Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode Title: Lube It Up For Baby Delivery?

Date: December 17, 2025
Host: Dr. Chapa

Episode Overview

In this episode, Dr. Chapa explores a common clinical question in obstetrics: does applying lubricant to the baby's head or the vaginal canal during the second stage of labor facilitate delivery? He dives into the evidence—reviewing key meta-analyses—to determine whether this widely observed practice is truly evidence-based, while retaining his candid, conversational, and humorous tone. The episode is designed for medical professionals at all stages, focusing on clinically relevant pearls for practice.

Key Discussion Points & Insights

1. Real-Life Clinical Scenario as Inspiration

• [01:06]
  Dr. Chapa recounts a night-call scenario where a resident tries to use “copious baby shampoo lube” to help a crowning baby’s head deliver, attempting to avoid vacuum extraction.
  • He interrupts:

    “What are you doing?” (Dr. Chapa, 04:42)

  • Explains the risk: excessive lube can hinder proper vacuum application if needed for assisted delivery.
  • The situation sparks the episode’s investigation into evidence for and against the practice.

2. Lubrication & Perineal Trauma Prevention

• [05:56]
  Dr. Chapa acknowledges that the use of lubricant is supported in certain contexts, specifically for:
  • Perineal massage with lubrication at the second stage or even antepartum (e.g., starting at 36-37 weeks) can reduce perineal trauma, especially in first-time mothers.
  • Data supports a trend toward fewer third- and fourth-degree lacerations.
  • For perineal trauma prevention, “that is a thing. Okay.”

3. Lubrication for Facilitating Delivery: What Does the Evidence Say?

[07:22]

A. 2019 Meta-Analysis Review

• Published in Journal of Maternal, Fetal and Neonatal Medicine.
• Included just 3 randomized controlled trials (RCTs) with strict inclusion criteria (N=512).
• Lubricant was administered intentionally—not merely for cervical exams—sometimes even as early as the first stage of labor.
• Finding:

  “There was no statistical significant difference comparing women who received lubricant gel during labor with those who did not in the lengths of the second stage or of the active phase of the first stage of labor.” (~[11:25])

• Conclusion: Lubricant during labor does not reduce the duration of the second stage.

B. 2022 Meta-Analysis Review

• Published in the Journal of Obstetrics and Gynecology Research.

• Included 19 trials, much larger sample size (N=5,445).

• Findings:

  • Lubricant at second stage does reduce perineal injury (“moderate certainty evidence”).
  • Also found a shorter duration of second stage—median reduction of 13.7 minutes.

• BUT:

  • The confidence interval for the reduction was “very broad,” meaning low precision.
  • Authors caution:

    “This, however, has very low certainty evidence, not low certainty evidence, very low certainty evidence.” (Dr. Chapa, paraphrased, [15:04])

  • The authors themselves say more robust studies are needed.

4. Professional Guidelines & Best Practice Recommendations

[17:24]

• Dr. Chapa emphasizes that no national or international guidelines (ACOG, FIGO) recommend lubricating the vagina to facilitate second stage labor:
  • “Vaginal lubrication is not part of any national or international labor management guideline.”
  • In cases of labor dystocia or failure to descend, management is guided by operative vaginal delivery or cesarean, not lube.

5. Risks, Harms, and Practical Considerations

[20:40]

• Lubricant doesn’t appear to cause harm per se, but:
  • It can hinder vacuum or forceps application—requires careful removal before use.

    “You better be darn sure you wipe all that stuff off to prevent fetal injury from either the vacuum cup or misapplied or slipped forceps, blades.”

  • Theoretical (but unreported) risk of a baby being so “slimy” as to be dropped.

Notable Quotes & Memorable Moments

• Dr. Chapa’s signature humor and exasperation:

  “I’ll get the lubricant. There’s no time for lubricant. There’s always time for lubricant.” ([01:06], recurring)
  “Well, then try axle grease.” ([03:03], joking about excess lube usage)
  “What do you do with a ring on your finger you can’t take off? Put lube on that!” ([02:26])

• On insufficient evidence for lubricating to help with delivery speed:

  “When you look at that scientifically through systematic reviews and meta-analyses, it just isn’t there.” ([22:48])

Timestamps for Important Segments

• [01:06] – Introduction to the clinical question and story that inspired the episode
• [04:45] – Description of the resident’s decision to lube and Dr. Chapa’s response
• [05:56] – Review of lubrication for perineal trauma prevention
• [07:22]–[11:25] – Review of the 2019 meta-analysis
• [13:45]–[17:24] – Review of the 2022 meta-analysis and its limitations
• [17:24] – Real-world guidelines and their silence on this practice
• [20:40] – Practical risks and “can it hurt?” discussion

Conclusions & Clinical Pearls

• Lubrication is supported to reduce perineal trauma, especially with perineal massage in primiparas.
• Evidence does not support using lubricant to speed up or facilitate vaginal delivery in second stage labor.
• No major US or international guidelines recommend this practice for delivery assistance.
• Lubricant use may complicate vacuum or forceps delivery if not thoroughly removed.
• Anecdote ≠ evidence: “Not for that. Unless you’re doing it just to protect the pelvic floor.”

Summary Table: Lubricant Use in Labor

| Purpose | Supported by Evidence? | Level of Evidence | Guideline Backing? | |-------------------------------------------|-----------------------|---------------------|--------------------| | Prevention of perineal trauma (massage) | Yes (esp. in primiparas) | Moderate/Conflicting | Sometimes recommended | | To facilitate/faster baby delivery | No | Low/Very Low | No |

Final Thought

“Podcast family, I think we’ve done what we’re supposed to do. ... As always, we’re thankful for you. ... And as always, we’ll see you on another episode of the No Spin Podcast.” (Dr. Chapa, [23:54])