because of the ARRIVE study, you may not want to electively induce. Consider this: Researchers initially found 22,533 participants, but only 6,106 — 27% — agreed to participate.

You don’t want an epidural: The study did not compare those who were induced with those who did not make use of an epidural.

You’re not giving birth at one of the participating hospitals: The hospitals participating in the study used the latest, progressive, long induction protocols that are not standard at many hospitals. Other induction protocols can carry a significantly higher risk of cesarean. 

You want to move around during labor, choose your own position, or don’t want continuous fetal monitoring: Being induced requires continuous fetal monitoring, which can restrict movement and birthing positions. 

You’re not in your early 20s: The study participants were all 23-24 years old. 

You’ve given birth before: The study only applied to first-time parents. 

You want to lower your cesarean risk by more than 3%-4%: Hiring a doula, laboring or birthing in water, choosing a midwife as your provider, and having an out-of-hospital birth can lower your c-section risk by as much as 60%. 

Casey Newman is a mother of two from Green who depends on wine to get her through bathtime and bedtime. She is a maternal and women’s health advocate who volunteers with several birth and maternal rights organizations and has spoken to Congress members about issues affecting moms.