In this episode, Dr. Rebecca Dekker dives into the evidence-practice gap, the disconnect between what research tells us is best during childbirth and what is actually happening in labor and delivery units around the world. She walks through the latest statistics on Cesarean rates, VBAC access, and the widespread use of non–evidence-based interventions, as well as the persistent underuse of practices proven to improve outcomes, like doulas, midwifery care, and birthing positions that support physiologic labor. Dr. Dekker also unpacks the systemic forces driving these gaps, including the role of paternalism, hierarchical power structures in healthcare, legal pressures, and the phenomenon of horizontal violence among healthcare workers. She explores how overlapping forms of oppression shape the experiences of both patients and providers. (02:40) Why research takes so long to become routine care (03:42) A look at U.S. cesarean rates and what's driving them (05:38) The rise and fall of VBAC access and why families struggle to get support (08:01) The "bait and switch" problem in maternity care (09:34) Interventions that are overused vs. underused during labor (11:47) How paternalism and medical hierarchy fuel the evidence gap (16:39) Horizontal violence among nurses, midwives, and doulas (19:11) Trauma and burnout across the maternity care workforce (23:04) Real signs of progress and positive change in birth settings Resources EBB 1 - Intro to Evidence Based Birth EBB 2 – What is Evidence Based Care? Listening to Mothers in California (Sakala et al., 2018) Basile Ibrahim et al. (2020) study on VBAC access and barriers Register for the EBB Course: How to Help Families Get Evidence-Based Care: evidencebasedbirthacademy.com/register/course-how-to-help-families-get-evidence-based-care/ 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.

Tras lo que debería haber sido un parto feliz, Sofía Herrera, (educadora perinatal, instructora de EBB, instructora de Hipnoparto y psicóloga social y clínica) pasó casi 20 años creyendo que padecía depresión posparto, hasta que sus estudios revelaron la verdad: había sufrido un trauma obstétrico. Esta revelación se convirtió en el motor de su trabajo de apoyo a las mujeres que dan a luz y de su lucha contra la violencia obstétrica generalizada y la desinformación arraigada en el sistema de atención a la maternidad en México. Sofía comparte lo que realmente significa el trauma, cómo las intervenciones sin consentimiento y la atención paternalista influyen en la experiencia del parto, y por qué tantas familias creen erróneamente que "fracasaron" cuando, en realidad, fue el sistema el que les falló. También describe los desafíos del parto en México —desde las altísimas tasas de cesáreas hasta las episiotomías de rutina— y cómo la educación basada en la evidencia empodera a las familias para encontrar una atención más segura y respetuosa. (02:26) El recorrido de 20 años de Sofía viviendo con un trauma no tratado (06:45) Patrones que observó como educadora de parto (10:20) Por qué el trauma psicosocial en el parto está poco investigado y mal comprendido (12:18) La propia experiencia de parto de Sofía (18:23) Las altísimas tasas de cesáreas en México (19:48) Cómo se manifiesta el paternalismo culturalmente y en las relaciones clínicas (21:08) Episiotomías de rutina y "protocolos" obsoletos que aún se enseñan (22:24) ¿Puede la educación sobre el parto prevenir el trauma? Cómo las familias informadas cambian el sistema (28:35) Diferencias entre hospitales privados y públicos en México (32:38) Cómo Sofía utiliza los recursos de EBB para apoyar y empoderar a las familias (35:19) El mejor consejo de Sofía para las familias que temen la violencia obstétrica o un trato irrespetuoso Recursos Conecta con Sofía: @sukhamoms Obtén folletos de EBB en español: evidencebasedbirth.com/translations/ Para obtener más información sobre Evidence Based Birth® y un curso intensivo sobre atención basada en la evidencia, visite www.ebbirth.com. ¡Síganos en Instagram y YouTube! ¿Listo para aprender más? Descargue la Guía de escucha del podcast de EBB o lea el libro de la Dra. Dekker, "Babies Are Not Pizzas: They're Born, Not Delivered!". Si desea participar en EBB, únase a nuestra membresía profesional (hay opciones de becas disponibles) e inscríbase en la lista de espera para nuestro programa de instructores de EBB. Encuentre un instructor de EBB aquí y haga clic aquí para obtener más información sobre las clases de preparación para el parto de EBB.

After what should have been a joyful birth, Sofía Herrera (childbirth educator, EBB Instructor, Hypnobirthing instructor, and social & clinical psychologist) spent nearly 20 years believing she had postpartum depression, until her investigation revealed the truth: she had experienced birth trauma. That realization became the catalyst for her work supporting birthing families and confronting the widespread obstetric violence and misinformation embedded in Mexico's maternity care system. Sofía shares what trauma really means, how unconsented interventions and paternalistic care shape birthing experiences, and why so many families mistakenly believe they "failed" when in reality, the system failed them. She also describes the challenges of childbirth in Mexico—from extremely high Cesarean rates to routine episiotomies—and how evidence-based education empowers families to find safer, more respectful care. (02:26) Sofía's 20-year journey living with untreated trauma (06:45) Patterns she saw as a childbirth educator (10:20) Why psychosocial trauma in birth is under-researched and misunderstood (12:18) Sofía's own birth experience (18:23) Mexico's extremely high Cesarean rates (19:48) How paternalism shows up culturally and inside clinical relationships (21:08) Routine episiotomies and outdated "protocols" still being taught (22:24) Can childbirth education prevent trauma? How informed families change the system (28:35) Differences between private vs. public hospitals in Mexico (32:38) How Sofía uses EBB resources to support and empower families (35:19) Sofía's top advice for families fearing obstetric violence or disrespectful care Resources Connect with Sofía: @sukhamoms Get EBB Handouts in Spanish: evidencebasedbirth.com/translations/ 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.

In this episode, Dr. Rebecca Dekker explores the research on birthing positions and tried-and-true midwifery practices for protecting the perineum during childbirth. She explains why the flat-on-your-back position we often see on television isn't ideal and walks through the key differences between upright, sacrum-flexible positions, and common hospital practices like lithotomy and routine episiotomies. Dr. Dekker reviews data from global research as well as real-world wisdom from midwives, including the extraordinary outcomes of hands-off, undisturbed birth approaches in the Philippines. She uncovers how hospital system pressures, caregiver convenience, and even obstetric violence drive the overwhelming use of recumbent positions and invasive interventions while sidelining evidence-based, patient-centered care. You'll hear firsthand strategies for minimizing severe tears, promoting intact perineums, and advocating for birth plans that prioritize the autonomy and comfort of birthing people. Content Warning: Discussion of tears of the vagina, severe tears from the vagina to the rectum, obstetric violence related to episiotomies, and being forced giving birth on your back. Resources

• For a full list of resources, visit: ebbirth.com/221
• Watch the video version here on our YouTube channel which includes study breakdowns and PowerPoint slides.
• Protecting the Perineum Series:
  • EBB 206 - Evidence on Perineal Tears and the Importance of Avoiding Episiotomy with EBB Founder, Dr. Rebecca Dekker
  • EBB 210 - Evidence on Warm Compresses and Hands-on vs. Hands-off for Protecting the Perineum
  • EBB 216 - The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker
  • EBB 218 - The Evidence on Perineal Massage during Labor with Dr. Rebecca Dekker

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 more than 80 hours of labor, Erica Wright found herself exhausted, emotional, and determined to keep trusting her body. With the steady support of her doulas (including EBB Instructor Tara Thompson), she discovered that birth doesn't have to go "according to plan" to be powerful. In this episode, Dr. Rebecca Dekker talks with Erica and Tara about how preparation, advocacy, and teamwork carried them through a marathon labor filled with unexpected turns. From switching hospitals late in pregnancy to finding strength through challenges, their story exemplifies flexibility, informed choice, and the power of doula support. (05:55) Tara's updates from Atlanta and her path to becoming an IBCLC (09:17) Erica's lightbulb moments from the EBB Childbirth Class (11:22) Switching hospitals at 35 weeks and advocating for the right fit (16:18) Labor begins: prodromal labor, GBS, and waiting for spontaneous birth (24:30) Hospital admission, challenges with staff, and early interventions (32:17) The Pitocin battle and advocating for movement and monitoring choices (35:40) Finding a supportive nurse and regaining freedom during labor (39:53) Tara's night shift: rest, affirmations, and encouragement (44:20) Deciding on the epidural and reframing "failure" as flexibility (49:18) The final stage: rest, relief, and meeting baby (55:12) Postpartum recovery and breastfeeding challenges (01:00:25) Tara's advice for navigating long labors (01:02:43) Erica's reflections on flexibility, intuition, and informed choice Resources Get in touch with Tara: tarasbirthservices.com | @taras.birthservices Connect with Tara's teammate, Brittany: @wellpreparednest Listen to EBB 146 - How Doula and EBB Instructor Tara Thompson Supports Families in Atlanta Listen to EBB 357 – Making Decisions about Elective Induction of Labor with Dr. Ann Peralta & Kari Radoff, CNM, from Partner to Decide The Evidence on: GBS (Group B Strep): evidencebasedbirth.com/groupbstrep/ The Evidence on: Pitocin During the Third Stage of Labor: evidencebasedbirth.com/evidence-on-pitocin-during-the-third-stage-of-labor/ Epidural during Labor for Pain Management: evidencebasedbirth.com/epidural-during-labor-pain-management/ Learn more about the Evidence Based Birth Childbirth Class: evidencebasedbirth.com/childbirthclass 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.

Across generations, birth workers have held space for families with skill, love, and deep purpose. In this episode, Dr. Rebecca Dekker talks with Elder Midwife Charlotte Shilo-Goudeau, a licensed Certified Professional Midwife from Louisiana, and Chanté Perryman, Director of Programs at Evidence Based Birth®, certified doula, and student midwife. Together, they explore what it means to embrace the dual calling of doula work and midwifery and how both roles are acts of service, advocacy, and healing. Elder Charlotte shares her journey from personal loss to becoming one of only a few Black midwives in Louisiana, carrying forward the wisdom of generations. Chanté reflects on how her experiences as a doula shaped her path into midwifery and her vision for compassionate, individualized care. They remind us that titles may change, but the heart of this work remains the same: being present, being of service, and being called to birth. (03:46) How Chanté's Birth Experience Inspired Her to Become a Doula (05:42) Elder Charlotte's Journey from Stillbirth to Midwifery as a Calling (10:59) How Doula Work Shapes Midwifery Care and Philosophy (14:34) Serving Underserved Communities as One of Four Black Midwives in Louisiana (19:01) Shifting from Midwife to Doula During Hospital Transfers (24:08) Chanté's Perspective on Identity, Service, and Humility in Birth Work (28:40) Micro vs. Macro Advocacy: Supporting Families and Legislative Change (37:29) Navigating Hospital Restrictions During the Pandemic (42:57) Lessons from Midwifery School (45:30) Advice for Those Considering Doula or Midwifery Paths Resources Follow Chanté on Instagram: @babydreamsmc Connect with Ms. Charlotte: midwifecharlotte.com Connect with an Evidence Based Birth® Instructor: directory.evidencebasedbirth.com Learn more about the National Perinatal Task Force: perinataltaskforce.com Visit the Commonsense Childbirth School of Midwifery: commonsensemidwifery.org Check out the Kentucky Birth Coalition: kentuckyhomebirthcoalition.com Visit the Mercy In Action College of Midwifery: mercycollegeofmidwifery.edu 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.

Introducing the My Doula Visit Workbook by Evidence Based Birth®. A tangible, interactive, and evidence-based guide designed to facilitate conversations, strengthen the doula-client relationship, and guide families through the most pressing topics related to pregnancy, birth, and postpartum.

What's Inside the My Doula Visit Workbook?

• A 115-page, full-color, spiral-bound workbook packed with evidence-based resources
• Structured guides for up to six prenatal visits + one postpartum check-in (but fully customizable to your practice!)
• 18 official EBB handouts, birth plan templates, journaling prompts, discussion questions, activities, podcast playlists, and postpartum guides
• Real-life photographs, colorful graphics, and easy-to-use worksheets
• Access to an exclusive online resource page with additional videos, worksheets, and more!

Want flexibility? No problem! Choose which sections to cover in person, virtually, or assign as self-study for your clients.

Orders open on Monday, November 24 at 12:00 p.m. EST with bulk ordering discounts available. Learn more and explore the workbook at ebbirth.com/doulaworkbook.

Want early access and special perks? Join the waitlist at ebbirth.com/waitlist to shop 2 hours early!

What if everyone had access to a doula, no matter their income? In this episode, Dr. Dekker talks with Amy Chen, Senior Attorney at the National Health Law Program (NHeLP), about the growing movement to make doula care accessible through Medicaid and insurance coverage. Amy shares how her personal birth experiences inspired her work advocating for Medicaid reimbursement for doulas and explains how more than 20 states (and counting) are now implementing or expanding coverage. They also unpack the biggest challenges and successes so far, from sustainable reimbursement rates and certification requirements to how doulas can navigate the Medicaid billing process. (03:17) How Amy's birth experiences led her to advocate for Medicaid coverage of doula care (06:54) The national shift toward Medicaid coverage for doulas after 2016 and early state pilots (11:50) How 23 states plus D.C. have implemented Medicaid doula benefits and what comes next (15:46) Lessons from California's rollout: raising reimbursement from $450 to $3,200 through advocacy (20:57) Why equitable reimbursement matters for sustaining the doula workforce (25:52) How families can find out if doula care is covered through Medicaid, private insurance, or employers (29:53) TRICARE's pilot program for military families and expansion to overseas bases (31:42) The challenges doulas face with Medicaid billing and how "doula hubs" help streamline the process (36:49) How upcoming federal Medicaid cuts could threaten maternal health gains (45:28) New 2024 research showing doula care cuts cesarean rates in half and lowers preterm births (48:12) Closing thoughts and key resources for doulas, advocates, and policymakers Resources NHeLP Doula Medicaid Project: https://healthlaw.org/doulamedicaidproject/ Best Practices for Medicaid Coverage of Doula Care (2025): https://healthlaw.org/doulamedicaidproject/bestpractices/ NHeLP Doula Medicaid Project State Tracker Chart: https://tinyurl.com/NHeLPStateTracker CA Department of Health Care Services Doula Benefit Implementation Report: https://www.dhcs.ca.gov/provgovpart/Documents/Doula-Benefit-Report.pdf Private Insurance Coverage of Doula Care: Spring 2025 State of the States: https://healthlaw.org/private-insurance-coverage-of-doula-care-spring-2024-state-of-the-states/ A Cost-Benefit Analysis of Doula Care from a Public Health Framework: https://healthlaw.org/resource/a-cost-benefit-analysis-of-doula-care-from-a-public-health-framework/ 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.

Hiring a doula can be one of the most impactful choices you make during pregnancy, but how do you actually find the right one? In this episode, Dr. Rebecca Dekker talks with Team EBB members and experienced doulas, Julie Fors and Chanté Perryman, to share insider tips on finding and interviewing a doula with confidence. Julie and Chanté walk you through where to begin your search, the most important questions to ask, and how to know if a doula's personality and philosophy are the right fit for you and your partner. They also tackle misconceptions about doula work, explain backup plans and postpartum support, and discuss how insurance and Medicaid are changing access to doula care. (06:19) The pillars of doula support (09:06) Where to start your doula search: Google, recommendations, and directories (12:20) Why interviews are essential before hiring a doula (17:49) Key questions to ask a potential doula (style, philosophy, postpartum support) (23:58) Backup doula plans and long labors (29:45) Common misconceptions about doulas and how to clear them up (33:30) Shifts in doula access: insurance, Medicaid, and nonprofit programs (37:06) How childbirth education and doula support work together (39:09) Tips for finding a postpartum doula and planning ahead (42:46) Overcoming nervousness about reaching out to doulas Access the EBB Signature Article, "Evidence on: Doulas" for all the scientific research on doulas + a comprehensive list of doula directories and interview questions! Resources Something new is coming! Join the waitlist: ebbirth.com/waitlist Get the Evidence on Doulas Tearaway Pads: ebbirth.com/shop Search the EBB Instructor Directory: directory.evidencebasedbirth.com/ Learn more about the EBB Childbirth Class: evidencebasedbirth.com/childbirth-class/ 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.

Can perineal massage during the pushing phase of labor really prevent tears? In this episode, Dr. Rebecca Dekker takes a close look at the research to uncover whether this technique truly helps reduce perineal trauma during childbirth.

She explains how health care staff provide perineal massage during labor, breaks down findings findings from key studies and meta-analyses, and examines how biases and variations in clinical practice shape the evidence. Dr. Dekker also explores why results from settings with high episiotomy rates may not apply everywhere and why skilled, supportive care and informed consent often play a bigger role in protecting the perineum than any single technique.

Content Warning: Discussion of perineal tears during childbirth, severe tears, obstetric violence, and episiotomy.

Resources

• For a full list of resources, visit: ebbirth.com/218
• Watch the video version here on our YouTube channel which includes study breakdowns and PowerPoint slides.
• Protecting the Perineum Series:
  • EBB 206 - Evidence on Perineal Tears and the Importance of Avoiding Episiotomy with EBB Founder, Dr. Rebecca Dekker
  • EBB 210 - Evidence on Warm Compresses and Hands-on vs. Hands-off for Protecting the Perineum
  • EBB 216 - The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker

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.

Dr. Sara Ailshire, an anthropologist and Evidence Based Birth® Research Team member, and her husband, Dr. Siavash Samei, an environmental archaeologist, share the story of welcoming their rainbow baby after loss. In this episode, Sara and Siavash open up about navigating miscarriage care in the wake of changing abortion laws in Ohio, the anxiety and hope of pregnancy after loss, and Sara's experience with developing preeclampsia near the end of her pregnancy. They describe how they worked with a supportive midwifery team, hired a doula for advocacy and comfort, and ultimately experienced an induction that honored their preferences for a low-intervention birth. Their story also sheds light on the realities of discrimination in healthcare, the importance of community support, and the resilience found in becoming parents after loss.

(01:58) Facing Miscarriage in Ohio and Barriers to Care (07:35) Pregnancy After Loss: Anxiety, Detachment, and Hope (13:04) Finding Midwifery Care in Kentucky and Planning a Low-Intervention Birth (20:29) Preparing for Birth: Classes, Doulas, and Advocacy Concerns (22:37) Early Signs of Preeclampsia and Navigating Blood Pressure Monitoring (30:33) Deciding on Induction at 38 Weeks (36:39) Laboring with Support and Moving Through Transition (42:43) Birth of Ferdous and Unexpected Placenta Complications (49:34) Advocacy, Microaggressions, and the Role of the Doula (54:23) Advice for Expecting Parents: Finding Calm, Support, and Autonomy Resources Learn more about preeclampsia: www.preeclampsia.org Miscarriage Care Instructions from Kaiser Permanente: healthy.kaiserpermanente.org Dobbs-Era Abortion Restrictions and Miscarriage Care: kff.org Navigating Miscarriage Management Post-Dobbs: whijournal.com Emotional Coping After Miscarriage: americanpregnancy.org An Account of a Miscarriage at Home: miscarriageassociation.org.uk Supply List for a Miscarriage at Home: miscarriagematters.org.nz Learn about the Jada System: organonpro.com The Birthing Spa in Stanford, Kentucky: thebirthingspa.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.