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Should Induction at 39 Weeks Be Standard?

Photograph by Twenty20

When two prominent OB-GYNs agreed to debate the idea of inducing moms-to-be at 39 weeks, it was assumed that one of them would take the “pro” side, the other, the “con.” After all, that’s how debates work, right?

Instead, something unexpected happened. Both doctors reviewed the medical research available and came to the same conclusion: Induction at 39 weeks is a good idea.

The debate was presented at a meeting of the American College of Obstetricians and Gynecologists (ACOG), an organization whose official guidelines state that induction “may be considered when a woman is in week 41, and is recommended if she is in week 42.”

So why would the two doctors—Errol Norwitz, chairman of obstetrics and gynecology at Tufts University School of Medicine, and Charles Lockwood, dean of the Morsani College of Medicine at the University of South Florida—be proponents of inducing at 39 weeks?

“My original assumption when asked to participate in this debate was that Dr. Norwitz would take the ‘pro’ side, since he has written about the risk of stillbirth after 38 weeks,” Dr. Lockwood told The Washington Post, “and I would take the ‘con’ side, since older literature suggested that C-section rates would likely be higher in the elective induction of labor at 39 weeks.”

But Dr. Lockwood surprised even himself when he ended up agreeing with Dr. Norwitz. After reviewing recent studies and creating his own model for predicting various outcomes, he found that that elective induction at 39 weeks suggested lower rates of stillbirth, Caesarean delivery and maternal and neonatal complications.

Of course, not everyone would agree with his conclusions. Cristen Pascucci, vice president of the advocacy group Improving Birth, argues that the induction recommendation “reinforces a century-old, pre-feminist American obstetric view that birth is pathological and the doctor’s job is to extract the fetus from the incubator—like in the ’50s, when every baby was pulled out of its shackled, unconscious mother by episiotomy.”

Others, like Rebecca Dekker, PhD, founder of the website Evidence Based Birth, add that the research supporting induction at 39 weeks is flawed, and that it may not have as significant an impact on C-section rates or stillbirths.

Ultimately, even Dr. Lockwood was careful to point out that obstetricians shouldn’t change their practices just yet and begin inducing at 39 weeks, noting that extensive research is still needed.

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