Can You Schedule?! Elective Induction at 39 weeks Explained

Even though I hate to admit it, I am one of those people who likes to have major control over things concerning them.

As such, and with a demanding cardiac anesthesiologist job, I was not satisfied with an “estimated” due date when I first got pregnant. There were overnight calls to reschedule, maternity leave to plan, research deadlines to meet… I couldn’t have all these things up in the air, I thought to myself, so I decided to look into the possibility of choosing my delivery date.

Normally, this isn’t controversial if you have a medical reason for a C-section, and since this is a planned surgery, it can be scheduled, but with normal vaginal delivery, things are not that straightforward. So how do I make this happen? Well, arguing the data always seems like a good starting point… so I found a recently published study suggesting that babies actually do better when moms are induced at 39 weeks, versus expectant management… plus, I was already walking around 3 cm open, was very uncomfortable sleeping, and ready to pop…And my OB finally said yes, reluctantly so.

First Things First: What Does "Induction" Actually Mean?

Induction of labor means that you are getting medications that start your uterine contractions, and labor begins. There are different approaches to this, including the use of prostaglandins to accelerate cervical ripening, breaking of the membranes, and intravenous oxytocin, or oxytocin drip, which I had myself. You may have heard of oxytocin before-yes, the same hormone that also regulates lactation and makes you fall in love at first sight with your baby.

Why Would a Doctor Suggest Inducing at 39 Weeks?

What I did, or requested, is called elective induction at 39 weeks. However, this is often recommended to women for various indications, such as diabetes, high blood pressure, heart or kidney disease, infection, etc. In such circumstances, induction is considered a much safer approach for both mom and baby.

Is My Baby "Done" at 39 Weeks? (Yes, and Here's Why)

Your baby will absolutely do fine if born at 39 weeks. The next logical question moms may wonder is how young a baby can be and still survive. We have really pushed these limits over the past few decades and the youngest reported gestational age for survival has been 21 weeks.

However, delivery before 23 weeks typically results in neonatal death, with overall survival rates of only 5-6% when all live births are included.

What the Research Says

The trial I mentioned earlier, which was just published during my first pregnancy (and yes, I printed it out for my appointment to convince my OB to induce me at 39), is called the ARRIVE trial. This study led to the American College of Obstetricians and Gynecologists recommending that it is reasonable to offer elective induction of labor to low-risk, first-time moms at 39 weeks of gestation. The trial involved 6,106 low-risk, first-time moms and showed a reduced risk of C-section and hypertensive disorders in those who were electively induced at 39 weeks.

The Benefits: Why Some First-Time Moms Choose This

Aside from the benefits shown in the ARRIVE trial such as like lower risk of C-section and hypertensive disorders (preeclampsia); other observational studies suggest there may be advantages for babies, too. These include a reduction in infectious and respiratory complications, as well as decreased mortality.

Some benefits are more practical, like being able to schedule your delivery, especially if you live in a remote area. And, in my case, induction helped relieve some of the minor discomforts of the third trimester, such as pelvic or back pain (I had terrible pubic symphysis pain), loss of appetite, and gastric reflux.

The Concerns: What to Weigh Before You Decide

Despite the ARRIVE study findings, elective induction rates at 39 weeks have only increased by about 6%. The reasons for this are probably multifactorial. Many people prefer to let nature take its course, believing that interfering with the natural progression of pregnancy might be harmful. Some OBs are also hesitant to offer elective induction because they may have had an experience where labor didn’t progress as expected, resulting in an unplanned C-section.

Regardless of the reason, it’s important to know your options and consider what’s best for you. For instance, baby size, risk of high blood pressure, severe reflux, or any other personal factors might influence your decision. Make this choice together with your OB, but be sure to understand your data.

You should also be aware that your OB and the hospital’s ability to accommodate an elective induction at 39 weeks depends on resource availability, staffing, and overall patient flow. Your request may only be scheduled after patients requiring immediate care have been addressed.

What the Induction Process Actually Looks Like

Not to get too technical, and to keep things simple: your OB can start with one method or combine several. Vaginal or oral prostaglandins (medications like misoprostol and dinoprostone) help with cervical ripening; balloon catheters and osmotic dilators are mechanical ways to achieve this; and then there’s the oxytocin drip. At some point, contractions will start, along with pain, which is when you can request an epidural if you wish, or proceed with your planned birth preferences.

Will It Affect My Birth Plan?

If you’re anything like me, and you’re expecting, you might be wondering: what exactly is a birth plan?! The first time someone asked me about this, my immediate response was, “What do you mean, birth plan? I come in and have the baby – that’s my plan!” Well, turns out a “birth plan” is a written document that outlines your preferences and wishes for labor, delivery, and immediate postpartum care, and it’s supposed to help improve communication during the birthing process, and no-induction at 39 weeks does not affect it.

So, what actually goes into a birth plan?

It’s usually a list of things you want (or don’t want) for your labor and delivery, stuff like how you’d like to manage pain (epidural, natural pain relief, or certain medications), who you want in the room with you, whether you prefer to move around during labor, how you want the baby monitored, what interventions you’d be okay with (like episiotomy or assisted delivery), what position you’d like to deliver in, and how you want your baby cared for right after birth (skin-to-skin, delayed cord clamping, feeding preferences). Some people even include details about the environment, such as the lighting, music, or whether they want photos taken. It’s basically your way of letting everyone know what matters to you on the big day.

Questions to Ask Your Doctor at Your Next Appointment

Would you recommend induction at 39 weeks for me – why and why not (risks and benefits for my situation)?
What is my cervix doing right now (Bishop score)?
What methods of induction would you use for me?
How long might my induction take?
Can I eat/drink during the process?
What are my chances of needing a C-section with induction?
What happens if the induction doesn’t work?
Will I be able to move around during the process?
When should I come to the hospital, and how should I prepare?
What pain management options will be available during induction?
Can I go home at any point if labor doesn’t progress right away?

Key Takeaways

Elective Induction at 39 weeks is a real option, and is endorsed by evidence.
Induction uses meds or procedures to start labor.
Doctors recommend induction at 39 weeks (or sometimes even earlier) for medical reasons, but it’s available to many first-time moms with uncomplicated pregnancies.
Your baby can safely be delivered at 39 weeks.
Your doctor may only confirm a date close to delivery, as it depends on how busy the labor and delivery unit is.
Induction at 39 weeks can reduce C-section risk and help with planning.
Ask about your options, process, and pain management; your voice matters.