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

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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

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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.