What You Need to Know About Elective Induction at 39 Weeks?

Is Your Doctor Telling You the Whole Story?

A Woman Discussing Elective 39-Week Induction with Her Doctor

You’re at your doctor’s office for another prenatal appointment. You know the routine by now. Urine sample, blood pressure, a quick listen to Baby, etc…

Everything’s still healthy and looking good! Yay!

Suddenly he drops this bombshell on you: “I went ahead and scheduled your induction for next week.” 

What?! You’re mortified. You’d been hoping for a natural birth this whole time. What is your doctor thinking? 

Inside, you’re confused, angry, and a little hurt. But on the outside, you keep your smile polite and ask, “Umm, and why do I need to be induced?” 

Your doctor gives you a few quick reasons. Something about 39 weeks being the best time for Baby to be born. And he mentions the risk of stillbirth going up—that really freaks you out! 

He says induction is perfectly safe and the best option for you and Baby. And that one study even says it lowers the risk of a c-section. That all sounds reasonable, and you don’t want to be a “difficult” patient. So you agree to the appointment and head home. 

But after a while, the conversation still doesn’t sit well. And you’re left wondering: Should I really get induced?

Doctor’s Liability

First of all, know that you are not alone! Doctors regularly offer—or even coerce—healthy, low-risk women into inductions at 39 weeks. 

Why do they do this? 

Let’s first remember that many doctors think they mean well. They’re very often great people who want what’s best for their patients. 

However, we must always remember that doctors have liability. 

They are responsible for the safety of you and Baby, while Baby is in the womb. So this means they are motivated to get Baby outside of your womb as soon as it’s reasonably safe (which for them is 39 weeks gestation). 

Also, doctors will always be sued more often for what they didn’t do. So if they don’t offer induction…to do something…they may be more liable than if they just wait-and-see (also called “expectant management”). 

So all of that is hovering in the back of their minds…possibly pushing them to believe induction is best for you. Even if it’s not. 

Let’s talk about that “evidence” the doctor shared at the appointment. Is induction at 39 weeks really better for Baby? Can it actually reduce the risk of cesarean? 

The ARRIVE Trial

This whole induce-at-39-weeks thing mostly comes from a study called The ARRIVE Trial. It was a study carried out in the US in 2018 by Grobman et al. They set out to see if induction at 39 weeks would lead to better health outcomes for newborns. 

The ARRIVE trial determined that induction at 39 weeks did NOT change health outcomes for babies. 

Meaning if your doctor told you induction would be better for Baby, they’re not giving you evidence-based advice. 

Since the study didn’t prove induction was better for Baby, they shifted their focus (and the headlines) to cesarean. Because the ARRIVE trial did find that induction at 39 weeks reduced the rate of cesarean—from 22% to 19%. 

Which is technically a reduction—but did your doctor tell you that it was such a small reduction? Probably not. 

However, the ARRIVE trial had plenty of flaws to it as well. (Such as many of the women who were in the spontaneous labor group actually ended up being induced!) If you’d like to learn more details about the study, you can check out the Evidence Based Podcast here.

Risks of Stillbirth

Now, let’s talk about the risk of stillbirth. That is the major reason doctors give for recommending induction. Especially as you get closer to or go over your due date. 

They may even tell you that your risk of stillbirth doubles every week you wait. That’s scary sounding stuff, right? 

Let’s look at the actual rates for stillbirth in low-risk women:

• At 38 weeks - 0.012% or 1 in 8333 (or 1.2 out of 10,000)

• At 39 weeks - 0.014% or 1 in 7142 (or 1.4 out of 10,000)

• At 40 weeks - 0.033% or 1 in 3030 (or 3.3 out of 10,000)

• At 41 weeks - 0.08% or 1 in 1250 (or 8 out of 10,000)

• At 42 weeks - 0.088% or 1 in 1136 (or 8.8 out of 10,000)

(Data from Muglu et al 2019, pulled from the book “In Your Own Time” by Dr. Sara Wickham pg. 98)

So technically, your risk of stillbirth does double from your 39th to 40th week of pregnancy. Because 0.033% is more than double 0.014%. But your absolute risk is still super, super tiny. Always remember 3.3 stillbirths out of 10,000 means that 9,996.7 women had live babies. 

Risks of Induction

And finally, let’s talk about if induction really is “perfectly safe” or not. 

The short answer is: NO. If induction was “perfectly safe” then you would not be required to have continuous fetal monitoring—a requirement at hospitals during an induction. 

They must monitor Baby closely in case the contractions become too intense for them. Which can happen because the contractions are being produced by synthetic hormones (Pitocin). If Baby is in distress too long, it may lead to a cesarean. 

Another risk: If your due date is not perfectly calculated, there’s always a chance that Baby simply isn’t ready to be born. And that by inducing at 39 weeks, you may actually be giving birth to a baby younger than that gestational age. This can lead to complications, NICU stays, and breastfeeding problems. 

Induction can also be more difficult for you, the birthing mother. 

When you go into labor naturally (or spontaneously), your body releases a hormone called Oxytocin. Oxytocin causes the contractions, but it also crosses the blood-brain barrier. This gives you a natural rush of endorphins causing you to feel less pain. 

Pitocin (the artificial version of Oxytocin) is what is typically used to start contractions for induction. Pitocin does the same thing to your body, but it does not cross into your brain. Which means the contractions feel more painful than natural ones. Pitocin contractions can also be stronger than natural ones. All this means more discomfort for you. 

And labor induction, especially if your body isn’t ready yet, can sometimes be a long process. Some women take up to three days from the start of the process until they’re holding their babies. 

This means they are usually exhausted by the time they finally meet their little one. Which can delay bonding and make the initial breastfeeding more difficult. That’s a factor few doctors talk about.

And remember that most women will naturally go past their due date—by 5-10 days on average. 

As always, it’s up to you to weigh the benefits and risks of what happens to your body. You decide if induction or waiting for labor to begin on its own is better for you. Your doctor cannot force you to be induced if you don’t want to be. If your doctor has already scheduled it, you can always call the hospital to cancel—even on the day of. 

Do your research and trust your intuition. You’ve got this, mama! 

If you're still struggling with indecision, talking to an experienced doula can help! Even if you know you won't be hiring a doula for your birth, many offer individual meetings for a flat fee. Click here to learn more!