Labor Induction: Unraveling the Flaws in the ARRIVE Trial

Labor Induction

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What exactly is a labor induction? And why is it such a hot-button issue?

An induction is an artificial start to labor. It sounds simple enough, but man is it nuanced.

 

So when does induction become part of the conversation? For a lot of moms, the word induction gets thrown around as they approach the 39-week mark. We can blame a lot of this on the infamous ARRIVE trial, which was conducted by the New England Journal of Medicine in 2018.

 

What is the ARRIVE trial?

A study looked at 6,100 patients and split them into two groups: half were placed in the induction group and half were placed in the expectant management group (meaning they would allow labor to happen on its own).

 

Researchers walked away from the trial saying that elective induction at 39 weeks pregnant will lower the risk of cesarean and lower the likelihood of having high blood pressure. Sounds great in theory. But, before we jump on the induction bandwagon, we need to decide for ourselves if the trial is reliable and if the results apply to us as unique individuals.

 

Does the ARRIVE trial do a crappy job representing the general population?

18% of the induction group resulted in cesarean births, while 22% of the expectant management group ended in a c-section. I find myself scratching my head over these numbers since even 22% is significantly lower than what we see on average in the United States.

 

Other notable stats: 8% of the women in the induction group had high blood pressure and 14% of the women who went into spontaneous labor also had high BP readings. Interestingly, when we look at both high-risk and low-risk pregnant patients in the US, only 5-6% of those women are diagnosed with high blood pressure. So why such high readings in both groups?

 

Furthermore, out of the 6,100 patients who participated in the study, 24% of those women were black. We know that black women account for under 15% of the general population in the US. It’s also important to point out that only 4% of the women in the study were over the age of 35. Women in this age group account for 18% of pregnant moms in the general population. There goes my representation! 

 

Things to consider and re-consider before consenting to an elective labor induction.

Some fans of the ARRIVE trial highlight that for every 28 inductions performed we can prevent 1 cesarean section. To that I will argue that for every 14 women who have continuous labor support (such as in-person Doula support), we can avoid 1 cesarean. That’s way more vaginal births.

 

I’m such a huge advocate for natural undisturbed birth. I believe strongly in letting mother nature do her damn thang. For millennia we’ve used 40 weeks for gestation. We know that 70% of pregnant mothers go into spontaneous labor within a 10-day window of their guess date. It is by no means an exact science, but you better believe that I trust in the body’s innate wisdom. Waiting until 41 and even 42 weeks for labor to start on its own is completely reasonable. Before inductions were slotted as routine practice for some providers, women all over the world allowed their bodies and their babies to determine the birthdate. 

 

Speaking of timelines, inductions often require cervical ripeners. These medical and mechanical interventions can take anywhere from 1-3 days to achieve the desired outcome. Sounds exhausting. This means more vaginal exams, more discomfort, a longer stay in the hospital, an increased risk of infection, increased anxiety, the release of stress hormones, and often- you guessed it- an increase in blood pressure. 

 

Why we need to take the blinders off.

Immediately after the ARRIVE trial results were published, we saw a 42% increase in elective inductions. That’s a crazy spike if you ask me. Shortly after the 2018 findings became public knowledge, things leveled back out. I guess we don’t always want to follow the trend…

 

One size does not fit all. One trial is not gospel. So when your doc sites the ARRIVE trial and claims there is no harm done by inducing at 39 weeks I hope you think of me and challenge that one-sided notion. 

 

Were you induced? If you could go back and change anything would you elect an induction? Share your story in the comments!

– Lisa V

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Article References:

Clinical guidance for integration of the findings of the ARRIVE trial: Labor induction versus expectant management in low-risk nulliparous women. (n.d.). value is what Coveo indexes and uses as the title in Search Results.–> ACOG. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2018/08/clinical-guidance-for-integration-of-the-findings-of-the-arrive-trial

Migliorelli, F. (2019, November 11). The ARRIVE Trial: Towards a universal recommendation of induction of labour at 39 weeks? PubMed.

Trends in labor induction in the United States, 1989 to 2020 : MCN: The American Journal of maternal/Child nursing. (n.d.). LWW. https://journals.lww.com/mcnjournal/citation/2022/07000/trends_in_labor_induction_in_the_united_states,.13.aspx

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