Induction at 39 weeks – does it really benefit women?

A presentation of the preliminary results of the ARRIVE study on Induction at 39 weeks was given recently at the Society for Maternal Fetal Medicine Annual Meeting. The internet is all abuzz about the results.  One group saying it indicates that if we want to reduce cesareans we should automatically be inducing at 39 weeks; and the other saying it is wholly inappropriate.

Dr. Rebecca Decker from Evidence based birth did a podcast on the subject, and did a great job at disseminating what we know so far.  This was my takeway from that podcast:

  1. Yes, this does seem to reduce cesareans by a very small amount – 3.5%
  2. But there were flaws in the study, including bias, and lack of true controls.
  3. This method does not work with the Midwifery Model of care.
  4. This method would only be for those who do not care if they have a medicalized/Interventional birth, or who truly medically need an induction.
  5. If you desire a natural birth there are much better ways to reduce your chances of a cesarean (see below).
  6. The NUMBER NEED TO TREAT (NNT) was 28.  That means you would have to induce 28 women to prevent 1 cesarean.
  7. Walking, Doulas, Waterbirth and Birth Centers all have an NNT# of 9. That means using these methods prevents 1 cesarean for every 9 women.  Not only statistically better, but all are much better, safer, and  less technical ways of preventing cesareans.
  8. Following ACOG’s new guidelines for Normal birth (reducing interventions, only inducing for medical reasons, allowing longer times in labor and pushing, intermittent auscultation, etc.) has been shown in two recent studies (Bell 2017, and Jabbernick 2017) to reduce the cesaren rate by anywhere from 25 – 50%.

Bottom line: You do  not have to have an induction to reduce your cesarean rate. There are safer, cheaper, easier ways of doing that.

That said, in looking at the statistics for my Bradley students it becomes obvious that taking a Bradley class also reduces your chances of a cesarean by more than 50% (from the national average of 32.1% down to 15%. Population 504, over a 22 year period).  The national average for Bradley students is even lower – 13%.

So, take a Bradley class, learn how to stay healthy and low risk, hire a doula, use a Midwife, and walk during labor. Consider using a Birth Center and having a Water-birth if those options are available in your area.

Contact me for more information: Amy  V. Haas, BCCE ajvhaas@gmail.com

https://clinicaltrials.gov/ct2/show/NCT01990612

https://www.sciencedaily.com/releases/2018/02/180201115718.htm

http://www.midwife.org/induced-labor-study-statement

http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/arrive-study-39-week-induction-reduces-frequency-cesarean-healthy-women

https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/

https://www.facebook.com/EvidenceBasedBirth/ -Live analysis of the study

http://www.ajog.org/article/S0002-9378(17)32491-2/fulltext