Why Evidence Matters - In Women's Health and Everywhere Else

When I started my ObGyn training we routinely did episiotomies, cutting a pregant patient’s perineum during birth. Turns out there was no evidence it did any good and much evidence it harmed patients.

When I started my ObGyn training we routinely did episiotomies, cutting a pregnant patient’s perineum during birth. Turns out there was no evidence that routine episiotomies did any good and much evidence it harmed patients.

In women with a history of herpes, weekly cultures for herpes were done during the last part of pregnancy. A cesarean was done when the culture was positive. Turns out there was no evidence it did any good and much evidence it harmed patients.

We routinely shaved patients’ perineum and gave them enemas. Turns out there was no evidence it did any good and much evidence it harmed patients.

Every day, obstetricians make decisions that affect two lives at once, a mother and her baby. That’s a level of responsibility that demands we get it right. And “getting it right” means basing our care on solid evidence, not tradition, habit, or what we learned in residency twenty years ago. Turns out we do of interventions that do no good and much evidence it does harm patients.

On the other hand, some refuse to intervene when it’s truly indicated. That can do more harm than good.

This isn’t just about being a good doctor. It’s about being an ethical one. A doctor who knows what’s right and what’s wrong.

The Ethical Obligation

When a pregnant woman puts her trust in us, she’s making a bet. She’s betting that we know what we’re doing, that our recommendations will help her, and that we wouldn’t suggest something unless we had good reason to believe it works.

That trust creates an obligation. We owe it to her to actually know the evidence behind what we recommend. We owe it to her to be honest when we don’t know. And we owe it to her to change our practice when new evidence shows we’ve been wrong.

This is what medical ethics looks like in the real world. It’s not abstract philosophy. It’s the concrete act of doing your homework before telling a woman what to do with her body and her pregnancy.

When We Get It Wrong

Medicine has a troubling history of confident recommendations that turned out to be harmful. We once told pregnant women to smoke to calm their nerves. We routinely performed episiotomies on nearly everyone, causing more harm than we prevented. We separated mothers from their newborns for hours after birth because... well, because that’s how we’d always done it.

In each case, the practices seemed reasonable at the time. Experts believed in them. Textbooks taught them. But the evidence wasn’t there—and when researchers finally looked carefully, the evidence pointed the other way.

The lesson is clear: confidence is not the same as correctness. Feeling certain doesn’t make something true. Only evidence can do that.

The Problem With “We’ve Always Done It This Way”

One of the biggest threats to ethical obstetric care is the normalization of deviance—the slow drift where questionable practices become accepted simply because everyone does them.

It works like this: Someone tries something new. It seems to work. Others adopt it. Soon it becomes standard practice. Years later, no one questions it because it’s just “how things are done.” The original rationale is forgotten. The evidence was never really examined.

This is how entire fields can go astray. Not through malice, but through the gradual acceptance of the unexamined.

Being ethical means resisting this drift. It means asking uncomfortable questions: Why do we do this? What’s the evidence? Does it actually help patients, or does it just help us feel like we’re doing something?

What Evidence-Based Ethics Looks Like

Practicing ethically in obstetrics means several things.

First, it means staying current. The evidence base changes. What was true ten years ago may not be true today. Reading the literature isn’t optional—it’s part of the job.

Second, it means being honest about uncertainty. We don’t have perfect evidence for everything we do. When the data is weak or conflicting, patients deserve to know that. Pretending we have certainty when we don’t is a form of deception.

Third, it means being willing to change. This is the hardest part. Admitting we’ve been doing something wrong wounds the ego. But clinging to outdated practices because changing feels like an admission of failure—that’s putting our pride above our patients’ welfare.

Finally, it means speaking up. When we see colleagues practicing without evidence, or when guidelines don’t match the data, we have a professional duty to say something. Silence makes us complicit.

The Bottom Line

Evidence-based medicine isn’t just a buzzword or a checkbox for hospital credentialing. It’s the ethical foundation of everything we do.

Our patients trust us with the most profound moments of their lives. They trust us with their bodies, their babies, and their futures. The least we can do is make sure our recommendations are grounded in reality.

Because in obstetrics, “I thought it would help” isn’t good enough. We need to know.