The 39-Week Rule: Toward a Pregnant Person-Centric View of Induction of Labor

Hannah Carpenter – University of Texas Medical Branch

Abstract: According to the “39-week rule”, established by the American College of Obstetricians and Gynecologists (ACOG), an induction of labor before 39 weeks of gestation is not recommended unless the pregnant person’s or fetus’s health is at risk. The justification for this rule is to reduce rates of adverse childbirth outcomes. Some have argued against this rule by pointing out that it leads to an increase in term stillbirth and adverse pregnancy outcomes. We offer a new argument against the 39-week rule by appealing to ACOG’s policy on abortion and proposing a patient-centered framework for labor induction. This approach seeks to reconcile ACOG's conflicting policies and empower pregnant persons in their birthing experiences.

First, we observe that the 39-week rule is in tension with ACOG’s policy on abortion, which seems to allow pregnant people to seek abortion at any point during pregnancy. While ACOG’s abortion policy prioritizes the autonomy and the well-being of pregnant persons, the 39-week induction rule neglects these factors and instead prioritizes fetal well-being in a manner inconsistent with ACOG's broader ethical framework. Second, we argue that ACOG should revise its policy on early induction of labor to accommodate the autonomy and the well-being of the pregnant person while protecting fetal well-being. More specifically, early induction should be allowed if 1) it respects patient autonomy, and 2) it would improve the patient’s well-being without sacrificing fetal well-being. This shift would align ACOG's policies with a more coherent and patient-centered approach to obstetric care.

Keywords: induction of labor, abortion, autonomy and welfare