We move from a Dolly Parton story to the very real ways policy, training, and clinical guidance shape what patients can access and what clinicians can safely provide. We break down the end of global OB billing, the risks of vaccine schedule “tweaks,” and why surgical convenience can quietly drive worse care.
• rural maternity deserts and why reimbursement must cover facility costs
• content warnings and protecting our own mental health while learning from high-profile perinatal cases
• the shift from global maternity fees to E/M problem-based prenatal visits
• work RVUs, delivery billing and why correct coding matters
• measles deaths, herd immunity and why splitting MMR increases missed protection
• robotic surgery dominance, laparoscopic deskilling and training priorities
• ACOG opportunistic salpingectomy guidance for ovarian cancer prevention
• practical techniques to complete salpingectomy during vaginal hysterectomy
• listener question on urinary retention and pudendal nerve injury myths

0:00 Welcome And A Dolly Parton Story

6:07 Perinatal Mental Health And Content Warnings

8:20 OB Billing Shifts From Global To E/M

15:17 Measles Deaths And The MMR Split

20:05 Robotic Dominance And Laparoscopy Deskilling

31:41 ACOG Salpingectomy Guidance And Ovarian Cancer

40:53 Vaginal Hysterectomy Tube Removal Techniques

53:10 Urinary Retention And Pudendal Nerve Myths

1:06:22 Final Takeaways And Where To Follow

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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

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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

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