A passion for supporting families during birth is the foundation for a career as a doula. But once that foundation has been laid, it takes business skills, boundaries, and collaboration to be sustainable.

In this episode, Dr. Rebecca Dekker talks with Katie Nyberg, founder of The Iowa Baby Ladies, about her journey from fifth-grade teacher to doula, trainer, and owner of one of Iowa's largest doula agencies. Katie shares the early lessons she learned about setting fees, communicating with clients, and navigating the unpredictable realities of on-call work. Katie also opens up about the exhaustion that once made her consider leaving birth work altogether, and the changes that helped her build a more sustainable career. She discusses how recognizing the root causes of burnout, diversifying income, creating intentional seasons of work and rest, and building supportive relationships with other doulas keep her going.

(02:05) Katie's journey from teacher to birth doula

(04:55) Early lessons in business, fees, and communication

(07:21) Setting healthy boundaries with clients

(11:40) Navigating childcare and the on-call doula lifestyle

(14:02) Preparing for long births and using backup support

(19:53) Recognizing and addressing doula burnout

(25:45) Saying no and making space for rest

(27:05) Growing The Iowa Baby Ladies

(33:41) Advice for new doulas getting started

(37:02) Overcoming imposter syndrome through education and experience

(43:13) Advice for building a lasting doula career

Resources

• Learn more about the EBB Instructor Program: https://evidencebasedbirth.com/become-an-evidence-based-birth-instructor/
• Find an EBB Instructor: https://evidencebasedbirth.com/find-an-instructor-parents/
• Follow Katie on Instagram: https://www.instagram.com/theiowababylady/
• Learn more about the Iowa Baby Ladies: https://theiowababylady.com/
• Evidence on: Doulas
• EBB 364 – How to Prevent and Heal Birthworker Burnout with Doctoral Student Ihotu Ali and Grace Flannery, Certified Professional Midwife

Perinatal mental health is often a misunderstood landscape shaped by stigma, cultural expectations, and invisible struggles that touch entire families.

In this replay episode, Dr. Rebecca Dekker sits down with Dr. Kat Kaeni, perinatal mental health certified psychologist, author of The Pregnancy Workbook, and host of the Mom & Mind podcast, to break the silence around postpartum anxiety, depression, OCD, and psychosis. Drawing on her professional expertise and personal experience, Dr. Kat reveals why shame and isolation are so common, how symptoms really show up for new parents, and what makes perinatal mental health distinct from other forms of mental illness.

They discuss the myths that keep parents suffering in silence, the real impact of mental health on babies and families, and how therapy and support groups, including free resources from Postpartum Support International, can empower families on the path to healing.

Content Warning: This episode includes discussions of perinatal mental health disorders, including postpartum depression, anxiety, OCD, and psychosis. Sensitive topics such as intrusive thoughts, stigma, feelings of guilt and shame, and the potential for harm to self or others are addressed. Listener discretion is advised, and we encourage anyone who may be affected by these topics to reach out for support through Postpartum Support International or a trusted healthcare provider.

(00:07:28) Unique Challenges in Perinatal Mental Health (00:11:05) Caregivers' Mental Health and Bonding Challenges (00:16:32) Parental Isolation Stemming from Anxiety and Depression (00:21:53) Emergent Postpartum Psychosis Symptoms (00:27:08) Overcoming Stigma in Perinatal Mental Health (00:31:54) Thought and Behavior Change Therapy for Depression (00:36:56) Perinatal Mental Health Challenges and Support

Resoureces

• EBB 197 – Addressing Perinatal Mental Health for Communities of Color with the Co-Founders of the Perinatal Mental Health Alliance for People of Color, Divya Kumar, Jabina Coleman, and Desirée Israel
• Postpartum Support International
• The Mom & Mind Podcast
• The Pregnancy Workbook: Manage Anxiety and Worry with CBT and Mindfulness Techniques

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Pregnancy, birth, and postpartum care should support the whole person, physically and mentally. In this episode, Dr. Rebecca Dekker talks with board-certified OB/GYN and perinatal coach Dr. Jessica Vernon about how integrative medicine can create a more holistic and personalized approach to obstetric care.

Dr. Vernon explains how integrative care combines traditional Western medicine with complementary approaches such as therapy, physical therapy, acupuncture, yoga, breathwork, meditation, and nutrition. She also shares how her own experience with postpartum anxiety and depression transformed the way she practices medicine and deepened her understanding of the physical, emotional, and identity-related transitions into parenthood. Plus, get practical guidance for changing providers, asking informed questions after a prior Cesarean, and navigating the overwhelming, and sometimes unreliable, health information found through social media and artificial intelligence.

(00:02:03) Dr. Vernon's journey into obstetrics and the influence of midwifery (00:05:47) Understanding matrescence and the transition into parenthood (00:07:14) What integrative medicine looks like in pregnancy and postpartum care (00:09:59) Bringing perinatal mental health and integrative medicine into obstetric practice (00:12:19) Gaps in traditional perinatal care and the need for individualized support (00:16:59) Supporting parents after infertility, pregnancy loss, birth trauma, or a difficult postpartum experience (00:21:32) Why it is okay to change providers (00:24:31) How infertility and pregnancy loss can shape a subsequent pregnancy (00:27:25) Practicing evidence-based, person-centered care that protects patient autonomy (00:29:02) Finding trustworthy pregnancy information online (00:32:27) Balancing medical evidence with personal intuition and individual circumstances

Resources

Connect with Dr. Vernon and learn more about her 1:1 perinatal coaching: https://www.drjessicavernon.com/

Follow Dr. Vernon on Instagram: https://www.instagram.com/dr.jessicavernon/

Then Comes Baby: An Honest Conversation About Birth, Postpartum, and the Complex Transition to Parenthood by Dr. Jessica Vernon: https://www.bloomsbury.com/us/then-comes-baby-9781538195925/

Matrescence: On Pregnancy, Childbirth, and Motherhood by Lucy Jones: https://www.penguinrandomhouse.com/books/714054/matrescence-by-lucy-jones/

Free Postpartum Support International online support groups: https://postpartum.net/get-help/psi-online-support-meetings/

PSI Perinatal Mental Health Provider Directory: https://postpartum.net/get-help/provider-directory/

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

After years of hearing traumatic birth stories and questioning whether parenthood was right for her, Heidi Gustad entered pregnancy determined to make informed decisions every step of the way. When she was diagnosed with insulin-managed gestational diabetes, debilitating migraines, and a rare umbilical cord abnormality called an umbilical vein varix, the birth center birth she had envisioned was suddenly no longer an option. In this episode, Heidi shares how evidence-based education, a supportive care team, and careful preparation helped her navigate unexpected changes with confidence. She and Dr. Dekker discuss what it was like to advocate for herself through multiple diagnoses, switch care providers late in pregnancy, and prepare for a hospital birth while still hoping for an unmedicated labor. Heidi also shares the surprising series of events that led to spontaneous labor before her scheduled induction, and how she welcomed her baby after a fast, nine-hour labor. (01:36) Overcoming a lifelong fear of pregnancy and choosing parenthood (05:13) Navigating migraines, gestational diabetes, and changing providers (08:52) Risking out of birth center care and finding the right hospital (11:11) Understanding a rare umbilical vein varix diagnosis (17:47) Building confidence through education, advocacy, and a supportive birth team (21:59) Preparing for birth with physical therapy, acupuncture, and evidence-based resources (25:50) Spontaneous labor begins weeks before a scheduled induction (32:02) Coping strategies for a fast, unmedicated labor (37:19) Postpartum recovery and breastfeeding (40:42) Heidi's advice on informed decision-making and birth preferences (43:06) Using anxiety and pain-coping techniques during labor Resources Find an EBB Childbirth Class: evidencebasedbirth.com/parentclasses/ Diagnosing Gestational Diabetes and the Glucola Test Evidence on: Induction for Gestational Diabetes Listen to EBB's Natural Induction Series on Acupuncture, Raspberry Red Leaf Tea, and Nipple Stimulation: evidencebasedbirth.com/category/series/natural-labor-induction-series/ EBB 304 – Q & A on PPD/Pitocin, Delayed Cord Clamping, Nubain, and Placental encapsulation: evidencebasedbirth.com/ebb-304-q-and-a-on-ppd-pitocin-delayed-cord-clamping-nubain-and-placental-encapsulation/ Read the research on Umbilical Chord Varix

• Fetal intra-abdominal umbilical vein varix: retrospective cohort study and systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/28876490/
• Isolated fetal umbilical vein varix and the association with intrauterine fetal death and fetal growth restriction: A systematic review, meta-analysis, and nested retrospective cohort study: https://pubmed.ncbi.nlm.nih.gov/38502055/
• The Development of the Umbilical Vein and Its Anatomical and Clinical Significance: https://pmc.ncbi.nlm.nih.gov/articles/PMC11954436/

Learn more about Spinning Babies®: spinningbabies.com For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Congenital cytomegalovirus (CMV) is the leading infectious cause of congenital disorders in the United States, but many pregnant families have never heard of it. In this episode, Dr. Dekker is joined by author Megan Nix who shares the personal story behind her memoir, "Remedies for Sorrow," and discusses how gaps in the system leave many families unaware of this common virus. Megan shares how her daughter Anna's congenital CMV diagnosis changed her family's life and launched her years-long investigation into why such a common condition remains largely absent from prenatal education. You'll learn what CMV is, how it spreads during pregnancy, evidence-informed prevention strategies, newborn screening and treatment, and why informed consent and narrative medicine matter for families navigating pregnancy and birth.

(02:01) Megan's journey into motherhood and how Anna's diagnosis led her to write the book (07:04) What congenital CMV is and why so few families know about it (10:26) Why CMV prevention isn't routinely discussed during pregnancy (15:40) Megan's illness during pregnancy and the missed opportunities for diagnosis (18:00) Antiviral treatment for newborns with congenital CMV (22:50) Steps pregnant families can take to reduce CMV exposure (25:55) Newborn screening for CMV and the current landscape of universal testing (32:16) Hearing screening, progressive hearing loss, and why early diagnosis matters (34:05) Parenting a child with developmental delays and what Anna has taught their family (40:11) Finding her voice, self-advocacy, and overcoming the culture of silence (46:41) Megan's final advice for pregnant families and where to learn more

Resources Get your copy of "Remedies for Sorrow": penguinrandomhouse.com/books/704982/remedies-for-sorrow-by-megan-nix/ Learn more about the National CMV Foundation: nationalcmv.org/ EBB 185 – The History of Narrative Medicine and Childbirth with Tyler Jean Dukes For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Fundal massage, also known as uterine massage, is often performed as a routine procedure after birth, but research shows it does little to prevent postpartum hemorrhage and can be painful for many. On today's replay episode of the EBB Podcast, nurse, community educator, and advocate Barbie Christianson joins Dr. Rebecca Dekker to talk about the myths surrounding this common postpartum procedure and how it connects to broader patterns of obstetric violence in maternity care.

Barbie explains the difference between a fundal assessment, a routine massage, and the massage used to treat active postpartum hemorrhage, and walks through what the evidence actually shows about each approach. She also shares trauma-informed scripts that nurses and providers can use to explain what they are doing and obtain informed consent, even in urgent, fast moving situations. Learn how unit culture, staffing, and fear based practice patterns can affect whether an unnecessary intervention becomes the default standard of care, and how to speak up and advocate for respectful care.

(02:40) Barbie's path from special education to labor and delivery nurse (04:36) Witnessing obstetric violence as a new nurse and learning the term (10:52) Defining fundal assessment versus fundal massage (18:06) When uterine massage is actually medically necessary (22:07) Recap: fundal assessment, routine massage, and massage for active hemorrhage (23:01) What the research says about routine fundal massage (26:04) How forceful and painful routine massage can be without consent (30:35) Misinformation about fundal massage on social media (34:11) Scripts for advocating for yourself if massage is done without medical need (37:00) How to assess and massage your own fundus after birth (39:26) What your uterus should feel like in the days after birth (44:35) A message to nurses who want to change their practice (45:11) Trauma-informed scripts for when massage is medically necessary (53:30) Unit culture and unaddressed trauma among nurses and providers

Resources

The Evidence on Pitocin During the Thrird Stage of Labor: ebbirth.com/thirdstage

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab a Pocket Guide, the My Doula Visit Workbook, or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the waitlist for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Emily Cook hoped for a low-intervention birth. But after managing high blood pressure throughout her pregnancy, her plans changed when she was diagnosed with preeclampsia late in her third trimester. In this episode, Emily shares how the EBB Childbirth Class helped her prepare to navigate an unexpected induction, magnesium therapy, and an epidural while still advocating for the birth experience she wanted. She talks about asking questions, requesting a lower-dose epidural so she could remain mobile, advocating for wireless fetal monitoring and hands-and-knees pushing, and finding confidence in making informed decisions even when things didn't go as planned. Emily also reflects on the emotional realities of postpartum, from recovering after preeclampsia and establishing breastfeeding to navigating grief after the unexpected loss of her grandmother just weeks after giving birth. Her story is a reminder that birth is only one part of the transition to parenthood, and that caring for the birthing parent is just as important as caring for the baby. (02:04) How Emily Found EBB (04:29) Her Original Birth Plan and Adapting to Preeclampsia (07:36) Advocating for Individualized Care During Labor (09:22) High Blood Pressure, Triage, and Preeclampsia Diagnosis (15:03) Induction Begins (20:08) Magnesium Drip and Feeling "Tethered" During Labor (25:57) Comfort Measures and Movement (29:07) Pushing on Hands and Knees and Meeting Her Baby (35:57) Postpartum Recovery and Continued Monitoring (40:47) Recovering from Preeclampsia (42:06) Grief and Postpartum (49:06) Emily's Advice for Expecting Parents Resources Learn more about the EBB Childbirth Class: evidencebasedbirth.com/parentclasses/ EBB 391 – Electronic Fetal Monitoring Advocacy Tips with Dr. Jennifer Lincoln, OB/GYN and Author of The Birth Book EBB 349 – An L & D Nurse's Advice for Advocating in the Birth Room with Trish Ware the Labor Nurse Mama Evidence on: Pitocin® During the Third Stage of Labor For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

How long does the pushing phase of labor typically last? Does precipitous labor run in families? And can drinking okra water actually make labor and birth easier?

In this Q&A episode, Dr. Rebecca Dekker tackles three questions submitted by EBB Pro Members. First, Dr. Dekker details the findings of a recently published study from France that found many birthing people spent less than 15 minutes actively pushing before birth. She explains the concept of delayed pushing and why these results may not be easily replicated in other birth settings. She also reviews the available evidence on precipitous labor, birth that occurs within three hours of the onset of contractions, and discusses whether fast labors appear to run in families. Finally, she examines the growing social media trend of drinking okra water during pregnancy, exploring the cultural history of okra as a nutritious food, separating popular claims from scientific evidence, and discussing what researchers currently know (and don't know) about its effects during pregnancy.

(02:34) Delayed pushing and active pushing times under 15 minutes (04:22) Understanding delayed pushing practices in France versus the United States (05:33) Study methods, hospital protocols, and participant characteristics (06:56) Results: Average pushing times, epidural effects, and birth outcomes (08:14) Key takeaways from the delayed pushing study (10:53) Does precipitous labor run in families? (12:21) Research on precipitous labor risk factors and prevalence (14:20) Is there evidence that fast labor is hereditary? (15:05) What are the benefits of drinking okra water during pregnancy? (17:46) Popular social media claims about okra water (18:46) What researchers did and did not find about okra water (21:15) Okra's cultural significance in pregnancy and postpartum traditions

For a full list of references, visit ebbirth.com/404.

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Even when caring for similar patient populations, some hospitals have significantly higher Cesarean rates than others, and factors like teamwork, psychological safety, leadership, staffing, and beliefs about childbirth can affect outcomes. In this episode, Dr. Rebecca Dekker talks with family physician and researcher Dr. Emily White VanGompel about how the culture of labor and delivery units can shape decision-making and influence the birth experience for families. Dr. White VanGompel explains the NTSV (nulliparous, term, singleton, vertex) Cesarean rate, why it is used as a quality measure, how hospitals have successfully reduced unnecessary Cesareans, and what families can look for when choosing a birth setting that supports vaginal birth. Plus, learn about the Labor Culture Survey (LCS), Dr. White VanGompel's research on the impact of the ARRIVE Trial on provider attitudes, and why conversations about reducing Cesarean overuse are important from a public health perspective. (01:58) Growing up around home birth and discovering differences in birth culture during medical training (09:05) How family medicine influences perspectives on childbirth, postpartum care, and long-term family health (12:46) What NTSV Cesarean rates are and why they are used as a quality measure (16:19) Defining labor and delivery unit culture and how it affects Cesarean decision-making (19:23) Lessons from hospitals that successfully reduced Cesarean rates (23:50) Real-world examples of hospitals that transformed their birth culture and lowered Cesarean rates (29:36) Common attitudes and beliefs associated with higher Cesarean rates (32:32) The Labor Culture Survey (35:44) The ARRIVE Trial, provider attitudes toward induction, and shifting birth culture (43:01) How families can evaluate hospitals and providers when seeking support for vaginal birth (48:24) Midwifery models of care and their potential role in supporting vaginal birth (52:40) How personal birth experiences influence clinician attitudes toward Cesarean and vaginal birth Resources View the original validation study that explains the creation of the LCS: https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12406 See how the first statewide use of the LCS found an association between labor culture and hospital-level cesarean rates: https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13123 Deep-dive into this qualitative study about how hospitals that lowered their cesarean rates changed their cultures: SpringerAccess research journals, articles, books and more | Springer Nature Linkarticle/10.1186/s12913-024-12108-3 See how this study used the Labor Culture Survey (LCS) to compare clinician beliefs and attitudes about induction of labor before and after the publication of the ARRIVE Trial: Sciencedirectsciencedirect.com science/article/abs/pii/S0884217522003914 For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

This summer, join Dr. Rebecca Dekker and the EBB Research Team for a four-part live series on "How to Read Research," starting June 30.

Get access to the full Summer School Series by joining the Quarterly EBB Pro Membership at a special summer rate!

Plus, enroll by June 28 and receive a free digital EBB Pocket Guide to Labor Induction!

Learn more and save your seat in our virtual classroom: ebbirth.com/summer

The way we move during labor shapes far more than our comfort. It helps determine how a baby navigates through the pelvis, and whether a birth can unfold with fewer interventions!

In this replay episode, Dr. Rebecca Dekker talks with Brittany Sharpe McCollum, a childbirth educator, doula, lactation counselor, and pelvic biomechanics educator. Brittany explains how the bones of the pelvis move during labor, why that movement matters for fetal positioning, and how everyone can benefit from intentional position changes during labor-- whether you're planning an unmedicated birth or not!

They explore the three planes of the pelvis, why opening the pelvic inlet and outlet require opposite movements, and how to match specific positions to where the baby is located in the pelvis. Brittany also shares her 5-4-3 rule for position changes, practical tips for inductions and epidurals, the power of asymmetrical positioning, and why movement is one of the few birth tools that carries benefit without risk.

(06:25) Exploring movement in childbirth (10:19) Understanding baby's position in labor (13:03) Benefits of movement during labor (17:31) Subtle pelvic movements in labor (23:05) Partner role during contractions (25:17) Managing rectal pressure during labor (27:57) Movement during labor (32:21) Importance of prenatal education (37:35) Understanding racism in obstetrics

Resources EBB Signature Article on the Evidence on Birthing Positions: ebbirth.com/birthingpositions Learn more about Brittany: blossomingbelliesbirth.com "Baby Got VBAC: An Inspiring Collection of Wisdom for Better Births After a Cesarean" Connect with Brittany on Instagram: @blossomingbelliesbirth

For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.