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.
Labor induction versus expectant management for low-risk nulliparous women. Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, Hill K, Thom EA, El-Sayed YY, Perez-Delboy A, Rouse DJ, Saade GR, Boggess KA, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA. New Engl J Med. 2018 Aug;379(6):513-523.
Cost of elective labor induction compared with expectant management in nulliparous women. Einerson BD, Nelson RE, Sandoval G, Esplin MS, Branch DW, Metz TD, Silver RM, Grobman WA, Reddy UM, Varner M, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) maternal-Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2020 Jul;136(1):19-25.
Customized probability of vaginal delivery with induction of labor and expectant management in nulliparous women at 39 weeks of gestation. Silver RM, Rice MM, Grobman WA, Reddy UM, Tita ATN, Mallett G, Hill K, Thom EA, El Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Thorp JM Jr, Chauhan SP, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2020 Oct;136(4):698-705.