Advertise on podcast: Thinking About Ob/Gyn

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.

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.

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.

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.

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.

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.

Antonia and special guest Kristi Angevine explore how physicians can rethink habits beyond routines to include default thoughts, feelings, and reactions, and how that shift relieves burnout and restores purpose. Practical micro-habits, internal validation, and redefining productivity help us lead better and live better. • habits as automatic thoughts, feelings, reactions • perfectionism, people pleasing, catastrophizing as learned solutions • survival seasons and low‑friction wins • two micro‑habits: emotional check‑ins and box breathing • escaping all‑or‑nothing with iterative learning • redefining productivity around alignment, not to‑do lists • internal validation and making yourself make sense • training culture, criticism, and choosing supportive mentors • identity beyond “doctor first” to include rest and health • coaching options: group community and private work Be sure to check out Thinking about obgyn.com for more information, and be sure to follow us on Instagram 0:01 Setting The Stage: Habits In Medicine 0:32 Introducing Dr. Kristi Angevine 2:05 Redefining What A Habit Really Is 4:20 Perfectionism, People Pleasing, Catastrophizing 7:12 Coping Gone Sideways And Burnout Risk 11:21 Unrealistic Standards And The Inner Critic 15:54 When Work Ethic Becomes Self-Neglect 19:30 Why Simple Routines Aren’t Easy 23:12 Survival Seasons And Low-Hanging Fruit 26:12 Two Five-Minute Habits That Stick 30:45 Escaping All-Or-Nothing Thinking 36:05 Internal Validation As A Mental Habit 41:05 Success Beyond The To-Do List 48:39 Burnout’s Roots And Moral Injury 52:42 Training Culture, Criticism, And Resilience Follow us on Instagram @thinkingaboutobgyn.

We challenge long-held beliefs about fibroids, highlight new ectopic pregnancy nuances, and dig into real-world dermoid cyst outcomes. We also unpack the evidence and ethics of 39-week induction after IVF and ICSI, balancing small absolute risks with maternal tradeoffs. • Evidence overturning links between fibroids and miscarriage, PROM and abruption • Distinguishing spontaneous versus iatrogenic preterm birth in fibroid pregnancies • Why myomectomy can raise early delivery and cesarean rates in some patients • Ectopic care updates: tube-sparing choices, HCG thresholds, two-dose methotrexate • Experimental adjuncts to methotrexate remain unproven • Dermoid data supporting laparoscopy, irrigation, and specimen bags over open surgery • Surgical decision making during pregnancy and avoiding uterine manipulators • IVF and ICSI timing: late stillbirth risk signals, limits of testing, 39-week logic • Shared decision making when absolute risks are low but values differ Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 1:33 Fibroids And Miscarriage Myths 5:53 Preterm Birth, PROM, And Hemorrhage 9:31 Myomectomy: Risks, Scars, And Outcomes 13:25 Ectopic Pregnancy: What’s New 18:37 Surgery Versus Methotrexate Nuances 22:05 Experimental Add-Ons To Medical Therapy 27:47 Dermoid Cysts: Real-World Data 32:48 Laparoscopy, Spillage, And Pregnancy 36:06 When Open Surgery Makes Things Worse 40:34 IVF, ICSI, And 39-Week Induction 48:05 Stillbirth Risk: What The Data Shows 55:20 Testing, Timing, And Shared Decisions 1:04:10 Practical Counseling And Tradeoffs Follow us on Instagram @thinkingaboutobgyn.

In this episode, Howard and Maddie White challenge shaky claims linking autism to circumcision and Tylenol, then zero in on speed as the byproduct of essential, evidence-based surgery. We show how essentialism, confidence, and efficiency reduce complications, lower costs, and improve outcomes in the OR. • correlation vs causation in autism narratives and bias in research • why operative time predicts complications across procedures • surgeon volume, variability, and outcome differences • evidence-based cesarean steps that cut time and bleeding • tool and method choices that are safer and faster • confidence as self-efficacy, not arrogance • practical efficiency: setup, flow, visualization, debrief • lean thinking, standardization, and reducing variation Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 00:00:00 Opening Banter & Autism Claims 00:02:35 Circumcision, Bias, and Correlation vs Causation 00:09:54 Why Speed in Surgery Matters 00:15:35 Surgeon Variability and Outcomes 00:19:35 Evidence-Based Cesarean: Essential Steps 00:27:20 Less Bleeding Through Minimal Dissection 00:31:20 Choosing Methods and Tools that Save Time 00:35:05 Confidence vs Arrogance in the OR 00:40:05 Practical Efficiency: Filming, Flow, and Setup 00:45:05 Visualization, Assisting, and Debriefing 00:50:00 Tools, Tech, and Mastering Basics 00:55:00 Standardization, Lean Thinking, and Takeaways Follow us on Instagram @thinkingaboutobgyn.

We push back on claims that Tylenol or vaccines cause autism and explain how weak methods, conflicts of interest, and cherry-picked data fuel public panic. We also unpack why diagnoses have risen—broad criteria, screening, and access—not because of a new environmental villain. • Summary of claims made at the press event and why they fail • What the cited acetaminophen paper did and didn’t show • Conflicts of interest, pay-to-publish venues, and bias • Why correlation isn’t causation; confounding by indication • Bradford Hill criteria applied to acetaminophen and autism • Sibling-controlled studies as the strongest current evidence • Amish and Cuba myths; diagnosis versus true prevalence • DSM-5 changes driving higher autism diagnoses • State-by-state variation explained by services and funding • Vaccine safety evidence contrasted with myths • Practical counseling: treat fever; use clear, strong evidence Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram 0:00 Setting The Record Straight 2:30 The Press Conference Claims 5:30 Tylenol, Vaccines, And Autism 9:30 The Study Behind The Hype 14:30 Conflicts, Bias, And Bad Methods 19:30 Correlation Isn’t Causation 23:00 Bradford Hill 101 28:30 Amish, Cuba, And Diagnosis Rates 33:30 Screening Tools And Subjectivity 37:30 Sibling Studies: The Strongest Signal 42:00 Why Meta-Analyses Can Mislead 46:00 What The “Navigation Guide” Misses 51:00 Vaccine Myths In Perspective 54:00 Why Autism Diagnoses Rise 59:00 DSM-5 And Access To Services Follow us on Instagram @thinkingaboutobgyn.

Dr. Howard Harrell explores common questions about birth alternatives posed by Anna, a mom-to-be with questions, examining scientific evidence behind claims often found online that challenge evidence-based obstetric practices. The discussion separates facts from philosophy by analyzing actual research data on interventions like epidurals, oxytocin, and birthing positions. • Maternal mortality has decreased 173-fold since 1850, coinciding with the rise of modern obstetrics • The "cascade of interventions" theory isn't supported by scientific evidence • Studies show epidurals don't increase cesarean delivery rates, contrary to popular belief • Oxytocin augmentation, when properly used, can decrease cesarean rates rather than increase them • Upright birthing positions don't show improved outcomes compared to lying on back • Hospital/provider cesarean rates matter more than specific interventions in predicting your risk • For low-risk pregnancies, intermittent rather than continuous fetal monitoring may reduce unnecessary interventions • Best approach combines respecting physiologic birth while using appropriate medical tools when needed Visit thinkingaboutobgyn.com for more information and follow us on Instagram. We'll be back in two weeks. 00:00:02 Introduction to Natural Birth Questions 00:02:09 Historical Maternal Mortality Statistics 00:05:54 Nutrition Myths and Modern Food Safety 00:11:34 Debunking the Cascade of Interventions Theory 00:21:32 Epidurals: Facts vs. Misconceptions 00:35:59 Birth Positions and Perineum Protection 00:44:20 Avoiding Unnecessary Cesareans 00:48:56 Continuous vs. Intermittent Fetal Monitoring 00:56:24 Artificial Rupture of Membranes Discussion Follow us on Instagram @thinkingaboutobgyn.

Howard and Antonia explore the safety of medications during pregnancy and the controversial reporting requirements for breast density on mammograms, examining how science is being overshadowed by fear-mongering in healthcare decision-making. • Examining the evidence behind avoiding fluconazole (Diflucan) in first trimester, finding that short courses likely pose minimal risk • Discussing the important distinction between possibility and probability when evaluating medication safety in pregnancy • Analyzing the wide variation in cesarean delivery rates across US counties, from 5.4% to over 53% for low-risk patients • Critiquing politically-motivated FDA actions on SSRIs, food dyes, and other health policies not supported by scientific evidence • Explaining why the FDA's requirement to notify women of dense breasts on mammograms may cause more harm than good • Demonstrating how supplemental testing for women with dense breasts leads to false positives and unnecessary procedures • Reviewing the historical development of prenatal diagnosis from early ultrasound to cell-free DNA testing 00:00:33 Evidence for Diflucan in Pregnancy 00:12:12 Cesarean Delivery Rates Across US Counties 00:16:39 FDA's Position on SSRIs and Food Dyes 00:28:46 Managing Dense Breasts in Mammography 00:44:46 History of Prenatal Abnormality Diagnosis Follow us on Instagram @thinkingaboutobgyn.

Dr. Jacqueline Vidosh shares her powerful journey as both an obstetrician and mother to Noah, who has trisomy 18, challenging traditional medical understanding of this condition and providing insights into compassionate patient care. Her story, recently featured in The New York Times, illustrates how medical perspectives on chromosomal conditions can evolve through lived experience, highlighting the spectrum nature of trisomy 18 and the importance of accurate, unbiased counseling. • Receiving the diagnosis during pregnancy and navigating the emotional process when medical training suggested a fatal outcome • Discovering that trisomy 18 exists on a spectrum with possibilities beyond what medical textbooks described • Managing Noah's complex medical needs including ventilator, tracheostomy, and gastrostomy tube while balancing family life • Advocating for appropriate medical interventions by challenging the assumption that care would be "futile" • Celebrating Noah's achievements and joys – his love of music, lights, and his unique ways of communication • Recent medical literature supporting interventions for trisomy 18/13 on a case-by-case basis • Using the SPIKES protocol for delivering difficult news with respect and compassion • Implementing trauma-informed care for families experiencing complicated pregnancies and NICU stays Read more about Noah's story in The New York Times article, available through the free link provided in our show notes. https://www.nytimes.com/2025/07/31/magazine/trisomy-18-edwards-syndrome-baby-treatment-care.html?unlocked_article_code=1.ak8.JRBu.7-qMQhelsVYx&smid=url-share 00:00:00 Introduction to Trisomy 18 Discussion 00:08:40 Receiving the Diagnosis 00:17:45 Challenging Medical Assumptions 00:27:30 Noah's Daily Life and Care 00:38:20 Joy and Connection with Noah 00:47:10 Navigating the Medical System 00:54:00 Breaking Difficult News Effectively Follow us on Instagram @thinkingaboutobgyn.

Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary. • ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants • Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances in neonatal care • Systematic reviews show no difference between chlorhexidine and iodine for vaginal prep before hysterectomy • Conservative management of placenta accreta spectrum disorders shows improved outcomes over immediate cesarean hysterectomy • Labor arrest Cesareans have highest blood loss among non-accreta cesarean indications • New HPV testing terminology recommends "HPV detected" rather than "positive" to avoid relationship misunderstandings • USPSTF preeclampsia prevention guidelines classify 89% of pregnant women as aspirin candidates despite limited evidence • Endometrial sampling best practices include stepwise approach starting with ultrasound before considering hysteroscopy In two weeks, Jacqueline Vidosch returns to discuss her son Noah who has trisomy 18, following a feature in the New York Times. 00:00:00 Episode Introduction 00:06:43 Post-Cesarean Antibiotics: Evidence Review 00:17:11 Delayed Cord Clamping Updates 00:22:13 Extreme Preterm Survival Case 00:26:40 Vaginal Prep and Placenta Accreta Management 00:30:11 Cesarean Blood Loss by Indication 00:34:21 HPV Testing Language Changes 00:37:45 Aspirin for Preeclampsia Prevention 00:51:33 Endometrial Sampling Question Follow us on Instagram @thinkingaboutobgyn.

Dr. Scott Guthrie joins us to explore the significant advances in neonatal care and the critical partnership between obstetricians and neonatologists to improve outcomes for newborns. Highlights include:  • Successful implemented delayed cord clamping across Tennessee hospitals through collaborative quality improvement project • Neonatal mortality has decreased 30% between 1999-2022 due to advances in medical care and prenatal management • Survival rates for 22-week premature infants have improved to 30-40%, with many having normal development • Modern ventilation strategies now allow extremely premature babies to avoid intubation completely • Delivery room practices have shifted from routine suctioning to prioritizing effective ventilation • Therapeutic cooling has revolutionized treatment for hypoxic ischemic encephalopathy when initiated within 6 hours • Historical treatment of meconium stained fluid has evolved as we better understood its pathophysiology • Neonatal intensive care advances were catalyzed by Patrick Kennedy's death from hyaline membrane disease in 1963 Join us for our continuing exploration of obstetrical and neonatal advances as we work together to improve outcomes for mothers and babies. 00:00:00 Introduction to Neonatal Care Advances 00:10:13 Neonatal Mortality Trends and Challenges  00:16:27Technological Evolution in NICU Care 00:24:07 Periviable Infants: Improved Survival Rates 00:31:09 Delivery Room Best Practices for Newborns 00:38:44 Modern Meconium Management Approaches 00:47:19 Therapeutic Hypothermia for HIE 00:55:42 Causes and Detection of Hypoxic Ischemic Encephalopathy 01:03:01 History of Neonatal Care Evolution 01:12:25 Concluding Thoughts on Collaborative Care Follow us on Instagram @thinkingaboutobgyn.