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])

Transcript

Dr. Chapa (0:00)

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Dr. Chapa (1:06)

I'll get the lubricant. There's no time for lubricant. There's always job. A lubricant Podcast Family in this episode we're going to examine, we're going to tackle a not uncommon situation. If you do obstetrics, remember, obstetrics is our main vibe. Even though, even though we do occasionally. Well, not occasionally, more than occasionally, shows some love to gynecological topics and reproductive endocrinology. But obstetrics is where it's at for us. So here's the situation. The patient got to second stage. She's right there. She's about to deliver. That fetal head is just about or is crowning. In other words, we're at plus four or plus five and it just won't clear that introidal or perineal skin. So what do you do? Well, of course you grab some lube. Well then try axle grease. The idea of lubing the head out sounds good. I mean, after all, doesn't that make sense? What do you do to a ring on your finger that you can't take off? Well, you put a little lube on that. What do you do with a screw that won't unscrew? Well, you put a little bit of lubrication on that. And so the point is made. So traditionally, either baby shampoo or some kind of water soluble gel gets all coated on the baby's head because we're going to just gel that kid out of that vagina. I'll get the lubricant. There's no time for lubricant. There's always time for lubricant. The question is though, is that anecdotal practice or Is that actually evidence based? Is there data for this? So we're going to do, in this episode, we're going to examine two meta analyses that actually came up with different conclusions. However, in this episode, we are going to explain why one of those meta analyses probably should be trusted more than the other. So we're going to tackle lube it up to get that kid out. Does that work? Listen in for details. This is Dr. Chapa's obgyn no spin podcast. Podcast family. Well, in typical fashion, real world situations become inspirations for the show. This is my week of night call. And on one of these nights, on call, in the middle of the night, we had a patient who was at second stage of labor. Baby was right there at plus 5, but she had already developed intra amniotic infection IAI. During that second stage, we ordered the appropriate antibody antibiotics, gave her IV fluid hydration, but the baby has now gone to one hundred and sixty to one hundred and seventy because of the IAI and maternal temperature rise. So I look at the resident and I'm like, look, it's having typical second stage D cells. Baby now has tachycardia. It's persisting category two. We're right there at plus five and it's not happening. Let's get an outlet and just facilitate delivery. Resident said, yeah, no problem. Great. So as I turn around to open up the vacuum to hand it to the resident, I see copious baby shampoo lube cord all over the baby's head and the introitus. What are you doing? So I was like, wait, hey, hey, what's going on? What are we doing? And so his answer, very innocently enough, was, well, I was trying to lube it out so that we hopefully don't have to do a vacuum because it's right there. To which I said, well, that sounds great. The problem is if it doesn't come out and it hasn't, and we now try to do the vacuum, it's pretty darn hard to create tension and a suction vacuum with a bunch of lube and shampoo all over the baby's head. What are you doing? Yeah, well, it didn't deliver, so we had to wipe off the excess soap and finally did apply the vacuum. And it was a simple outlet vacuum. But all to say is that made the great discussion of brother, what is the data? Show me the evidence that lubing it up for delivery actually is a thing. And very honest. He said, wait, there's no data for that. Well, that led to this. What are you doing? Yeah, that led to this episode and that's why we are here. So it's interesting because lube in, in the vaginal area, slash. Perineum has been looked at in, in two ways, guys, right? The first way has been looked at for the prevention of perineal trauma with the idea that lubricated tissue, because there's less friction forces, are less likely to tear. And I gotta be honest, hey, there is some data for that. It's con. It's a little conflicting, but, but it still favors the trend is that perineal massage with lubrication at second stage, or ideally even before labor, like at 36 or 37 weeks to prepare for labor can relax the pelvic floor muscles, the ischiocavernosis, superior transverse perineal muscles, bulbocavernosis muscles, all of that stuff right at the introitus, that ug diaphragm, all of that can be loosened with massage. So if they're not going to do it antepartum, then beginning that second stage with a little bit of lubrication, especially on the superficial transverse peroneal muscles and the bulbo cavernosus muscles, yes, you can ideally reduce some perineal trauma. Even third and fourth degree lacks. Now that data has held true primarily in no lip parish patients. All right, once I've had a test of the vagina, test of passage, then typically that recall and that muscle laxity still stays there to some degree, although some of that can be recouped with Kegel exercises. However, if there's a long inter delivery interval, like you know, five years or so, then even though they're not in oliparis, perineal massage again could be considered because it's been such a long time since the last delivery. So yes, there is data where perineal massage and lubricant at the second stage, or once again ideally antepartum before labor begins can reduce some perineal trauma. That is a thing. Okay, but that's not really what we're going to talk about because our focus here is on lubing that kid up, grease it up so that he can slide out of the vagina like a slip and slide. Well, then try axle grease. Well, is that a thing? Well, let's take a look at the data and we're going to cover this rather than looking at individual studies, we're going to do systematic reviews and meta analyses because there's two that are relatively recent and the most recent One was in 2023. I'm sorry, 2022. And then the previous one was in 2019. So again, not long ago. And they have conflicting answers here. So I found this very interesting. So we're going to start as we walk down the timeline. First in 2019, in the Journal Maternal, Fetal and Neonatal medicine. That was December 2019. And then we'll jump ahead to 2022, where the second meta analysis was done. This one was in the Journal of Obstetrics and Gynecology Research. Two different systematic reviews separated in time by three to four years with two different results. However, one of these systematic reviews should be trusted more than the other. And that's not me saying that. I'm not being mean. The authors themselves, that quote, less trustworthy. End quote. Meta analysis tell you, they're like, hey, FYI, I told you what I found, but interpret it with caution because of this. And I'm explaining that here in a minute. Okay? So while there is some benefit, there has been some benefit to perineal massage for perineal trauma. That's not our focus here, okay? Our focus is on lubing the kid up to slide that kid out like a slip and slide. In 2019, the first systematic review on this, which we're gonna cover, was published. And I chose that one because, again, it's still relatively recent. And I thought it was very well done because they were very strict in their criteria. Of the studies that went in for this review, this was only three RCTs. Three RCTs. When we jump ahead to 2022, we're gonna talk about the second study, systematic review and meta analysis, that used 19 trials. So when you're less stringent of the criteria and the studies that you use, that that's gonna affect some of your results that make sense. So super tight, super strict criteria, you end up with three RCTs. Now, what was interesting is that in these studies, which a total N was only 512. Okay. The total study of participants here grouped together was 512. They included studies that used lubrication starting in the first stage of labor. Like, oh, hey, you're 4 centimeters, you're 6 centimeters, now you're 7 centimeters. And they applied lube. They lubed up the vagina starting in the. The first stage of labor. Oh, I don't want to critique somebody else's study or their design, but that's kind of weird. I mean, why would you do it? It's going to leak out. And again, it's not like a pipe that you're trying to put in another pipe into or a fitting that you got to keep lubing that up you, if you're going to do it, you'd figure that you would do it at second stage. But hey, what do I know? All trials used water soluble gel and they used about 2 to 5mls for each vaginal examination. Now that's different, okay? This is different than just a little bit of, you know, lube on your finger, you know, to do the cervical exam. This is purposely for the. For the purpose. Purposely for the purpose. Oh, Lord have mercy. See, I'm on nights, I'm telling you guys, this is what happens when you do this post call. They put lube in the vagina, not just as lubrication for the cervical exam. Okay, so two to five mls for each vaginal examination as it kind of coated the vaginal walls. All right, so short of it is, let's just get to the results. Quote. 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. End quote. So let's just stop there for a minute. So lubing it up did not prevent labor protraction. Lubing up the vagina like a pipe didn't prevent arrest of dissent. That is why there is zero international or national guidance that says, hey, are you kind of falling off the labor curb? Why don't you just lube up that puppy up, put a lot of grease in there and that's going to do it. Vaginal lubrication is not part of any national or international labor management guideline. So the conclusion was vaginal application of lubricant during labor does not reduce the length of second stage of labor in women with singleton gestations undergoing an attempt at spontaneous vaginal delivery at term. End quote.