Can you request to be induced at 39 weeks

For Healthy Pregnancies, Inducing Labor at 39 Weeks Is Safe

September 6, 2018

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Babies are “due” after 40 weeks of gestation, but evidence suggests that infant mortality and complications are lowest for those delivered at 39 weeks, when a fetus is considered full term. Some obstetricians have recommended inducing labor at 39 weeks to reduce the risk of complications.

But the practice isn’t routine. Physicians worried that elective induction at 39 weeks might increase the rate of C-sections, and no randomized studies had determined whether induction might be safer than the usual care—letting nature take its course until around 41 weeks and inducing labor after that.

A new clinical trial, recently published in the New England Journal of Medicine, provides some answers. The CUIMC Newsroom spoke with Annette Perez-Delboy, MD, a maternal-fetal medicine expert at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center and a member of the trial’s research team.

Q: What was the purpose of this clinical trial, and what were the results?

This trial was designed to compare maternal and perinatal outcomes in women who were induced at 39 weeks’ gestation and those who either went into labor spontaneously or were induced at 41 to 42 weeks if spontaneous labor did not occur.

Based on previous retrospective studies, our thought was that delivery after 40 weeks may be associated with a higher risk of complications, such as maternal preeclampsia and low Apgar scores for neonates. To avoid complications, some doctors have been interested in inducing labor at 39 weeks, when the risk of complications is lowest. But we didn’t have enough evidence to determine if elective induction in low-risk first-time mothers could improve outcomes, so we conducted a randomized clinical trial to find out. We also questioned the older literature that induction before 40 weeks might increase the number of deliveries by cesarean section, so we looked at this outcome as well.

We found that maternal and perinatal outcomes in both groups were similar: The group that delivered later had slightly more neonatal deaths and complications, although the difference wasn’t statistically significant. However, the group that was induced at 39 weeks had significantly fewer C-sections and lower rates of preeclampsia, which is one of the leading causes of maternal morbidity.

Q: Will these findings change clinical practice?

These findings will give women and their providers options that once were considered taboo. They show that elective induction at 39 weeks is now a valid option. This is particularly important for women known to be at risk for preeclampsia.

Of course, while the study showed that induction at 39 weeks is safe, some women may still prefer to let nature take its course and allow labor to begin naturally. It’s a personal choice, but women have the option to decide.

Q: Were the findings surprising, and, if so, why?

The findings were not what we had predicted. We had expected neonatal outcomes to be better in the group induced at 39 weeks. While the numbers pointed in the direction of benefit, the findings were not statistically significant. We were also surprised at the marked benefit to maternal health by reducing the rate of preeclampsia and other pregnancy-associated hypertensive disorders.

We were also glad to validate our secondary hypothesis that induction at 39 weeks was associated with fewer C-sections. Many of the women in this group had a low Bishop’s score—a rough measure of a woman’s readiness to deliver vaginally. In general, a low Bishop’s score is associated with a higher risk of delivery by C-section, so doctors tend to avoid induction in women with a low score. But having a low score didn’t seem to affect the likelihood of delivering vaginally. This adds a new piece of information to the puzzle about whether and when to induce.

Q: Are your results generalizable to all women with healthy pregnancies? Or are there certain women for whom the results don’t apply?

Our study was the largest randomized trial to study this question. It included 6,100 healthy women from 41 urban and community hospitals, which have varying protocols for labor induction and management. In addition, there were no significant differences in results according to the mom’s race or ethnicity, age, or body mass index. However, the results are only generalizable to the type of women who were eligible for the study. Importantly, they had to be low-risk, with no other medical or obstetric issues that would impact delivery, and they had to be delivering their first baby.

Additionally, we only enrolled women with a reliably estimated due date. We aren't always able to obtain an accurate estimate, so we can’t be sure if the results apply when we don’t have good dating.

Q: What questions remain unanswered?

There are several unanswered questions, which will be addressed in secondary analyses of this study. One question is the cost associated with a 39-week induction. Labors that are induced are generally longer than spontaneous labors, so induction may be associated with an increase in cost. But because the induced group had fewer cesareans, there may also be cost savings. Other questions concern the use of Pitocin (the drug to induce labor), length of labor, and resource utilization. It may be challenging for some centers to accommodate a potential increase in inductions, though fewer women delivering after going into labor spontaneously may offset that.

References

Annette Perez-Delboy, MD, MBA, is an associate professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons.

The study, “Labor Induction versus Expectant Management in Low-Risk Nulliparous Women,” was published Aug. 9 in the New England Journal of Medicine.

Additional study investigators from the Department of Obstetrics & Gynecology at VP&S included Ronald Wapner, MD, professor of obstetrics & gynecology, and Cynthia Gyamfi-Bannerman, MD, the Ellen Jacobson Levine and Eugene Jacobson Professor of Women’s Health. Other authors are included in the paper.

The work was supported by the National Institutes of Health. Conflicts of interest are included in the paper.

Medical reasons for inducing labor

Inducing labor (also called labor induction) is when your provider gives you medicine or breaks your water to make labor start.

Your provider may recommend inducing labor if your health or your baby’s health is at risk or if you’re 2 weeks or more past your due date.

Inducing labor should only be for medical reasons. If your pregnancy is healthy, it’s best to wait for labor to start on its own.

If your provider recommends inducing labor, ask about waiting until at least 39 weeks to be induced so your baby has time to develop in the womb.

What is inducing labor?

Inducing labor (also called labor induction) is when your health care provider gives you medicine or uses other methods, like breaking your water (amniotic sac), to make your labor start. The amniotic sac (also called bag of waters) is the sac inside the uterus (womb) that holds your growing baby. The sac is filled with amniotic fluid. Contractions are when the muscles of your uterus get tight and then relax. Contractions help push your baby out of your uterus.

Your provider may recommend inducing labor if your health or your baby’s health is at risk or if you’re 2 weeks or more past your due date. For some women, inducing labor is the best way to keep mom and baby healthy. Inducing labor should be for medical reasons only.

If there are medical reasons to induce your labor, talk to your provider about waiting until at least 39 weeks of pregnancy. This gives your baby the time she needs to grow and develop before birth. Scheduling labor induction should be for medical reasons only.

What are medical reasons for inducing labor?

Your provider may recommend inducing labor if:

Your pregnancy lasts longer than 41 to 42 weeks. After 42 weeks, the placenta may not work as well as it did earlier in pregnancy. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.
Your placenta is separating from your uterus (also called placental abruption) or you have an infection in your uterus.
Your water breaks before labor begins. This is called premature rupture of membranes (also called PROM).
You have health problems, like diabetes, high blood pressure or preeclampsia or problems with your heart, lungs or kidneys. Diabetes is when your body has too much sugar (called glucose) in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys. High blood pressure is when the force of blood against the walls of the blood vessels is too high and stresses your heart. Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia).
Your baby has a stopped growing. Or your baby has oligohydramnios. This means your baby doesn’t have enough amniotic fluid.
You have Rh disease and it causes problems with your baby’s blood.

What are the risks of scheduling labor induction for non-medical reasons?

Scheduling labor induction may cause problems for you and your baby because your due date may not be exactly right. Sometimes it’s hard to know exactly when you got pregnant. If you schedule labor induction and your due date is off by a week or 2, your baby may be born too early. Babies born early (called premature babies) may have more health problems at birth and later in life than babies born on time. This is why it’s important to wait until at least 39 weeks to induce labor.

If your pregnancy is healthy, it’s best to let labor begin on its own. If your provider talks to you about inducing labor, ask if you can wait until at least 39 weeks to be induced. This gives your baby’s lungs and brain all the time they need to fully grow and develop before he’s born.

If there are problems with your pregnancy or your baby’s health, you may need to have your baby earlier than 39 weeks. In these cases, your provider may recommend an early birth because the benefits outweigh the risks. Inducing labor before 39 weeks of pregnancy is recommended only if there are health problems that affect you and your baby.

If your provider recommends inducing labor, ask these questions:

Why do we need to induce my labor?
Is there a problem with my health or the health of my baby that may make inducing labor necessary before 39 weeks? Can I wait to have my baby closer to 39 weeks?
How will you induce my labor?
What can I expect when you induce labor?
Will inducing labor increase the chance that I'll need to have a c-section?
What are my options for pain medicine?

Last reviewed: September, 2018

See also: 39 weeks infographic

description, features, norms, recommendations, contraindications, what you need to know

The last terms of gestation are a heavy burden and burden for every woman. There are many new unpleasant sensations, discomfort, where everyone is already dreaming of getting rid of this as soon as possible and meeting with their baby. When the 39th week of pregnancy comes, many are interested in how to speed up the process of onset of labor. To make everything possible and there are 5 ways leading to an early meeting with your baby.

Contents of the article

When should such measures be taken?

There are several reasons that justify this action:

Multiple pregnancy . At this time, the children are already fully prepared for the birth. It is not worth continuing the perinatal period further, this can lead to unpleasant consequences.
Large child . When an ultrasound scan shows the large size of the fetus and its weight, the doctors themselves suggest using such measures so as not to lead to ruptures or to prevent the need for a caesarean section.
Medical indicators . Stimulation may be required in case of Rh conflict, complications with the heart in the embryo. Also, it will be required if you have hypertension or diabetes.
Difficult childbirth . The acceleration of the appearance of the fetus can be caused by premature discharge of water, weak and rare contractions, the immaturity of the uterus, or its strong extension.

Is it dangerous?

When your doctor urges you to take such steps, it is a very serious and difficult decision to make. For several reasons, many think and consider the option of 39week of pregnancy as you can speed up the birth. But you need to know if there are consequences of such actions, and whether they threaten the health of the embryo.

The process should be performed only in the case of a medical indication, in order to preserve the normal life of the mother and her baby.

Possible consequences:

The birth of a child becomes very painful.
Not always effective, leading to caesarean section.
Intensified contractions and reducing the time between them.
When a large amount of the drug is administered, there is a risk of reducing the amount of oxygen supplied to the fetus.

Therefore, the artificial activation of the end of gestation carries risks. If there are fewer of them than the further continuation of gestation, the doctor makes the right decision.

It is not worth making independent decisions so that this does not negatively affect the child.

Contraindications

There are cases where such actions are strictly prohibited and you will have to wait for the biological activation of the organism.

The pelvis of the woman in labor is much smaller than the head of the embryo.
Bad heart monitor readings.
Incorrect position of the baby.
Women's health problems.

5 ways to quickly resolve the perinatal period.

There are several methods used in this case, based on medical assistance or of a folk character.

What gynecologists do:

Prostaglandin hormone use . It helps to bring the uterus to a mature state, to open it to such a size that the baby's head can easily pass. With its introduction, you get minimal risks, which is important, since there is no entry into the bladder with amniotic fluid. They introduce it into the vagina as far as possible, use suppositories, gels on the recommendation of a doctor.
Use of oxytocin . This is a special hormone produced by the pituitary gland and affects the rapid activation of the muscle fibers of the vagina. It can be prescribed in the form of tablets or intramuscular injections, droppers. It does not affect the opening of the uterus and, after receiving by the body, increases labor pain. Assign with antispasmodics to eliminate severe discomfort. It is forbidden to use in such situations: the inability to exit the embryo naturally, its incorrect position, the sensitivity of the mother to the drug, scars on the uterus, placenta previa and much more.
Amniotomy . Opening the fetal bladder is the introduction of a special tool in the form of an elongated stick with a hook into the woman's vagina, which breaks it and accompanies the outflow of amniotic fluid. It is painless, does not affect the baby and leads to the fastest onset of labor. It happens that after this, the contractions do not start, which forces the gynecologist to apply one of the first methods.

What can you do:

Physical exercise . Long walks in the fresh air, cleaning around the house. However, this method will only work if the cervix begins to open and prepare for the baby's exit.
Sexual intercourse . In the sperm of a man there is a large concentration of prostaglandin, which helps prepare the way for the completion of the perinatal period.

These are all the nuances that at the 39th week of pregnancy will give a solution to the question of how to give birth faster. Remember, everything you do at this stage should be solely on the advice and agreement with your doctor.

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How to induce labor naturally

There are at least seven ways to induce labor that are supported by science. Let's take a look at each of these "evidence-based" methods.

1. Sexual intercourse

Many women manage to induce natural childbirth through sex. This is because semen contains prostaglandins, the same hormone-like compounds found in cervical ripening drugs such as Cervidil.

The key to having sex for natural induction is not to do it once. With this natural method of labor induction, "3 times is the way to go." It is assumed that three ejaculations contain the same amount of prostaglandins as Cervidil.
Of course, at 40+ weeks of pregnancy, frequent sex is definitely not what the expectant mother dreams of, but it is definitely the best alternative to cervidil and pitocin, which can lead to more painful contractions and even rupture of the membranes or fetal distress.

2. Nipple stimulation

Nipple stimulation can actually help induce labor or hasten a stalled or slow labor. You should stimulate the entire breast, not just the nipples. Try a slow, rhythmic breast massage behind the areola.

You can do this yourself or ask your partner to help.

3. Evening Primrose Oil

Evening Primrose Oil contains prostaglandins that help prepare the cervix for childbirth. However, there is limited research on the efficacy and safety of evening primrose oil. Evening primrose oil can actually prolong labor by several hours when used vaginally. It can also cause early rupture of membranes, meaning your waters break before contractions begin.

Although many mothers claim that oil speeds up labor, there is still a risk, so it should be considered as a last resort.

4. Castor oil

Castor oil causes the intestines to contract, which can stimulate uterine contractions. But like evening primrose oil, this method should also be used with caution and only with the approval of your midwife or doctor.

Although many mothers have used it with great success and no other interventions. Yet it should be remembered that intestinal contractions cause terrible diarrhea. At best, this can be inconvenient; at worst, it can cause dehydration. If you and your birthing team decide to try this method, be sure to drink at least 500 ml of water to keep yourself hydrated and maintain healthy electrolyte levels.

5. Red raspberry leaf tea

Red raspberry leaf tea is a great way to tone the uterus during pregnancy and can also help induce labor.

Because of its stimulating effect, most midwives do not recommend drinking until the second trimester. For labor induction, increase the dose of this tea.

6. Eating dates

Research shows that eating dates during pregnancy helps women achieve greater cervical dilation, intact membranes, and more spontaneous labor when the time comes for delivery. Oxytocin use was significantly lower in women who consumed dates, and the average duration of the first stage of labor was shorter in women who consumed dates. As the study concludes, “dating dates during the last 4 weeks before delivery significantly reduced the need for labor induction and induction and resulted in more favorable labor.”

What else can help induce labor?
While not backed by science, many moms claim these natural or "anecdotal" ways to induce labor.

1. Pamper yourself

Pamper yourself is a great way to relax and focus before your baby is born. Sure, prenatal massage is great, but you might want to focus on the feet, which have special trigger points that can induce labor. A foot massage, reflexology, or even just a pedicure can be rewarding and definitely an enjoyable pastime.

2. Guided Relaxation

Soothing affirmations, guided meditation, and deep breathing can do wonders to help your body relax and prepare to welcome your baby. Fearful thoughts and anxiety can lead to the release of adrenaline and other stress hormones that stop the birth process.

Interestingly, before giving birth, cats go to a dark, quiet place. Darkness helps bypass stress hormones and increases levels of melatonin, a key hormone that can help trigger hormonal cascades. You can try this by turning off the lights, closing your eyes and focusing on your body and the amazing feat you are about to accomplish.

3. Nutrition

Follow your ideal pregnancy diet and remember to drink water. Childbirth is hard work and you will need all the support you can get. Although nutrition may not stimulate labor, it will definitely help you feel strong, prepared, and calm when labor actually begins.

4. Exercise

Moderate exercise is fantastic throughout pregnancy, and some women have been lucky enough to induce labor by walking, cycling, swimming, or other exercise. By moving our body, we can help the baby into its birth position and open up our pelvis for a faster delivery. However, the main thing is not to overdo it. You don't want to be tired when labor starts.

5. Acupuncture, acupressure and chiropractic

In addition to mental readiness, you and your child need to be physically ready, and acupuncture, acupressure and chiropractic can help with this. Acupuncture is a potentially useful way to induce labor, but there isn't a lot of solid research on this topic. However, acupuncture and acupressure have been used for many years to induce labor and are trusted by many women.

The idea of acupressure is that acupuncture and acupressure help to unblock any stagnant energy, which can help the child to get into the correct position. Specifically, acupuncture points for inducing labor are found on the feet, arms, and back. They stimulate the thyroid, digestive and reproductive systems.

Chiropractic induction methods are based on the same idea. Opening and balancing the pelvis with chiropractic helps your baby get into the correct, deep position and stimulates your body for labor.

Find a suitable acupuncturist for pregnant women or contact a local mothers' group for recommendations.

6. Pineapple

The bromelain in pineapple and other tropical fruits is said to induce labor by stimulating the uterus. On the other hand, it may just be the stimulation of the intestines from eating a large amount of pineapple, which causes labor. Either way, it's a delightful way to induce labor naturally.

7. Spicy food

Some mothers use spicy food to induce labor. Like castor oil, spicy foods stimulate the intestines. Keep in mind that spicy foods can cause stomach upset, a side effect that is best avoided during childbirth.

8. Eggplant Parmesan

Scalinis Restaurant near Atlanta, Georgia, claims to have helped more than 300 women go into labor within 48 hours with its famous eggplant parmesan. Don't live near a restaurant? Dish you can try at home:

Ingredients:

3 medium eggplants
0. 5 cup flour
6 eggs, beaten
2 cups Italian breadcrumbs
1L cups marinara sauce
1/2 cup grated romano cheese
1/2 cup grated parmesan cheese
200 gr mozzarella cheese, grated
2 cups ricotta cheese

How to cook:

After washing the eggplants, cut them into slices.
Lay the eggplant slices on a layer of paper towels and sprinkle with a little salt, then cover with another layer of paper towels and press down with something heavy. This will remove excess moisture. Let them sit for about an hour.
Working with one eggplant slice at a time, dust it with flour, then dip in beaten eggs, then coat well in breadcrumbs. Fry in hot olive oil on both sides until golden brown.
In a baking dish, alternate layers of marinara sauce, eggplant slices, ricotta, Parmesan, and Romano cheese until the baking dish is filled. Sprinkle with grated mozzarella cheese and bake for 25 minutes at 375°C. Let stand 10 minutes before serving.
Note. For a gluten-free option, use chickpea or buckwheat flour in place of flour and almond flour or semolina in place of breadcrumbs.

9. Homeopathic remedies

Homeopathic remedies are generally considered safe during pregnancy. Common homeopathic remedies used to induce labor include Pulsatilla 200C, Caullophyllum 200C, and Cimicifuga 200C. Some midwives recommend alternating all three times every three days until labor begins. Consult your gynecologist for dosage.

For more information on homeopathic remedies during pregnancy and childbirth, read Homeopathic Medicines for Pregnancy and Childbirth by Richard Moskowitz and Homeopathy for Pregnancy, Childbirth and Your Baby's First Year by Miranda Castro.

10. Special Exercises

This chart helps misplaced babies get into the ideal birthing position, which puts pressure on the cervix and stimulates labor.

This simple procedure consists of three parts, including:

1, Start in cat/cow pose with knees wide apart, then lower chest as low as possible and buttocks as high as possible. Swing while maintaining this position for 30 minutes. This helps the baby move out of the pelvis a little, allowing him to rotate and change his head position.
2. Roll onto your left side, straighten your bottom leg, then lift your top leg as high as you can. Roll forward using pillows for support. Maintain this position for 30 minutes.
Do your best to move for at least 30 minutes. Lunges, walking up and down stairs in twos, sideways, sitting on a birth ball, and hula hoops are especially helpful because they put your pelvis in an asymmetrical position.

Which food induces labor?

As noted above, when it comes to food to induce labor, dates are the best choice. Research shows that dates reduce the need for induction and shorten labor. Pineapple and spicy foods can also help induce labor, although there isn't much evidence to support these theories, only a lot of anecdotal evidence.

How long does it take to have a baby after induction?
As with most aspects of childbirth, there is no hard and fast rule. Every woman is different: for some mothers, induction of labor can take only a few hours, for others it can take several days. And sometimes induction doesn't work at all.

Why does induction cause more pain?
Our body naturally produces oxytocin, a hormone that stimulates contractions. During induction, a woman is usually given a synthetic form of oxytocin, such as pitocin, to speed up contractions. This can cause labor to start too quickly, resulting in stronger and more intimate contractions.

What are the risks of induction?
The risks of induction vary depending on the method of induction, but the biggest risk is that the induction will fail. In 25% of cases, induction failed - this may mean that the mother is in labor for a long time, but a caesarean section may be required eventually. It can be physically taxing and emotionally draining for a mom.

Other risks include:

Low fetal heart rate: The strong, frequent contractions caused by pitocin may cause discomfort to the baby.
Uterine rupture: The strong, frequent contractions caused by Pitocin can cause the uterus to rupture. This is most common in mothers who have previously had uterine surgery.
Excessive bleeding in the mother after childbirth: When stimulated, the uterus may not contract properly after childbirth.
Infection: Rupture of membranes can put mother and baby at increased risk of infection.

What if I miss my due date? Should I induce labor?
Absolutely not! You have the right to refuse anything that does not suit you, including induction of labor.

At 40 weeks gestation, there is no evidence that induction is necessary in a normal healthy pregnancy. Remember that your due date is determined by a number of factors, including the average length of pregnancies in your family, the accuracy of your due date calculation, and your individual child. Your baby and body are the ones who initiate labor and usually know when they are ready.

If you are over 41 weeks pregnant
There is no reason to consider induction in a normal healthy pregnancy before 41 weeks, and you may want to wait even longer before trying any of these methods. If you choose to go through 41 weeks without trying to induce labor, your healthcare provider will likely keep a close eye on you.

If you have passed 42 weeks of pregnancy
Natural induction of labor is still a priority and may increase the likelihood of other labor interventions. If mom and baby are healthy, it is perfectly reasonable and scientifically justified to give birth at 42 weeks.

How did other mothers induce labor?
I asked moms on my Facebook page about ways to induce labor naturally. Here are some of their responses:

My water broke but my contractions didn't start. That night I went for acupuncture and two hours later I had a nice steady contraction rhythm! — Jill B.
Massage of painful points, sex, walks. — Norma O.
I have massaged the pressure points on my feet and around my ankles that are supposed to induce labor. That night I went into labor, that is, a week before the expected date of delivery! I also started drinking 1 cup of red raspberry leaf tea a day at 32 weeks pregnant and gradually increased it to 4 cups by the time I was due.
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