Inducing labour at 39 weeks has been declared 'safer'. Here's what mums have to say about it.

New research from The University of Melbourne has analysed data from 14 studies and found that choosing to induce labour at 39 weeks seems to have much better outcomes for mums, as compared to 'expectant management' (allowing the pregnancy to continue until labour begins naturally or there's reason to induce later). 

Looking at the pooled data of over 1.6 million women, the study found that inducing labour at 39 weeks gestation was associated with lower labour-related and neonatal complications overall, including reduced likelihood of macrosomia (a newborn that is much larger than average) and low five-minute Apgar scores (a basic indicator of health where a higher score indicates better health after birth).

It also found that inducing labour early led to a 37 per cent decrease in the risk of perineal injury in mothers – including serious third or fourth-degree tears. Severe perineal injuries affect around one in 20 women in Australia, and these injuries can often require surgeries and take many months to heal. 

Additionally, bringing the birth forward to 39 weeks reduces the likelihood of forceps or vacuum extraction being used. 

The only drawback that the study found was that, among first-time mothers induced at 39 weeks, there was a higher chance of shoulder dystocia (the baby's shoulder getting stuck in the pelvis).

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The co-lead of the research, Dr Roxanne Hastie, told Mamamia that the research is reassuring, considering that the number of women choosing to induce at 39 weeks has been on the rise for the past few years globally (in fact, more than 40 per cent of labours are now induced at 39 weeks in Australia).

The Melbourne study builds on previous research, including the landmark ARRIVE study (A Randomised Trial of Induction Versus Expectant Management), which was published in 2018. The trial looked at thousands of first-time mothers in the US and found that labour induction at 39 weeks led to lower cesarean delivery rates (by 18 per cent) and lower risk of hypertensive disorders (by nine per cent).

"That trial found that [induced labour at 39 weeks] had good outcomes for babies," Dr Hastie said. 

"That evidence kind of empowered women and healthcare providers to say, 'Look, if you do want to have an elective induction, it's safe." 

Leigh, who gave birth to her son three years ago, told Mamamia that she was comfortable with the decision to get induced from very early on in her pregnancy, as she had had a complicated history of fertility and anxiety related to that. 

"I knew I wanted to be induced from about halfway through my pregnancy... it was what I was most comfortable with. I went to a private hospital and had a private [obstetrician], as I needed additional care in relation to my previous losses," she said. 

Leigh had to have an emergency C-section in the end but she said that she doesn't have any regrets about the decision to induce early.

"He's here safely and that was the only end goal for me." 

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However, Eliza, who gave birth two years ago to her second child, Poppy, told Mamamia that she ultimately regrets her decision to induce labour at 39 weeks.

"Basically, I wanted to be really organised because I also had a two-year-old and I love being organised."

Eliza's birth was complicated by her first child being sent home from daycare with gastro, which ultimately infected her husband and made him too sick to stay in the birthing suite. Eliza also experienced labour complications that she describes as "super traumatic". 

"Poppy came out blue and unresponsive (she was fine in about 30 seconds) I had a haemorrhage... I couldn't hold my baby, my sister did all the initial skin-to-skin [contact]." 

"Basically, I think Poppy wasn't ready to come out and if I'd just waited and hadn't tried to be so organised, it would have been much smoother," Eliza said. 

Early induction can be a controversial topic and for some mums, the choice of whether or not to undergo induction can be fraught and emotional. For example, some report that induced labour is more painful than labour that starts on its own. Some mums are also simply distressed at the prospect of births not happening according to personal preference. 

Antonia*, who gave birth last year, told Mamamia that she was anticipating being induced early due to her diagnosis of gestational diabetes and the risk that her baby would be too large for a vaginal birth. She said she was advised to induce but decided to wait for natural labour.

"Given all my scans indicated otherwise [that the baby would not be too large], I felt conflicted. I did a lot of my own research and ended up challenging my medical team.

"I'm really glad I did because I had the birth I hoped I would. I don't think the experience would have been the same if I was induced as recommended," she said. 

However, there are risks associated with pressing ahead with pregnancy when an induction has been recommended. 

Dr Hastie pointed out that the only intention of The University of Melbourne study was to empower women through information to make the best decisions for themselves. 

"I know that there is a bit of apprehension around inductions. I think that can also be attributed to the fact that, for a lot of people, that's their first experience of labour because induction is a lot more common in first-time mums," she said. 

Dr Hastie also noted that in the 2018 ARRIVE study, women who had been induced compared to those who "waited and watched" actually felt more in control and had a more positive birth experience overall. 

"So I think the jury is still out on the experience of induction of labour and everyone will experience it really differently. So, we're not saying one's better than the other, we're just saying this is the evidence so that women can make their own informed decisions with healthcare providers," Dr Hastie said.

Elfy Scott is an executive editor at Mamamia.

Image: Canva. 

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