Elective Labor Induction in First-Time Moms at 39 Weeks of Gestation

The optimal timing of delivery for low-risk pregnancies is not known. Risks of complications increase after 39 weeks of gestation, but inducing labor may increase the need for cesarean delivery, leading to policies prohibiting elective induction before 41 weeks. To address this dilemma, Robert Silver, MD, and colleagues at the University of Utah Department of Obstetrics & Gynecology randomized 6,106 low-risk, first-time pregnant women to either induction of labor at 39 weeks or expectant management (waiting for spontaneous labor but undergoing active intervention should the need arise). Results of the study showed that the induced group had a 16% lower rate of cesarean deliveries, lower rates of some medical complications, higher satisfaction with their labor experience, and similar or lower medical costs. These findings led to a general acceptance of elective induction of labor as a reasonable option for first-time mothers at 39 weeks' gestation. Further research has facilitated personalized calculations of probability of vaginal birth after induction and risk of medical complications with expectant management, empowering women to make informed decisions about their birth experience.