The 39-Week Induction Debate: The Real Pros and Cons You Need to Know

First, let’s clarify what we’re talking about.

An induction of labor (IOL) is the process of using medications or other methods to stimulate uterine contractions to begin labor artificially. It’s a common procedure, but it’s important to distinguish between two main types:

• Medically Indicated Induction: This is when there’s a clear health reason to deliver the baby sooner rather than later. Common reasons include preeclampsia, gestational diabetes, issues with the placenta, or the water breaking without contractions starting. In these cases, the benefits of delivering the baby outweigh the risks of continuing the pregnancy.
• Elective Induction: This is a scheduled induction for non-medical reasons. The 39-week elective induction debate centers on this type—choosing to induce labor once the pregnancy has reached the 39-week mark, which is considered ‘full term.’ At this stage, the baby’s lungs are fully developed, and they are ready for life outside the womb.

How is Labor Induced?

The methods used can vary depending on how ‘ready’ your body is for labor, a factor your provider measures with something called a Bishop score. This score assesses your cervix’s dilation, effacement (thinning), and position. Depending on your score, the process might include:

• Cervical Ripening: If your cervix isn’t soft and open, methods like medication (prostaglandin gels or inserts) or a small balloon catheter may be used to help it prepare.
• Membrane Stripping or Sweeping: A provider can use a gloved finger to separate the amniotic sac from the wall of the uterus, which can release hormones and sometimes trigger labor.
• Amniotomy (Breaking Your Water): A provider uses a small, sterile hook to rupture the amniotic sac. This is typically done when the cervix is already partially dilated.
• Pitocin: A synthetic form of the hormone oxytocin is given through an IV to start and regulate contractions.

Understanding these basics is the first step. It’s not a single switch that’s flipped, but a process designed to gently nudge your body into the beautiful, powerful work of labor.

The conversation around elective 39-week inductions changed dramatically after a major study called the ARRIVE trial was published in 2018.

This large, randomized controlled trial provided some surprising results that challenged long-held beliefs. Let’s explore the potential ‘pros’ that emerged from this research and what they could mean for you.

A Lower Chance of Cesarean Section

This is perhaps the most significant and counterintuitive finding. For years, the prevailing wisdom was that inducing labor increased the likelihood of a C-section. However, the ARRIVE trial found the opposite. In the study group of low-risk, first-time mothers, those who were induced at 39 weeks had a lower rate of C-sections (19%) compared to those who waited for labor to start on its own (22%). While a 3% difference may seem small, it’s a meaningful reduction in major abdominal surgery.

Reduced Risk of Hypertensive Disorders

The study also found that the group induced at 39 weeks had lower rates of developing high blood pressure disorders of pregnancy, such as gestational hypertension and preeclampsia. These conditions can be serious for both the birthing parent and the baby, so any reduction is a significant health benefit.

Potential for Better Neonatal Outcomes

While the overall rates of serious complications for babies were low in both groups, the babies in the induction group required less respiratory support after birth. This suggests a smoother transition for the newborn. Additionally, though the risk is very low in the final weeks of pregnancy, the placenta can begin to function less effectively as a pregnancy goes past 40 or 41 weeks. An induction at 39 weeks eliminates the small but devastating risk of stillbirth associated with going significantly past the due date.

“For many families, the element of planning can be a powerful tool against anxiety. Knowing when you’ll go to the hospital allows you to arrange childcare, take time off work, and mentally prepare, which can create a calmer, more controlled birth experience.”

For many, the psychological benefits of having a scheduled date are also a major pro. The last weeks of pregnancy can be physically and emotionally draining. Having a set end date can alleviate stress and anxiety about when labor will begin.

While the ARRIVE trial presented compelling benefits, an elective induction is not without its potential downsides. It’s crucial to look at the complete picture to understand if it aligns with your personal health and your hopes for your birth experience.

A Potentially Longer and More Intense Labor

An induction is a process, not an event. It can sometimes take a long time—even 24 to 48 hours or more—to get labor established, especially if your body isn’t showing natural signs of readiness. Furthermore, contractions brought on by Pitocin can often be more intense and more frequent than those in spontaneous labor, without the gradual build-up. This can be physically and emotionally taxing.

Increased Need for Pain Management

Because of the potential intensity of induced contractions, many people who undergo induction find they are more likely to request an epidural for pain relief. If your goal is an unmedicated birth, an induction might make that more challenging (though certainly not impossible). There’s no right or wrong way to manage pain—it’s about knowing the possibilities.

Less Freedom of Movement

An induction often requires more intensive monitoring. This can include continuous electronic fetal monitoring and an IV line for Pitocin and fluids. This can tether you to the bed, limiting your ability to walk around, use a birthing ball, or change positions freely—all things that can help labor progress and manage pain.

The ‘Cascade of Interventions’

This term refers to the idea that one medical intervention can lead to a series of others. For example, an induction might lead to a need for an epidural, which can sometimes slow labor, which might then require more Pitocin. While each step is taken with safety in mind, it can lead to a more medicalized birth experience than some parents envision.

So, what does all this mean for you? It means you are at the center of a shared decision-making process with your healthcare provider. This isn’t about your doctor telling you what to do; it’s about having a collaborative conversation.

Your unique medical history, your pregnancy journey, and your personal values are all critical pieces of this puzzle. The findings of a large study are an important guide, but they don’t erase your individual circumstances.

Key Questions to Ask Your Doctor or Midwife:

To help you prepare for this important conversation, consider bringing a list of questions to your next appointment. This shows you are an active participant in your care and helps ensure you get all the information you need.

1. Am I a good candidate for an elective induction? Based on my health, my baby’s health, and my pregnancy so far, what are your thoughts?
2. What is my Bishop score? Can you explain what it means and how it might predict the success of an induction for me?
3. If we proceed with an induction, what methods would you recommend and why? What would the process look like from start to finish?
4. How might an induction affect my birth plan? For example, my wishes for pain management, movement, or water immersion?
5. What are the policies at my hospital/birthing center regarding inductions? (e.g., How long will they let the process go on before suggesting a C-section?)
6. If we choose not to induce at 39 weeks, what does monitoring look like at 40 and 41 weeks? What are the signs that would make an induction medically necessary later on?

Remember, it is perfectly okay to say yes to an induction, and it is perfectly okay to say no. You can also change your mind. The goal is to feel respected, heard, and confident in the path you choose.