#102: The Research That Reshaped Birth—and the Lessons We’re Still Learning from the ARRIVE and Term Breech Trials

Clara O'Rourke
Nov 11
6 min read

The ARRIVE Trial and the Term Breech Trial reshaped modern birth practices in ways researchers never intended. From skyrocketing inductions to the loss of vaginal breech training, these studies reveal how even “gold-standard” science can miss the human side of birth.

Clara invites you to take a mindful pause: to look beyond the data, question how evidence gets translated into policy, get curious about how the research was designed, and remember that true evidence-based care must center the individual—not just the research.

You’ll Learn:

What the ARRIVE Trial and the Term Breech Trial actually found (and what they didn’t)
How these studies shifted policy, practice, and training worldwide
Why over-reliance on “evidence” can erase skills, intuition, and personal choice
How to bring mindfulness into your decision-making about induction, breech birth, or any medical recommendation
Why traditional and holistic birth practices still matter—even if they’ve never been studied

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Before we dive in, a quick disclaimer: nothing in this post constitutes medical advice. I am not a medical professional, and this content is meant for educational and reflective purposes only—to help you understand how research influences maternity care and how you can use mindfulness to navigate it.

Mindfully Assessing Evidence

If you’ve been part of this community for a while, you know our focus is always on bridging mindfulness and evidence—understanding what science says while honoring what your intuition knows.

But what happens when the evidence we’re told to trust turns out to be incomplete, or even misinterpreted? And what happens when research that’s meant to open doors ends up closing them?

Today we’re unpacking how two landmark studies—the ARRIVE Trial (2018) and the Term Breech Trial (2000)—reshaped birth in ways researchers never intended.

Because evidence is powerful, but it’s only as wise as the way we interpret it.

The ARRIVE Trial: When “Safe” Becomes “Standard”

In 2018, the ARRIVE trial was published in The New England Journal of Medicine by Grobman et al. Researchers enrolled over 6,000 low-risk, first-time birthing people. Half were induced at 39 weeks, and half waited for labor to begin naturally.

What the headlines said

The big media takeaway?

“Induction at 39 weeks doesn’t increase risk—and might even lower cesarean rates.”

Sounds reassuring, right?

But when we look closer, the primary outcome—serious neonatal complications—wasn’t significantly different between the two groups. And while there was a reduction in cesarean rates (from 22.2% to 18.6%), that’s a modest difference, especially compared to the much higher average cesarean rates across U.S. hospitals.

What the data didn’t show

The ARRIVE trial took place in select hospitals with experienced providers, specific induction protocols, and a relatively low baseline cesarean rate. Only about 6% of participants received midwifery care—far lower than what many birthing people experience in community or midwife-led settings. So this study took place in a context that is not reflective of many birth settings in the USA.

Despite these limitations, hospitals across the U.S. began offering (some often encouraging) elective 39-week inductions, citing the ARRIVE trial. The American College of Obstetricians and Gynecologists (ACOG) deemed it “a reasonable option”—but in many hospitals, “reasonable” quickly morphed into “standard of care.”

After the ARRIVE Trial (2018) showed a lower cesarean rate for elective induction at 39 weeks (18.6% vs 22.2% in the trial arms) New England Journal of Medicine+1 hospitals across the U.S. increased their 39-week induction rates. However, a 2023 national interrupted time-series analysis found that although induction at 39 weeks rose (aIRR ~1.10), the cesarean rate among low-risk first-time mothers delivering at 39+ weeks only dropped from ~25.1% to ~24.7% (aIRR 0.988) — far less dramatic than the trial’s findings.

Induction is not a guarantee of cesarean reduction — outcomes depend on how induction is managed, the context, and who is doing it.

The consequence

Induction rates rose dramatically, yet national cesarean rates didn’t fall.

In a regional study of 13 hospitals, elective induction increased by 42% after ARRIVE publication, but there was no statistically significant change in cesarean births (RR 0.96; 95% CI 0.89-1.04). Quality Health

These data suggest that scaling a trial’s protocol across different hospital settings does not guarantee similar outcomes. This reminds us that data doesn’t live in isolation—it lives in systems, protocols, and human habits.

Before accepting any recommendation, it’s worth asking:

Does this study reflect my hospital’s environment?
Were the people in this study like me?
What would this mean for my birth experience?

Mindfulness in evidence isn’t just about staying calm—it’s about critical awareness.

The Term Breech Trial: When Skill Disappears

Let’s rewind to the year 2000. The Term Breech Trial, published in The Lancet, compared planned cesarean versus planned vaginal birth for breech babies (babies positioned bottom-first instead of head-down).

The results seemed clear: cesarean appeared safer than breech vaginal birth. Within months, hospitals worldwide stopped offering vaginal breech births. Medical schools stopped teaching them.

And just like that, breech became synonymous with cesarean in many countries.

But here’s the problem

The study had major flaws:

Only about half of those assigned to vaginal birth actually birthed vaginally.
Protocols weren’t followed consistently across study sites.
Some of the poor outcomes assigned to the participants vaginal breech group were due complications seperate from mode of delivery.
Provider skill varied dramatically—some teams had extensive breech experience, others almost none.

As researcher Dr. Andrew Kotarski put it,

“Using a randomized control trial for something as skill-dependent as vaginal breech birth is like comparing apples to galaxies.”

The result? Breech training stopped, skills were lost, and decades later, most hospitals can’t safely offer vaginal breech births—not because it’s inherently unsafe, but because no one is trained to do it safely.

A more nuanced view

Later research, like the PREMODA Study (2006) from France and Belgium, found that in hospitals with experienced teams and careful selection, vaginal breech births can be as safe as cesareans.

Today, major organizations—including ACOG, RCOG, and SOGC—acknowledge that planned vaginal breech birth is a valid, safe option when conditions and provider skill align.

The danger wasn’t birth itself—it was the loss of knowledge when policy outpaced nuance.

The Bigger Picture: When Policy Outpaces Wisdom

Both the ARRIVE and Term Breech trials reveal the same pattern:

Research produces a finding.
The policy adopts it too broadly.
Training and practice shift.
Choice and nuance disappear.

This isn’t evidence-based care—it’s evidence-as-dogma.

Mindful, evidence-based care means asking:

How does this research apply to me, in my body, in this setting?
What is my provider’s skill and experience with this procedure?
What are my personal values, fears, and hopes for birth?

Evidence-based care weaves three strands together:

High-quality research
Clinician experience and skill
The birthing person’s unique values and needs

When we remove any one of these threads, the whole fabric unravels.

Where Mindfulness Meets Research

Mindfulness isn’t passive acceptance—it’s active curiosity.

It invites us to pause before accepting “best practice” as universal. It reminds us that data tells one part of the story, and our bodies, intuition, and lived experience tell the rest.

Not every wisdom practice—like movement, massage, herbal care, or prayer—fits neatly into a randomized control trial. But that doesn’t make it less valid. It just means science hasn’t found a way to measure its depth yet.

Bringing It All Together

So as you prepare for birth—or support someone who is—remember:

Evidence is a tool, not a commandment.
Policy should serve people, not the other way around.
Mindfulness bridges the gap between data and intuition.

Pause before accepting any blanket recommendation. Read beyond the headlines. Ask:

“Does this evidence reflect me?” “What does my intuition say?”

Because your body’s wisdom belongs in the conversation.

Resources Mentioned

Download Clara’s Free Birth Plan Template, used at over 5,000 births.
Ready for an evidence based birth class? Check out A Path to A Powerful Birth
The Birth Advocacy Toolkit is a great option for expectant parents who have already taken a class but want to make sure their preferences are heard and want evidence based information to help make their decisions.
Evidence Based Birth: Evidence on the ARRIVE Trial and Elective Induction at 39 Weeks
Evidence Based Birth: Evidence on Breech Birth
Grobman WA, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. NEJM, 2018.
Evidence Based Birth: “Evidence on the ARRIVE Trial and Elective Induction at 39 Weeks.”
Nethery E, et al. Obstet Gynecol, 2023. Post-ARRIVE induction impact study.
Hannah ME, et al. Planned Cesarean vs Planned Vaginal Birth for Breech. Lancet, 2000.
Kotaska A. BMJ, 2004. “Inappropriateness of RCTs for complex intrapartum phenomena.”
Goffinet F, et al. PREMODA Study. Am J Obstet Gynecol, 2006.
RCOG Green-top Guideline No. 20b (2017).
ACOG Committee Opinion No. 745 (2018).
SOGC No. 384 (2019).

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