I want to talk about the topic of induction at 39 weeks. I was teaching a class the other evening and a client came up and told me that her doctor told her that she induces at 39 weeks. This client is a healthy first-time mom with no comorbidities, she is a physical therapist who is very physically fit. So there is no reason for induction other than, this is the doctor’s common practice. This doctor sent the patient a copy of the arrive study and only pointed out the increased c-section rate for the group that was not induced at 39 weeks. What this doctor didn’t point out about the arrive study, is that doctors followed very strict guidelines in this study, such as giving patients at least 12 hours in early labor, they used cervical ripening for unfavorable cervix which led to a c-section rate of 19%, which is unusually low. In a study done in 240 California hospitals done on low-risk first-time mothers being induced c-section rates were 32% with some rates as high as 60%. In the arrive study most of the women 94% were cared for by physicians, studies show that midwives have a low cesarean rate without the use of elective inductions. In the US cesarean rate is 5% for planned home births and 6% in midwifery led birth centers (Cheyney et al., 2014; Stapleton et al., 2013).
In my 17 years of nursing in labor and delivery units, I have witnessed so many failed inductions. As mentioned in this study doctors followed strict guidelines such as giving mothers 12 hours of early labor before making a call of failure to progress. Honestly in my experience, this kind of patience is not seen with many doctors and hospitals. I have worked in 12 different states as a traveling nurse and I observed the same thing all across the US. Doctors rush inductions, if the patients aren’t dilating at a rate they feel is adequate, they start talking c-section.
In this study, the relative risk reduction of cesarean sections in the induction group was 16%. Many studies have shown a much larger risk reduction using other approaches such as people assigned to continuous support (such as with a doula) risks were decreased by as much as 25% (Bohren et al., 2017). Also, patients with less invasive monitoring such as hands-on listening compared to continuous fetal monitoring were 39% less likely to have a c-section (Alfirevic et al., 2017). Comfort measures such as upright birthing positions and water birth have also shown as much of a 16% decrease in cesarean rates.
So when considering your doctor’s recommendation of elective induction at 39 weeks, consider these things. First what are your preferences, does the facility you are delivering at have the staffing and resources to handle longer labor, what are their protocols for failed induction. If there are no complications early labor can last as long as 24 hours or more, and oxytocin can be given 12-18 hours after mothers’ water is broken before induction is considered a failure to progress.
Ask questions when your doctor starts talking inductions, use your Benefits Risks Alternatives Intuition No/not now. Ask what your bishops score is, if its less then 8, talk cervical ripening, not Pitocin. Discuss options for cervical ripening and what the risks and benefits are of each option. Talk with your provider about natural inductions options.