The Arrive Study
I get asked A LOT about The ARRIVE Study. It’s a hot topic. For some people they are thrilled to hear there is science backing up an induction and some folks are terrified because they feel pressure from their provider and don’t feel aligned with a 39-week induction. Before we dive into the issues with this study. Let’s take a look at the history that you should know.
Around 41% of all pregnant people will have an induction suggested to them and 44% of those will be because you’re close to your due date or ‘full term.’ (quotations because we think one absolute date determines a baby’s readiness to be born and that’s simply not how it works) This means almost half of all labors are suggested to be medically initiated….where has our trust in ourselves gone?!
Let’s take a quick pause for one moment and think about birth for what it actually is--a natural event. Without human intervention, there would be so much less birth trauma, so many less c-sections, far fewer inductions, and our trust in our bodies (and in nature) would be restored. Pregnancy is not an illness. Birth is not a medical event (90% of the time with a healthy respect for the 10% cases who truly require medical support and intervention). You are doing a very natural thing that billions of women have done before you for millenniums before you. Truly, take a moment to think about that. Millenniums.
There are a few things to know when discussing The ARRIVE Study with your provider!
Number 1: The ARRIVE study set out to prove something and it did just that. That shouldn’t be a surprise. That’s exactly what experiments and science are supposed to do. But don’t stop there. Challenge it. Look into it. Ask questions. Make sure it is applicable to YOU and YOUR birth goals.
My thoughts: That is true with all research. Listen, research is funded--you can’t hold that against them. However, you can (and should!) look into the funding of research and look into how the study might have shown bias in any way. Again, it doesn’t make it bad science or a bad study necessarily, but it does make it something you want to know just to keep in the front of your mind.
Number 2: There are some pretty big holes in this study like the criteria you need to meet to yield these same results for yourself is pretty strict—people who feel strongly about a low intervention birth, people who have care by a provider with a high c-section rate, and people who do not feel like induction is aligned with their birth goals are all not recommended to use this approach. This can be seen in their recruiting—22,533 women were invited to participate and only 6,106 did.
My thoughts: Yikes! That’s a huge number of folks who said, ‘no thanks!’ I believe this is because you are hard pressed to find birthing people who don’t have preferences on how their labor begins, how long their pregnancy goes, or the outcome of their labor. That’s a very specific type of birthing person to not have preferences on all of that. Therefore, if you do care about one of these, these results might not be applicable to you.
Number 3: There was a slight decrease (3%) for 39-week inductions compared to spontaneous labor. We must balance someone’s birth goals with such a small decrease. Lastly, the researchers did not specify an induction protocol so all of these inductions were done in whatever way each provider felt was best. That’s a lot of variability to try and generalize to every birthing person.
My thoughts: For so many birthing people, when they consider the small decrease and the idea of benign induced, they just don’t line up. Most folks would rather take on the 3% risk for the chance to go into labor naturally. Since we don’t have a single method for induction, this is going to be highly dependent on your provider--what their preferred method is, their c-section rate, their comfortability using varied methods--and your education and preferences--do you know about balloons and cervical ripeners. What standard protocol for pitocin is and what your alternatives are for that? The more educated you are on your options, the less risk you have for a c-section.
Number 4: Many providers aren’t actually presenting it as an option--rather the recommended route. In addition, most providers are not taking into account or having intentional, informed discussions about the three criteria The American College of Obstetrics and Gynecology set’s forth: the values and preferences of the pregnant woman, the resources available (including personnel), and the setting in which the intervention will be implemented. In addition they also state, “A collaborative discussion with shared-decision making should take place with the pregnant woman.” This is direct instruction to offer it as an option, discuss risks and benefits, and share about the criteria to determine if the patient is a good fit. Finally, another issue with the way providers proceed with The ARRIVE Study is that many providers take into account the Bishop Score. While it’s not the best scoring system, it’s at least helpful data! Read more about the Bishop Score here!
My thoughts: I’ve actually never seen a provider do a bishop score as part of this. While it’s not recommended by ACOG or included in the criteria, it makes logical sense to see what someone’s cervix is up to before we induce them.This would be a fantastic place for providers to think outside the box in order to give easy, individualized care that truly makes a big difference in patient satisfaction and, possibly, outcome---just imagine if we stopped inducing people without checking their cervix first. A simple conversation with the patient about what the bishop score is, what it tells us, and why it may be helpful to evaluate before moving forward with the ARRIVE trial findings would probably be a game changer in so many lives.
What about a failed induction?
Did you know you can leave and go home after a failed induction? It’s true, you can. If you and your baby are safe, and you have not made any decisions that require continuous monitoring, you have the option to go home. (You always have the option to go home, but that obviously wouldn’t be advised if you or your baby weren’t safe.) Read more about failed inductions, here.
It’s also important to know that ACOG recommends “if the maternal and fetal status allow, cesarean births for failed induction of labor in the latent phase can be avoided by allowing longer durations of the latent phase (up to 24 hours or longer) and requiring that oxytocin be administered for at least 12–18 hours after membrane rupture before deeming the induction a failure.”
The Bottom Line
We are not treating pregnancy as a healthy medical event, rather something that is uncontrollable and dangerous. We aren’t providing birthing people with individualized care, rather blanket statements that leave them with emotional and physical scars.
Evidence Based Birth says “Current research evidence has found that elective induction at 39 weeks does not make a difference in the rate of death or serious complications for babies. For mothers, induction at 39-weeks was linked to a small decrease in the rate of Cesarean compared to those assigned to wait for labor (19% Cesarean rate versus 22%)”
It’s ultimately up to you! You know your baby and your body! You are the most qualified person to make this call!
If you want to learn more about your birth choices or how to advocate for your birth goals, join The Birth Lounge!
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