[Elective induction of labour at 39 weeks; better than expectant management in low-risk women]

The ARRIVE trial has shown that elective induction of labour at 39 weeks improves maternal and foetal outcomes in comparison with expectant management. Caesarean sections, hypertensive disorders and neonatal ventilator support were all found to be reduced after elective induction. The trial was performed in an American nulliparous low-risk population. Several American professional organizations have now adapted their recommendation on elective induction in nulliparous low-risk women. These organizations now suggest informing women about the potential benefits, and offer elective induction in a model of shared decision-making. In the Netherlands there has been some reluctance amongst professionals to address this issue. This might be related to a conservative obstetric approach and the Dutch obstetric model with its three separate levels of care. Nevertheless, this subject should be addressed in a scientific, professional and unprejudiced way, given the evidence and potential implications for the large group of low-risk women and neonates in the Netherlands.