05/15/2026
Conversations around 39-week induction and stillbirth risk matter.
But so does how we have them.
Right now, many patients hear:
“We recommend induction at 39 weeks to reduce the risk of stillbirth.”
What they often don’t hear is:
- what their individual stillbirth risk actually looks like,
- how that risk changes day to day or week to week,
- what specific factors are contributing to that recommendation,
- or how their personal circumstances impact the recommendation.
When someone hears the word stillbirth without context, fear takes over.
And fear without understanding is not informed consent.
Stillbirth means a baby dies in the uterus at or after 20 weeks of pregnancy. It is a rare but devastating outcome, and conversations around it absolutely matter. But patients deserve clear, individualized conversations about what that risk actually looks like for them.
Many people are not looking to ignore recommendations. They’re looking for the medical reasoning behind them so they can fully participate in decisions about their care.
That means looking at individualized risk factors such as:
- gestational diabetes (well controlled vs not well controlled),
- high blood pressure or preeclampsia,
- placental function concerns,
- fetal growth restriction or baby measuring small,
- amniotic fluid levels,
- and other maternal or fetal conditions that may change risk.
Because these details matter.
Not every 35+ patient has the same risk.
Not every higher BMI pregnancy has the same risk.
Not every gestational diabetes pregnancy carries the same level of concern.
Patients also deserve conversations about absolute risk versus relative risk, because the way numbers are presented can completely change how they are understood.
Absolute risk is the actual chance of something happening.
For example:
If the risk of stillbirth is 1 in 1,000 pregnancies, the absolute risk is 0.1%.
Relative risk compares one group or situation to another.
So if someone says:
“Your risk increases by 5% with each additional day of pregnancy,”
that is a relative change — not a jump to 5% overall risk.
If the baseline risk is 0.1%, a 5% relative increase raises it to about 0.105%.
Another example:
If one group has a risk of 1 in 1,000 and another has 2 in 1,000, the relative risk is doubled — which sounds large — but the absolute difference is 1 additional case per 1,000 pregnancies.
Both numbers matter.
Relative risk helps identify patterns and increased concern at a population level.
Absolute risk helps patients understand what that actually means for them.
Without both, conversations can unintentionally create fear instead of clarity.
And in maternal health right now, we should be making time for individualized conversations and individualized risk assessment.
Is it time consuming? Absolutely.
Does it make a difference? Absolutely.
Do we have all the answers? No.
But blanket statements are not enough either.
Too often, lived experience, personal preferences, trauma history, support systems, and individual circumstances get lost in rushed clinical environments where decisions are made quickly and understanding gets compressed.
This doesn’t mean risk should be minimized.
And it doesn’t mean providers should avoid difficult conversations.
It means patients deserve individualized counseling, transparent discussions, and information presented in a way they can actually understand and use in decision-making.
A recommendation alone is not the same as individualized counseling.
Wanting to understand the “why” behind a recommendation is not refusal of care.
It’s informed decision-making.
