What Did the ARRIVE Trial Really Say About Induction at 39 Weeks?
This is my favorite topic and I’ve wanted to write about it for a long time. I have worked with COUNTLESS families who have been told they “need” and induction.
Usually? It’s because of their age.
If you’ve been told you “should just be induced at 39 weeks to avoid a C-section,” chances are the ARRIVE trial was mentioned somewhere in the conversation.
But what did the study actually show? And is it even relevant anymore?
Let’s break it down—with a side of advocacy.
First, What Is the ARRIVE Trial?
The ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) was published in 2018. It looked at more than 6,000 people across 41 hospitals in the U.S. and asked:
For low-risk, first-time parents, does inducing labor at 39 weeks reduce the risk of C-section compared to waiting for labor to start on its own (expectant management)?
The answer?
Yes—but only by a small margin.
What Did the Results Actually Say?
People induced at 39 weeks had:
A slightly lower C-section rate (18.6% vs 22.2%)
A slightly lower rate of hypertensive disorders
Similar rates of newborn complications
Sounds good, right?
Well… not so fast.
What the ARRIVE Trial Didn’t Tell Us
1. Many people in the expectant group were still induced.
This wasn’t a study of induction vs spontaneous labor. It was early induction vs maybe-later induction. Nearly 40% of those who waited still got induced for other reasons.
2. Induction took days.
The average induction time in the ARRIVE trial was more than 24 hours. For some people, it took 3–4 days in the hospital. That’s a lot of time, a lot of intervention, and a lot of emotional and physical toll.
3. Most participants were not representative of U.S. birthing populations.
The trial had strict inclusion criteria:
First-time parents only
No medical complications
Singleton, head-down babies
Highly compliant hospital staff following a specific protocol
This doesn’t reflect the broader population—especially those labeled “high-risk,” people of color, or anyone with a history of birth trauma.
What Evidence Based Birth Says
According to EBB:
The ARRIVE trial showed that routine elective induction at 39 weeks is reasonable—not mandatory.
It should be one option on the menu, not the default plan.
Informed consent and shared decision-making matter more than blanket policies.
Since the trial, many hospitals have quietly (or not-so-quietly) pushed for more 39-week inductions, citing this data—even when the birthing parent doesn’t meet the original study criteria.
EBB’s founder Rebecca Dekker, PhD, RN, puts it this way:
“Just because a policy is evidence-based doesn’t mean it’s patient-centered.”
Why It Might Not Be Relevant Anymore
When the ARRIVE trial came out in 2018, it reflected practice norms at the time.
But in the years since, induction methods, monitoring practices, and provider attitudes have shifted.
For example:
Many hospitals now don’t allow people to go beyond 41 weeks regardless of personal preference.
Some providers have started scheduling 39-week inductions as a standard, regardless of true low-risk status.
The impact of COVID, burnout, and staffing shortages has changed how induction is managed and monitored.
So we’re not comparing apples to apples anymore.
Questions to Ask Before a 39-Week Induction
What’s the reason for the induction?
Do I meet the original ARRIVE trial criteria?
What’s the hospital’s protocol—am I likely to be in labor for days?
Can I go home during cervical ripening, or will I be admitted?
What happens if I decline or wait until 40 or 41 weeks?
How does this align with my values and preferences for this birth?
The Be Well Baby Bottom Line
The ARRIVE trial gave us some useful info—but it didn’t rewrite the rules of birth.
Elective induction at 39 weeks might be the right choice for some people, especially if:
You want more control over timing
Your hospital has a supportive induction protocol
You’re emotionally ready and feel fully informed
But it’s not a blanket recommendation for everyone.
Your body, your baby, your birth—your call.
We’ll just make sure you have all the facts.
Love,
Emily
