Should I Induce Early?

What does the data have to say about inducing early when maternal age is over 35? Is it actually worth it or a good idea?

—Ashley

Over the past five years or so, we have seen a move toward more routine inductions. The primary reason for this is the ARRIVE trial, a 2018 study that suggested that a policy of routinely inducing at 39 weeks did not increase the chance of a C-section. There is some debate as to whether this finding should have changed policy as much as it did, but at this point a lot of doctors will allow, suggest, or even encourage induction at 39 weeks as a general matter.

This encouragement is more likely for women who have any risk factors for a negative pregnancy outcome, and this includes “advanced maternal age” (over 35). Older women are at (slightly) higher risk for a variety of issues that can arise at the end of pregnancy (preeclampsia, for example). If we accept that induction at 39 weeks does not significantly impact infant outcomes, then the fact that there is some additional risk to waiting makes it an even better idea.

This is the sense in which there is logic to the idea above — older age increases the risk in waiting, and there is little value in waiting. There are two important caveats. First, there is nothing special about 35. There is no magic wand that makes you higher-risk the day of your birthday; this is an arbitrary age cutoff. The added risk at 42 is higher than at 35, and at 35 versus 30. So, while the logic is of some value here, the particular age cutoff isn’t.

Second: There are other factors to consider. Any elevated risks are small in magnitude, and the experience of birth is different with an induction. If your goal is to go into labor on your own and labor at home for some period, that isn’t possible with an induction. Nothing in the data would suggest this is a choice you have to make, so it’s worth talking it through with your doctor, rather than relying on a blanket recommendation.