#281 | Dr. Philpott; Ob/GYN: what men should know can go wrong during childbirth

About this episode

Vance opens the "Memento Mori" five-part death-and-life series with OB/GYN Dr. Tim Philpott, using his own experience as a father (natural delivery, a scheduled C-section, and a scary low-oxygen moment with his second daughter) to steer a wide-ranging conversation about childbirth. Philpott walks through epidural mechanics and rates, the psychology of dads who "wither" in the delivery room, the statistics and unpredictability of stillbirth and miscarriage (one in three pregnancies), and the emotional split between joy and grief that defines the job. A recurring throughline is institutional risk and innovation: the ARRIVE trial upending induction/C-section assumptions, the thalidomide and DES tragedies and the FDA reviewer who blocked thalidomide in the US, and the reality of malpractice as literally the third-largest line-item expense in his practice after rent and personnel. Philpott and Vance also dig into the "philosophical," sometimes adversarial split between medical obstetrics and midwifery, COVID-era delivery-room restrictions, postpartum depression, and Philpott's direct, personal framing of the fertility "window" — advising patients to make a yes/no decision about having children by age 35 given declining physiological odds after that point. The episode closes on a warm story about a couple who lost a baby to stillbirth and later had a healthy son (and then twins) with Philpott's care, and transitions into a Legacy Interviews clip with Ben Lawler on brotherhood and family businesses.

“The fertility doesn't last forever. And so striking a balance is, is as usual probably the better option... I usually say make your decision by the time you're 35. That doesn't mean you have to have a baby by the time you're 35, but you wanna make your decision about will I or won't I have a try to have children.”

“I think most people really want to have a connection, an emotional connection with their OB GYN. And so I think that is a very, it's a great comfort when you have that connection, you feel like there's a greater level of trust. And that's a huge part of what we do.”

“There was another drug or was another drug called DES... This woman at the FDA was a hero and that she recognized that there was something missing from the data, that it didn't appear to be as safe as it was originally advertised... She blocked it and thank God, because she saved a lot of babies.”

Key moments

• Framing of the Memento Mori series and the philosophy of memento mori — remembering mortality to value the present.
• Epidural rates (~85%) and mechanics; distinction between "natural" and "unmedicated" delivery language.
• Miscarriage framed as "a club" — comfort found in learning it's common (1 in 3 pregnancies) rather than a personal failure.
• The "adversarial" tension between midwife philosophy (labor as natural process) and OB training (intervene, medicate, operate) — reframed by Philpott as "philosophical differences," not adversarial.
• The ARRIVE trial (NEJM, Aug 2018) reversed conventional wisdom that induction raises C-section risk — 39-week induction now shown to lower it.
• Physical mechanics of a C-section described in detail, including the risks (bleeding, infection) and the bacterial-flora difference for C-section babies.
• Thalidomide and DES stories — an FDA reviewer's caution in the 1950s-60s prevented US thalidomide approval; contrasted with the difficulty of running new-drug trials in pregnant populations today.
• Malpractice cost is the third-largest line item in Philpott's practice expenses, and residency training doesn't formally cover it.
• The fertility "window of opportunity" — advice to decide by 35 whether to have children, balanced against career timing and rising chromosomal-abnormality risk with age.

Notable quotes

“The fertility doesn't last forever... make your decision by the time you're 35.”

“This woman at the FDA was a hero... she saved a lot of babies.”

“I've got about eight minutes where I've gotta get... ready to go... slap yourself in the face.”

“It's the like number three line item on my expenses... after rent and personnel.”