Based on best evidence, as women enter the late-term period, it
is appropriate for midwives and physicians to discuss the benefits
and risks of elective induction and expectant management. There
is no clear right or wrong path with regard to induction at 41 or
42 weeks. Based on what we know from the Hannah PostTerm trial,
the lowest Caesarean rates will happen in women who go into
labour spontaneously or who choose elective labour induction. The
highest Caesarean rates will happen in women who initially choose
expectant management but end up with an indicated or elective
induction in the late-term or post-term period. Elective induction
at 41–42 weeks may decrease the risk of stillbirth and meconium
aspiration, and induction may be a particularly salient option for
women who have experienced a previous loss or those who have
additional risk factors for stillbirth, such as being over the age of
35 years.43 Most research articles and guidelines say that because
there are benefits and risks to elective induction and expectant
management, the women’s values, goals, and preferences should
play a part in the decision-making process, as well as information
about her personal birth history, chances of a successful induction
(i.e. cervical ripeness), and alternatives.7,41 Ultimately, after
receiving accurate, evidence-based information and guidance
from her health care provider, women have the right to decide
whether they prefer to induce labour, or wait for spontaneous
labour with appropriate foetal monitoring8,40 in the late-term and
post-term period.