Dogmas in Obstetrics: Evidence-Based Standards, Clinical Judgement and Patient-Centred Care

Obstetrics requires standards, guidelines and established pathways to support physiological birth and to manage rare emergencies reliably. Standards become problematic, however, when they are detached from their evidentiary basis, original indication or individual clinical context and are applied as dogmas. This narrative review and conceptual analysis examines typical mechanisms of dogmatic decision-making in obstetrics: routine interventions without individual indication, seemingly precise thresholds, medico-legal safety routines, inconsistent definitions of obstetric complications, psychological norms of 'correct' birth, and reservations towards digital innovation. Selected examples include foetal monitoring in low-risk labour, amniotomy and episiotomy, shoulder dystocia, timing of cord clamping, induction of labour, antenatal corticosteroid administration, maternal autonomy and patient-reported outcome and experience measures. The analysis argues that modern obstetrics can be neither dogma-free nor rule-free. Instead, it requires a reflective balance of standardisation, clinical judgement, team competence, transparent communication and organisational learning. Less dogmatic obstetrics does not imply arbitrariness; it means consistently linking each routine to evidence, plausibility, context, resources and the informed preferences of the patient.