Does the ARRIVE trial merit changing obstetric practice? Some reflections four-year postrelease

It has been 4 years since the release of the study Labor Induction versus Expectant Management in Low-Risk Nulliparous Women, also known as the ARRIVE trial. As researchers and speakers who frequently present to the United States and international audiences about models of care and strategies to support normal physiologic labor and birth, we have had ample opportunity to engage with practitioners who consistently ask about our perspectives on the ARRIVE trial's findings and methods. Many note the marked increase in pressure they feel to induce at 39 weeks since the study's publication in 2018.

In this commentary, we discuss some of the concerns that have been brought up during these conversations.

We focus on the trial's key findings and reflect on factors critical to consider as translation into clinical practice is negotiated.