We have discussed the rationale and evidence behind the recommendation for expedited birth (induction of labour or Caesarean section) from 41 weeks’ gestation, which is outlined in the NICE guideline for inducing labour (NG207, https://www.nice.org.uk/guidance/ng207/chapter/recommendations).
In summary:
Most women will go into spontaneous labour by 42+0 weeks’ gestation. We support giving every reasonable opportunity to allow spontaneous labour and birth, unless there is a reason to recommend otherwise. There are risks and associations with induction of labour (including a higher uptake of regional anaesthesia, postpartum haemorrhage, and the need for operative vaginal birth) and Caesarean section (including visceral trauma, postpartum haemorrhage, infection, and the impact on future pregnancies).
From 41 weeks (and markedly more so from 42 weeks) there is an incrementally higher risk of needing emergency Caesarean birth and/or neonatal unit admission, and (a small but significant) increase in the risk of stillbirth and neonatal death. Shortening the pregnancy reduces the risk of stillbirth.
[The stillbirth rate is even higher in Black and Asian women than White women].
The medical recommendation and offer is for induction of labour or Caesarean section from 41 weeks, with a view to having achieved delivery by 42 weeks. A woman’s decision to decline this against medical advice will be honoured.
Other/new complications or conditions (e.g. hypertension or fetal concerns) would influence this recommendation, often towards earlier intervention.
If planned birth is declined, CTG surveillance (twice per week) may be offered but is of little predictive value for an adverse outcome. Ultrasound scans, including for umbilical Doppler indices, is likely to be of limited value.