Thinking About Ob/Gyn

Antonia Roberts and Howard Herrell

A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more.

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S12 · E4
August 19 · 59 min
Episode 12.4 Cesarean Delivery And Obesity
JJ Cox joins us as we talk through what actually changes when we perform cesarean delivery in patients with morbid obesity, from incision planning to anesthesia risk to the wound that has to heal at home. We share practical tips, review key trials on negative pressure dressings and antibiotics, and focus on decisions that protect both safe delivery and lower wound complications. • panniculus anatomy driving incision choice more than BMI • using ultrasound to find the uterus when landmarks mislead • paniculus retraction treated as an anesthesia maneuver • distance and geometry limiting exposure and delivery technique • planning the wound’s postoperative “home” before making the cut • negative pressure wound therapy evidence including the 2020 JAMA trial and skin blistering risk • skin glue vs standard dressings as competing narratives with limited data • closing deep subcutaneous space in layers to reduce dead space • avoiding staples and favoring subcuticular suture based on available evidence • antibiotic prophylaxis realities including azithromycin dose questions and shortage workarounds • extended postoperative antibiotics data shift when azithromycin is already used • OR contamination habits including Yankauer discipline and glove-changing debate • calling for help early and building a short pre-op plan to prevent downstream problems Be sure to check out thinking about obgyn.com for more information. And be sure to follow us on Instagram. 0:00 Welcome And Guest Introduction 2:55 Why These C-Sections Are Higher Risk 7:00 Picking The Incision With Ultrasound 14:25 Panniculus Retraction Is Anesthesia Critical 17:35 Delivery Tips When Distance Is The Enemy 19:55 Think About The Wound Before Cutting 24:20 Negative Pressure Dressings What Trials Show 34:45 Subcutaneous Closure Sutures Beat Shortcuts 38:55 Antibiotics Dosing Azithromycin Reality Check 45:55 Contamination Control Yankauer And Gloves 52:10 Assistance Planning And Hemorrhage Limits 55:30 Meta-Analysis Takeaways And Closing Follow us on Instagram @thinkingaboutobgyn.
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S12 · E3
August 5 · 59 min
Episode 12.3 Conception timing, tips for obese laparoscopy, and more!
We challenge a few stubborn pieces of OB-GYN “common sense” and ask what the data actually supports, from trying to conceive after miscarriage to how we start and adjust ovulation induction. Then we shift into practical laparoscopy tips for obese patients and end with a sober look at how evidence quality shapes care, from magnesium sulfate debates to the rise in pregnancy-associated overdose deaths. • why waiting a full cycle after first-trimester miscarriage lacks evidence for better outcomes • why routine progestin withdrawal bleeds before letrozole or clomiphene can be unnecessary and even harmful • how stair-stepping ovulation induction dosing can shorten time to ovulation • four operating room tips for minimally invasive surgery in morbid obesity, including port geometry and Trendelenburg dry runs • what a recent D&E fetal demise paper suggests about DIC and hemorrhage risk beyond 28 days • why retrospective birth registry studies can mislead when randomized trial data exist • how Medicaid timing findings highlight confounding rather than causation • a clever low-port approach to perforated IUD removal using a transabdominal hysteroscope • why overdose deaths are rising faster in pregnant and postpartum people and what fentanyl changes Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And What We’re Reading 0:29 The Myth Of Waiting After Miscarriage 1:08 Skip The Provera Withdrawal Bleed 7:49 Data On Conceiving Sooner 13:52 Laparoscopy Setup For Obese Patients 25:07 D&E After Second Trimester Demise 28:39 Magnesium Sulfate And Study Quality 39:06 Medicaid Timing And Confounding 44:57 Single Port Perforated IUD Removal 49:33 Overdose As Leading Pregnancy Associated Death 57:57 Book Shout Out And Closing Follow us on Instagram @thinkingaboutobgyn.
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July 23 · 59 min
Episode 12.2 Cuff Dehiscence and Classic Papers
Howard Herrell and Stuart Winkler question long-standing OB-GYN habits that feel “routine” but do not add value, then replace them with evidence and practical decision-making. We move from hysterectomy follow-up and cuff dehiscence management to the data behind cesarean sutures, endometrial cancer evaluation in postmenopausal bleeding, and the ongoing shift to HPV-based cervical cancer screening. • why routine 6 to 8 week vaginal cuff exams after hysterectomy may not prevent or predict dehiscence • how telehealth post-op care can improve access while keeping symptom-driven safety nets • four tips for evaluating and managing vaginal cuff dehiscence, including when laparoscopy matters • what Ethicon discontinuing chromic and plain gut could mean for cesarean technique choices • how the CORONIS trial informs chromic vs Vicryl decisions and why transfusion risk is part of the conversation • where the 4 mm endometrial stripe rule came from and why it can fail in real-world care • why persistent postmenopausal bleeding still warrants endometrial biopsy despite reassuring ultrasound • how race, tumor subtype, and fibroids affect endometrial cancer detection and counseling • the arc from Pap smear cytology to HPV DNA testing, vaccines, and primary HPV screening • why self-collected HPV testing may raise screening uptake for patients avoiding speculum exams Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And Today’s Game Plan 0:35 Rethinking The Six-Week Pelvic Exam 13:25 Four Practical Tips For Cuff Dehiscence 24:42 Chromic Gut Is Disappearing 35:40 CORONIS Trial And Cesarean Sutures 42:22 Postmenopausal Bleeding And The 4 mm Rule 53:12 HPV Testing Takes Over Screening Follow us on Instagram @thinkingaboutobgyn.
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S12 · E1
July 9 · 1 hr 5 min
Episode 12.1 IVF Add-Ons and More!
We follow the footnotes on a common gyn rule, then use that same evidence-first lens to question popular fertility add-ons and persistent pregnancy myths. Along the way, we talk pretest probability, counseling tradeoffs, and why simple cutoffs often replace better clinical reasoning. • tracing the “biopsy Bartholin cysts after 40” claim back to weak citations • using pretest probability and exam features to decide on selective biopsy • weighing hysteropexy versus hysterectomy for prolapse with long-term cancer risk in mind • breaking down a Lancet review of IVF add-ons and what actually shows benefit • spotting how marketing and online forums amplify unproven fertility interventions • reviewing data on sedentary time in pregnancy and why activity restriction persists • debunking “walking progresses labor” with randomized trial evidence • clarifying early diabetes testing as screening for preexisting diabetes and when A1C makes more sense than early glucose tolerance tests Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And What’s Ahead 0:23 Bartholin Cyst Biopsy Age Rule 14:17 Prolapse Repair With Uterus Preservation 21:45 IVF Add-Ons And The Lancet Review 37:35 Pregnancy Activity Myths And New Data 50:53 Early Diabetes Testing And A1C Follow us on Instagram @thinkingaboutobgyn.
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S11 · E13
June 25 · 1 hr 4 min
Episode 11.13 PMOS, PCOS, and the Metabolic Truth
Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients. • the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms • why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care • how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed • SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal • why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead • patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium • lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery • fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And Guest Introduction 2:01 The 3-Gram Ancef Habit 12:02 PCOS Becomes PMOS 12:55 How The Criteria Got Complicated 22:00 Insulin Resistance And Free Testosterone 30:40 Hormone Panels And TikTok Myths 32:30 Ovarian Follicles Are Not “Cysts” 36:03 Treating Symptoms Without Dismissing People 46:12 Fertility Trials And Lifestyle Results 57:27 ACOG At 75 And Why Join Follow us on Instagram @thinkingaboutobgyn.
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S11 · E12
June 10 · 1 hr 1 min
Episode 11.12 The Malpractice Crisis Is Real And Blaming Evidence-Based Care Makes It Worse
We push back on the idea that obstetrics “deserves” a malpractice crisis and explain how bad incentives and junk science can turn normal evidence-based care into courtroom blame. We also break down a few widely shared clinical myths and new research so we can practice with clearer eyes and less narrative noise. • placental grading on ultrasound as low-value data with poor predictive power and high reader variability • how malpractice commentary can seed plaintiff-friendly arguments against evidence-based off-label use • why blaming misoprostol or “high-dose” oxytocin oversimplifies multifactorial outcomes • quality improvement bundles as useful tools but weak proof without controls or causal clarity • how massive verdicts and paid expert testimony can clash with modern science on cerebral palsy and HIE • the FAA’s five hazardous attitudes and practical antidotes for high-stakes clinical work • new data on LEEP versus cold knife cone for CIN, recurrence, HPV clearance, and access tradeoffs • genetics and BMI as major drivers of gut microbiome patterns, not influencer narratives • what a 1993 Doppler trial can and cannot prove, plus why replication changes conclusions Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And Season Update 1:15 Placental Grading Myth On Ultrasound 6:44 Calling Out A Malpractice Influencer 14:06 The 2011 Policy Bundle Examined 23:20 What Drives The OB Malpractice Crisis 30:00 How Mega Verdicts Get Made 36:59 Five Hazardous Attitudes From Aviation 44:31 LEEP Versus Cone For CIN 48:04 Genetics And The Gut Microbiome 52:17 Does Doppler Ultrasound Harm Babies? 1:00:37 Recommendations And Closing Follow us on Instagram @thinkingaboutobgyn.
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S11 · E11
May 28 · 1 hr 4 min
Episode 11.11 When Evidence Misleads
We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice. • why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work • the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean • medical reversal, surrogate endpoints, and how trust erodes when practice changes late • why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs • how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity • the amnioinfusion comeback as a case study in applicability and overconfident conclusions Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And Today’s Big Question 3:48 Why “Thinking About OBGYN” Exists 11:54 The NEJM Push For One Trial 16:38 Medical Reversal And Trust Problems 24:43 AI Proteins And CRISPR Pressure Tests 32:33 Bayes Thinking Beyond P Values 36:43 Why Meta-Analyses Often Mislead 41:08 Bias And Heterogeneity Red Flags 46:24 Amnioinfusion And A Meta-Analysis Comeback 1:02:29 Final Warnings And How To Learn Follow us on Instagram @thinkingaboutobgyn.
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S11 · E10
May 13 · 59 min
Episode 11.10 New Guidelines For Cervical Cancer Screening and More!
We bring back the biggest takeaways from the ACOG ACSM, then move fast through the newest guidance and the newest hype shaping real OBGYN care. We focus on what the evidence actually supports, where practice still lags behind, and how “labels” can quietly push patients toward harm. • conference highlights including rural OBGYN access and what gets attention on the exhibit floor • vitamin K shot refusal trends and why late bleeding still matters weeks after birth • 2026 ACOG cervical cancer screening changes with primary HPV testing preferred for ages 30 to 65 • self-collected HPV screening and the systems needed to keep follow-up safe • why annual Pap testing and cytology-only strategies increase overdiagnosis and can miss HPV risk • postmenopausal bleeding workup shifting toward ultrasound plus endometrial biopsy up front • large baby induction data and why outcomes can worsen without neonatal benefit • third-trimester ultrasound screening performance and the real-world labeling effect • early proof-of-concept therapy for preeclampsia targeting sFlt1 removal to prolong pregnancy • hysterectomy duration and route as drivers of venous thromboembolism risk • laboring down claims from retrospective reports versus randomized trial findings • debunking physiologic third stage claims and reaffirming active management to prevent hemorrhage Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram. 0:00 ACOG Meeting Takeaways And Rural Access 3:58 Vitamin K Refusal And Newborn Bleeding 6:37 Cervical Screening Moves Toward HPV 14:48 Postmenopausal Bleeding Now Needs Biopsy 20:00 Tylenol Data And Macrosomia Induction 28:34 Ultrasound Labeling Effect And Liability Fears 37:29 Removing sFlt1 To Buy Time 40:14 Longer Hysterectomy Surgeries Raise VTE Risk 42:14 Laboring Down Claims Versus RCT Reality 49:59 Counseling Fatigue Without Ignoring Risk 54:21 Third Stage Myths And Hemorrhage Prevention 58:42 Evidence Literacy And Closing Notes Follow us on Instagram @thinkingaboutobgyn.
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S11 · E9
April 29 · 52 min
Episode 11.9 Vaccine Q&A
We answer vaccine questions head-on, using real numbers to separate online fear from how vaccines, immunity, and public health actually work. We break down why diseases feel “gone,” what the modern schedule really exposes babies to, and how to spot misleading claims around ingredients, autism, and VAERS. Featuring Kate Moloney and our vaccine-hesitant friend Anah. • why vaccine success makes diseases look eradicated while risk returns when coverage drops • Stanford modeling estimates for measles, diphtheria, polio, and rubella without vaccination • meningococcal meningitis basics, who is most at risk, and why outcomes can be catastrophic • why clean water and sanitation do not explain protection from droplet-spread viruses • what antigens are and why antigen exposure is far lower than decades ago • downsides of delaying vaccines including longer vulnerability and more office visits • aluminum, formaldehyde, and mercury claims explained with real-world comparisons • “natural immunity” tradeoffs including measles pneumonia, immune amnesia, and SSPE • long flu and post-viral inflammatory syndromes as quality-of-life consequences • how vaccine schedules change, why the autism claim is debunked, and what profit incentives really look like • what VAERS can and cannot tell you, plus how bias and viral claims distort reports • why newborn hepatitis B vaccination exists, screening gaps, and true serious side effects • rubella history and why vaccination primarily protects fetuses 1:05 Do We Vaccinate Too Much 3:32 Modeling A World Without Vaccines 6:20 Meningitis And Fast Catastrophes 8:28 Clean Water Is Not A Vaccine 11:02 Antigens And The Modern Schedule 15:44 Why Spacing Shots Can Backfire 16:53 Aluminum Formaldehyde Mercury Facts 22:00 Natural Immunity And Measles Damage 26:16 Long Flu And Post Viral Illness 28:26 Profit Fears And Autism Claims 31:26 VAERS Limits And Bad Math 38:39 Why Newborns Get Hepatitis B 45:09 Real Side Effects And Detox Scams 48:37 Rubella And Protecting Fetuses 51:57 Final Takeaways And Next Steps Be sure to check out thinkingaoutobgyn.com for more information and be sure to follow us on Instagram. Follow us on Instagram @thinkingaboutobgyn.
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S11 · E8
April 15 · 1 hr
Episode 11.8 MTHFR, Bed Rest, and More!
We take on four stubborn myths in modern obstetrics and follow the evidence instead of the vibes, from thrombophilia testing to bed rest to seizure prophylaxis. We also spotlight a patient-empowering insulin strategy that may improve gestational diabetes outcomes faster than usual care. • distinguishing recurrent pregnancy loss evaluation from venous thromboembolism testing • focusing thrombophilia workups on antiphospholipid antibody syndrome when criteria are met • explaining why MTHFR variants and PAI-1 polymorphisms do not belong in routine panels • unpacking how social media and narrative fallacies keep low-value tests alive • reviewing the AWARE trial and why activity restriction lacks benefit and carries harms • clarifying reasonable pregnancy activity modifications versus false labor prevention claims • assessing late preterm antenatal corticosteroids for twins and the hypoglycemia signal • discussing inertia of practice and why weak evidence becomes hard to undo • breaking down patient-led insulin titration for gestational diabetes and why it may reduce macrosomia • evaluating laboring down and long-term pelvic floor outcomes plus statistical pitfalls • answering a listener question on Keppra alternatives to magnesium for preeclampsia seizures Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And What We’re Reviewing 0:28 Thrombophilia Testing After Miscarriage 3:51 What Belongs In A VTE Panel 5:55 MTHFR And PAI1 Myth Busting 13:36 Activity Restriction And The AWARE Trial 23:27 Practical Counseling Without False Promises 27:08 Late Preterm Steroids For Twins 32:53 Patient-Led Insulin Titration In GDM 38:38 Laboring Down And Pelvic Floor Outcomes 47:51 Keppra Versus Magnesium For Preeclampsia 1:00:25 Wrap Up And Where To Follow Follow us on Instagram @thinkingaboutobgyn.
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S11 · E7
April 2 · 1 hr 2 min
Episode 11.7 Professional Guideline Discrepancies on Labor And Delivery
We talk with Dr. Emily Donelan about how conflicting labor management guidelines can derail communication between nurses and physicians and quietly raise patient safety risks. We map the biggest friction points and lay out practical ways to reconcile guidance locally while pushing for a unified national approach. • defining “communication dystocia” and why guideline discrepancies create real bedside conflict • how evidence gaps drive teams toward institutional culture and inertia in practice • the ARRIVE trial as a case study in differing priorities and framing • a detailed induction vignette showing where amniotomy, oxytocin titration and uterine activity definitions collide • why the 20 mU/min oxytocin threshold persists and what newer data suggests • tachysystole rules, Category II tracings and how prescriptive language shapes nursing behavior • delayed pushing versus pushing at complete dilation and the moral distress it can create • the need for standardized evidence grading and cleaner citations across organizations • a national interprofessional reconciliation program and who must be at the table • one actionable step for tomorrow: stay curious and surface the real reason behind the disagreement Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. 0:01 Why Guideline Conflicts Matter 3:52 The ARRIVE Trial Framing Problem 12:23 A Labor Case Where Rules Collide 24:08 Oxytocin Thresholds And Litigation Fear 33:26 Pushing Timing And Moral Distress 38:05 Who Should Write Unified Guidance 44:04 Evidence Grading And Bedside Decisions 52:05 Inertia In Practice And De-Implementation 1:00:14 Takeaways Plus A No-Evidence Pet Peeve Follow us on Instagram @thinkingaboutobgyn.
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S11 · E6
March 19 · 56 min
Episode 11.6 Ovarian Torsion & The Pitt
We use a plotline from The Pit to separate ovarian torsion facts from TV fiction and explain why Doppler findings can’t replace clinical judgment. Then we answer a listener question on trial of labor after myomectomy and how we counsel when the data are thin and the details matter. • why “competency porn” and “certainty porn” can distort real expectations of care • how color Doppler actually works and why red and blue do not always mean artery and vein • PCOS misconceptions and what really increases torsion risk • ovarian torsion as a clinical diagnosis and why preserved Doppler flow cannot rule it out • ultrasound clues that help beyond flow alone, including the whirlpool sign and peripheral follicles • when oophoropexy might be considered and why it remains controversial • why detorsion usually beats oophorectomy even with a black or blue ovary • limits of lab tests and the need to think in probabilities, not binaries • false positives and false negatives in pregnancy testing, including the hook effect and real-world mix-ups • counseling on vaginal delivery after myomectomy, focusing on depth, cavity entry, number and location of incisions, and shared decision-making Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 0:01 Welcome And What We Cover 0:32 The Pit Torsion Plot Setup 3:06 Competency Porn And Public Expectations 8:39 Color Doppler Basics BART Rule 10:09 PCOS Myths And Torsion Risk 13:27 Endometriosis Guidance And Clinical Diagnosis 18:29 Torsion Diagnosis Beyond Doppler Flow 24:30 Oophoropexy When It Helps And Harms 29:22 Scoring Tools For Torsion Triage 32:48 Detorsion Versus Oophorectomy And Recovery 37:09 Certainty Porn And Limits Of Tests 41:09 Pregnancy Tests False Positives And Negatives 47:10 Listener Question TOL After Myomectomy 50:01 Counseling Factors And Limited Rupture Data 55:31 Closing And Next Guest Tease Follow us on Instagram @thinkingaboutobgyn.
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S11 · E5
March 5 · 59 min
Episode 11.5 Gray Journal Cesarean Delivery Edition
We unpack the Gray Journal’s special edition on Cesarean Delivery, separating strong evidence from expert habit, and spotlight where technique, culture, and policy collide. From TXA and barbed sutures to better metrics and imaging, we share what to adopt now and what to question. Featuring Maddie White. • evidence versus expert opinion across the special issue • TXA at cesarean shows no meaningful outcome gains • barbed versus braided sutures and the cost of “speed” • why fundamentals beat gadgets for blood loss and time • critique of New Jersey NTSV study and outcome framing • imaging pearls for post‑cesarean complications • infection prevention steps supported by trials • history of cesarean steps and why we dropped some • rising cesarean rates driven by non‑clinical forces • better classification systems and dyadic metrics • balancing maternal and neonatal outcomes • tool use in obesity and cost‑conscious choices Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram 0:01 Why A Massive C‑Section Special Issue Matters 3:15 Expert Opinion vs Evidence: Read With Caution 5:44 Safety Basics: Wear Eye Protection 7:46 Evidence‑Based Technique Still Stands 10:55 TXA At Cesarean: Reanalyzing TRAAP2 18:19 Barbed Sutures And The Myth Of Speed 27:30 Operative Time: Fundamentals Over Gadgets 33:54 New Jersey QI Study: Claims And Confounders 42:05 Outcomes Framing: “Cone Heads” And Bias 49:15 Imaging After Cesarean: What To Look For 54:35 Infection Prevention And SSI Takeaways Follow us on Instagram @thinkingaboutobgyn.
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S11 · E4
February 19 · 1 hr 9 min
Episode 11.4 Syphilis and lots more!
We examine why U.S. maternal mortality headlines mislead, showing overdose and violence dominate early postpartum deaths while obstetric causes decline. We then cover strong evidence for opportunistic salpingectomy, debunk a shaky Cochrane-fueled home birth claim, clarify Nexplanon’s five-year approval and bleeding management, confirm no Tylenol-autism link, and walk through modern syphilis testing in pregnancy before closing with pragmatic magnesium use after delivery. • overdose and violence as leading postpartum deaths • pitfalls of cross-country maternal mortality comparisons • fentanyl trends and infant risk • opportunistic salpingectomy reduces ovarian cancer risk • how bad meta-analyses distort home birth safety claims • intent-to-treat and risk matching in birth setting data • Nexplanon five-year efficacy and bleeding treatments • no association between acetaminophen and autism • syphilis screening algorithms and pregnancy timing • magnesium postpartum as seizure prophylaxis, not BP treatment Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 0:00 Setting The Agenda: What Really Kills Moms 0:33 Redefining Maternal Mortality And Comparisons 2:11 Violence, Overdose, And Postpartum Risk 5:33 State Variability And Media Narratives 8:15 Data On Drugs, Fentanyl, And Infant Harm 11:06 Opportunistic Salpingectomy: New Evidence 14:06 Population Study And Risk Reduction Ranges 16:16 Cochrane Review And Home Birth Claims 20:24 Why Bad Meta-Analyses Mislead 24:15 Real-World Data And Intent-To-Treat For Birth Setting 28:02 Pain, Epidurals, And Cultural Narratives 31:00 Nexplanon Five Years And Bleeding Fixes 35:21 Tylenol And Autism: Meta-Analysis Revisited 38:04 Syphilis Testing In Pregnancy: Why It’s Hard 42:25 Traditional Vs Reverse Algorithms Explained 47:05 Managing Discordant Results And Reinfection 50:11 History, Ethics, And Tuskegee Lessons 54:15 Listener Question: Magnesium Duration Postpartum 59:05 Clinical Judgment Over Dogma And Wrap Follow us on Instagram @thinkingaboutobgyn.
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S11 · E2
February 4 · 1 hr 1 min
Episode 11.3 Preventing Surgical Complications
We map a prevention-first approach to OBGYN surgical complications—from environmental fixes and technique to early detection, skilled repair, and honest recovery—so fewer patients are harmed and clinicians carry less hidden burden. Practical steps, board-level reasoning, and real cases bring it to life. • applying primordial to quaternary prevention to surgical harm • avoiding unnecessary hysterectomy and favoring safer routes • bladder repair tactics by size and location • ureter injury recognition, stenting, and reimplant options • bowel injury triage, Lembert technique, and resection thresholds • four practical tips to prevent bowel injury • vascular control from aorta to epigastrics and presacral bleeds • preventing neuropathies with smarter positioning and retractors • disclosure with HEAL and supporting clinicians with just culture • key historical insights 0:00 Framing Complications With Prevention 2:55 Primordial To Quaternary: The Model 7:30 Urologic Risks: Bladder First 16:20 Trigone, Stents, And Calling For Help 23:45 Ureter Injury Playbook 33:20 Delayed Ureter Injuries And Management 38:05 Small Bowel: From Serosa To Resection 46:30 Colon Injuries: Repair Or Resect 52:40 Four Tips To Prevent Bowel Injury 58:10 Vascular Injury: Aorta To Epigastrics Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram Follow us on Instagram @thinkingaboutobgyn.
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S11 · E2
January 22 · 1 hr
Episode 11.2 Rethinking VBAC Risk and a Lot More!
We unpack new studies that reshape how we counsel on VBAC after short intervals, update what we tell BRCA carriers about estrogen therapy, and explore how self-collected HPV tests can reduce screening gaps. We also question surgical marketing, workforce trends, and the shaky evidence behind aspirin dosing for preeclampsia. • Short interpregnancy interval as a VBAC risk factor, not a contraindication • Absolute uterine rupture rates in spontaneous vs induced labor • Estrogen therapy in BRCA carriers and treated gyn cancers • Cervical screening overuse and underscreening in insured populations • Self-collected HPV testing intervals and access benefits • OB-GYN workforce shortages and rural distribution gaps • Endometriosis surgery indications versus fertility claims • Robotics versus laparoscopy outcomes and training priorities • Aspirin dose trials, lack of placebo arms, and abruption signals • Reading statistics correctly and demanding better editorial standards 0:00 Setting The Agenda: New Studies 0:40 Short Interval Pregnancy And VBAC Risk 3:10 Quantifying Uterine Rupture By Spacing 8:10 Induction, Augmentation, And Rupture Math 9:40 HRT In BRCA Carriers: New Evidence 13:05 Estrogen After Gyn Cancers: Practice Gaps 17:40 Cervical Screening: Overuse And Underscreening 22:30 Self-Collected HPV Testing Guidance 27:00 OB-GYN Shortages And Distribution 33:20 Endometriosis Surgery And Fertility Claims 41:20 Robotics Vs Laparoscopy: Outcomes And Training 47:20 Aspirin Dosing For Preeclampsia: No Signal 55:30 Interpreting Stats And Editorial Standards 59:20 Closing Notes And Next Steps Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram Follow us on Instagram @thinkingaboutobgyn.
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S11 · E1
January 8 · 55 min
Episode 11.1 Smarter Hysterectomies, Lower Costs
Jamie Perry joins this episode as we share ten standout women’s health breakthroughs from 2025 and then get practical about value in endoscopic hysterectomy. The focus is simple: cut waste, save time, protect quality, and expand access through better selection, technique, and team flow. • Key 2025 breakthroughs shaping care and counseling • Why OR time outweighs device price • Preference cards as a lever to reduce waste • Three-arm robotics and smarter instrument choices • Laparoscopic tips: barbed suture, simulation, quadrant workflow, vessel skeletonization • Robotic tips: patient selection, docking discipline, turnover efficiency, data tracking • Same-day discharge and ERAS as non-negotiables • When vaginal route is truly better and why referrals matter Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram 0:00 Setting The Stage: Why Endoscopy 1:12 Ground Rules And Focus On Value 2:12 Top 10 Women’s Health Breakthroughs Of 2025 15:56 Defining Value In Hysterectomy 18:20 Preference Cards And Instrument Waste 21:28 Three-Arm Robotics And Instrument Costs 24:04 Time As The Biggest Cost Driver 29:56 Same‑Day Discharge And ERAS 33:44 Four Laparoscopic Efficiency Tips 41:28 Four Robotics Efficiency Tips 47:02 When To Choose Vaginal Hysterectomy 54:10 Data Tracking, Referrals, And Culture Change Follow us on Instagram @thinkingaboutobgyn.
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S10 · E13
Dec 25, 2025 · 1 hr 2 min
Episode 10.13 Estrogen, Free Birth, And Misinformation
We unpack what WHI actually showed about estrogen-only therapy and breast cancer in light of new supporting data, then confront the free birth trend’s preventable harms and the business model behind it. We share clear tools to spot false claims, review new aspirin data on preeclampsia, and outline twelve practical ways to cut waste in gyn surgery. • estrogen-only therapy associated with lower breast cancer diagnosis and mortality • combined estrogen plus progestogen neutralizing estrogen’s protective signal • rare abdominal pregnancy case illustrating basic testing safeguards • free birth movement risks, censorship of bad outcomes, and money incentives • red flags in birth-related posts and the SIFT fact-checking method • four quick filters to vet social content before sharing • nuanced view on aspirin for preeclampsia with mixed trial evidence • twelve surgical sustainability steps that save cost and reduce waste Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 1:11 Estrogen Therapy And Breast Cancer Risk 6:41 What WHI Actually Showed 11:22 Progesterone, HRT Fads, And Risks 15:35 Wild Case: Abdominal Pregnancy Behind Tumor 20:42 Free Birth Trend And Tragic Outcomes 25:37 How The Misinformation Business Works 30:10 Red Flags In Birth Content Online 35:10 The SIFT Method For Fact-Checking 40:20 Four Tips To Vet Social Posts 46:25 Live Walkthrough: Debunking A Viral Post 52:40 Digital Hygiene And Curating Feeds 56:48 Aspirin For Preeclampsia: Mixed Evidence Follow us on Instagram @thinkingaboutobgyn.
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S10 · E12
Dec 11, 2025 · 1 hr
Episode 10.12 The V-Word
We trace the arc from variolation and Jenner to mRNA, show how vaccines leverage natural immunity, and explain why maternal shots protect both parent and newborn. Data, history, and personal stories make the case that prevention beats cure for OBGYN care. • pertussis surge in Kentucky and preventable infant deaths • child mortality then and now and what changed • variolation to Jenner and the origins of vaccination • how innate and adaptive immunity learn and remember • vaccine types and why today’s antigens are fewer • effectiveness data across polio, measles, rubella, Hib • sanitation myths versus vaccine impact • Wakefield’s fraud and why autism claims fail • three major studies debunking autism myths • essential pregnancy vaccines and timing • RSV options and COVID safety during pregnancy • herd immunity as protection for newborns 0:02 Setting The Stage: Vaccines Under Fire 1:09 Pertussis Surge And Preventable Tragedy 2:20 Child Mortality Then And Now 4:19 What Killed Children In 1850 5:31 Out Of Sight, Out Of Mind 9:51 Origins Of Vaccination: Variolation To Jenner 15:20 Vaccines Use Natural Immunity 20:00 Types Of Modern Vaccines Explained 25:30 Innate And Adaptive Immunity 101 28:40 How Effective Are Vaccines Really 33:40 Polio’s Human Cost And Iron Lungs 39:00 Measles, Rubella, And Pregnancy Risks 44:20 Sanitation Myths Versus Vaccine Impact 47:05 The Wakefield Fraud And Aftermath 52:20 Big Studies Debunk Autism Claims 55:20 Essential Vaccines In Pregnancy 58:00 Takeaways And Next Steps Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram Follow us on Instagram @thinkingaboutobgyn.
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S10 · E11
Nov 27, 2025 · 57 min
Episode 10.11 Smarter Cancer Screening, Safer Obstetrics
We share a practical, clinic‑tested system for hereditary cancer screening that standardizes intake and education, then confront how malpractice pressures distort obstetric decision‑making, fetal monitoring, and access to care. Former ACOG president Dr. Richard Waldman offers data, history, and solutions we can use now. • digital workflow that screens every patient annually from age 18 • video education improving informed consent and test completion • one in four patients meeting hereditary testing criteria • management changes after testing including MRI, meds, referrals • addressing cost and genetic discrimination concerns • OBGYNs as leaders in genetics amid counselor shortages • malpractice landscape, rising verdicts, and physician burnout • neonatal encephalopathy criteria grounding courtroom science • fetal monitoring limits, category II overreaction, cesarean pressure • VBAC safety tied to selection, readiness, and team systems • safety culture, simulation, and checklists reducing risk Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram Follow us on Instagram @thinkingaboutobgyn.
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