From Routine to Regret: 60 Obstetric Practices We Abandoned
We shaved, starved, and separated. We meant well. The evidence said eventually otherwise. This is Post 1 of an 11-part series. From RoutineTo Regret
This is Post 1 of an 11-part series: FromRoutineToRegret
Those of us who completed obstetrics and gynecology residency training in the late 1970s and early 1980s entered practice with a confidence born of rigorous apprenticeship. We had learned our craft from attending physicians who themselves had trained a generation earlier. The practices we adopted seemed as permanent as the laws of physics.
We shaved perinea. We administered enemas. We performed episiotomies on nearly every first-time mother. We kept laboring women strictly NPO, nothing by mouth, sometimes for 24 hours or more. We monitored every fetus continuously. We clamped cords immediately. We separated mothers from their babies and placed newborns in nurseries for observation. We put infants to sleep face down.
These were not controversial choices. They were simply what obstetricians did.
Four decades later, virtually every one of these practices has been abandoned, modified beyond recognition, or actively discouraged by the same professional organizations that once endorsed them.
The number is 60.
Sixty routine obstetric practices, once taught with authority and performed without question, that failed when subjected to rigorous scientific evaluation.
Nineteen antepartum.
Twenty-one intrapartum.
Twenty postpartum and neonatal.
Supported or refuted by 210 references, 37 of which were published in the American Journal of Obstetrics and Gynecology.
The story of how these practices rose and fell is not just a history lesson. It is a warning. Because the forces that sustained harmful practices for decades are the same forces operating in obstetrics today: medicolegal fear, financial incentives, training inertia, and the simple human resistance to admitting we were wrong.
The Scope of Reversal
Consider the categories. In the antepartum period, we prescribed diethylstilbestrol (DES) to prevent miscarriage. It caused cancer. We prescribed bed rest for preterm labor, preeclampsia, and growth restriction. Cochrane reviews found no benefit for any indication while documenting thromboembolic disease, bone loss, and psychological harm. We X-rayed pelvises, drew weekly estriol levels, performed serial amniocenteses for lung maturity testing, and cultured for herpes every week in the third trimester. Not one of these tests improved outcomes.
In the labor room, the transformation is even more striking. The admission ritual of 1982, shaving, enema, IV, NPO, flat on your back, continuous monitor, has been dismantled piece by piece. The WHO recommended against routine shaving and enemas in 1996. Cochrane reviews found no evidence supporting strict NPO. Upright positioning proved superior to mandatory lithotomy. And the most entrenched practice of all, continuous electronic fetal monitoring in low-risk labor, was shown in the Dublin trial of 1985 to increase cesarean and operative vaginal delivery rates without improving neonatal outcomes.
That was 40 years ago. We are still doing it.
Free Subscriber Bottom Line: Over the past four decades, 60 routine obstetric practices have been abandoned after failing rigorous scientific evaluation. The average time between definitive evidence and actual practice change was 10 to 20 years. Some practices persisted even longer. The forces that delayed change then are the same forces operating now.
Below, paid subscribers get:
The complete table of all 60 abandoned practices with era of use, year of definitive evidence, and year of guideline change
The evidence-to-practice gap analysis showing how long each reversal took
Which abandoned practices still linger in some institutions today
A framework for identifying which current practices may be next
The full series roadmap for the 10 posts to come
