EBB 1: Intro to Evidence Based Birth®

Dr. Rebecca Dekker – 00:00:00:

Hi, everyone. On this episode, I’d like to reintroduce you to Evidence Based Birth®. Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hey everyone, and welcome to a re-recording of the very first episode of the Evidence Based Birth® podcast, where I’m going to introduce everyone to Evidence Based Birth®. If I haven’t met you before, my name is Rebecca Dekker, and I’m your host for the EBB Podcast. This episode that I’m re-recording, episode number one, was originally published in January 2018, and now I’m re-recording an updated version in 2025. A lot has changed between 2018 and 2025, and I thought it was time to publish a new version of our introductory episode. So today I’m going to explain to you about how Evidence Based Birth® began, and then in later episodes, I’m going to re-record episodes two and three, also from the year 2018, to teach you even more about evidence-based care. So I wanted to kick off this podcast by telling you the story of how Evidence Based Birth® was born and where this movement even came from. And I think it’s really important for you to know what my story is, and I’ve realized over the years that a lot of people don’t actually know anything about my story or how EBB began. So I’m excited to share that with you today.

 

So, as I already said, my name is Rebecca, and I’m a nurse with my master’s and my PhD in nursing. And I live in Lexington, Kentucky, where I work full-time at Evidence Based Birth®, publishing research on childbirth and making it available to the public. Before that, I was nursing faculty at the University of Kentucky, and I spent my working hours teaching nursing students all about pathophysiology and pharmacology, and the bulk of my other hours as nursing faculty was spent doing clinical research with research participants. So back then I designed and got funding for and led randomized controlled trials and other types of studies. And I was really immersed in the whole world of research. But today I’m happy to tell you that since the year 2016, I have worked at Evidence Based Birth® full-time alongside about 13 other team members. I am the mother to three children. They are currently aged 11, 13, and 16. And I’ve been married more than 20 years to the most amazing guy named Dan Dekker, who is 100% supportive of what we do at Evidence Based Birth®. And he actually does a lot of work for EBB behind the scenes.

 

So going back to when I was a student getting my master’s and doctorate in nursing, I was really immersed in the whole world of evidence-based practice. You know, research evidence was something that we talked about all the time. We lived and breathed research evidence, both in the research team that I was a part of, and also as I was teaching nursing students about evidence-based practice, both in the clinical setting and in the classroom. So when I got pregnant for the first time, I was getting close to the end of my PhD program, and Dan and I were really looking forward to having our first baby. We took the hospital childbirth class at the university, and I read a couple of books about pregnancy and birth, but other than that, we didn’t do very much preparation. Really, my goal was to be a, quote, good patient. I didn’t really want to make any waves. I wanted to do as my doctor told, and I wanted to be flexible because I knew that birth is unpredictable. So I kind of felt like, well, if I need an epidural, I’ll get one. If I don’t need an epidural, I won’t get one. But other than that, I didn’t really have any plans in mind for this birth. I just wanted to place 100% of my trust in the medical team and let them run the show since they’re the ones who know what they’re doing.

 

I also really, really wanted to be seen as a good patient. I didn’t want to be that kind of patient that the nurses are talking about at the nurse’s station. I wanted to be well-liked by the nurses because I knew that meant that you get better care if you’re well-liked. And harmony has always been important to me. I’m a peacemaker. I’m a middle child. I’m the fifth out of six children. And I am much happier and less stressed when everyone is getting along, which I guess is no surprise to any of you to hear that didn’t happen a lot in my family, but it was something I always strived for was peace. So I really wanted to get along with the doctors and nurses at my birth. So what happened was my water broke at 39 and a half weeks. And I immediately took a shower and we headed to the hospital because that’s what we had been told to do. If my water broke, I was told to go to the hospital. When I got there, I was about two centimeters dilated, and my contractions were already setting into a good pattern. They were about every five to seven minutes apart. So I had gone into labor on my own, even though my water broke first. But even though I was already in labor, right from the beginning, they recommended I go on Pitocin. But because I was already having pretty good contractions that were frequent, I did say no thank you. And that was, you know, a little scary for me to say no, but it didn’t really make sense to me to start Pitocin when I was already contracting every five minutes.

 

So after I made it through the triage process, which was annoying and a whole other story in itself, I got into my hospital room and the nurse who dropped me off in the wheelchair at the labor and delivery room said to me, all right, Rebecca, go ahead and use the bathroom right now, because that’s the last chance you’ll have to use the bathroom while you’re here in labor. And then I’ll never forget this. When I got back into bed, the nurse who was assigned to me came in and said, all right, Rebecca, from now on, you have to use a bedpan. You’re not allowed out of bed because your water has broken and there’s too high a risk of the cord coming out in front of the baby’s head, which is not true. But at the time I didn’t know any better. So they got me in bed, they hooked me up to an IV, IV fluids and continuous monitoring, and I was told I was no longer allowed to eat or drink anything because I was in labor. So I was hooked up to different wires and monitors and just basically left to lay there with my contractions through the night. So my waters had broken at around 11 p.m. at night. And so I labored to the rest of the night like that, just kind of laying on my back in bed, not allowed to get up. And then starting in the early morning hours, I started getting visits to my room by some of the residents who kept saying, you know, don’t you think you want Pitocin or we really need to put you on Pitocin. But I just felt like I didn’t need it yet. I was still having contractions every five hours. However, after several hours of pressure and people asking me over and over, I did give in. I said, sure, you can start the Pitocin, but if you start Pitocin, I want an epidural because I’d heard that Pitocin-induced contractions were more difficult to manage. I did have some complications during the placement of the epidurals. That was a very stressful experience. And then I was able to rest and labored through the rest of the day.

 

Got to 7 p.m. that night when it was finally time where I felt like I had to push. And so I put my call light on and I told them, hey, I have the urge to push. I think it’s time for me to push my baby out. And unfortunately, it was a very inconvenient time to be completely dilated. I was completely dilated at 7 p.m. when everybody was in report, both the nurses and the residents. So I was told over the call light system that I would have to wait 30 minutes before I could start pushing. So I pushed the button on my epidural several times to give myself doses to help numb that feeling because the feeling to push was really intense and strong. And the only way I could ignore it is if I numbed myself more with the epidural. So then by the time everybody got there at 7:30 p.m., I was too numb to push effectively. My pushing phase with my first baby ended up taking about three hours. And I will say that the one truly evidence-based part of my experience was that my obstetrician never even brought up the fact that maybe I should have a Cesarean. She really believed in my body’s ability to birth my baby. And she never even said the word Cesarean. She just had a lot of patience. And I think she was a little bit ahead of her time and more aware of the research on how long it can take a first-time mom with an epidural to push. I did end up giving consent for my baby to be born with the help of a vacuum assisted delivery.

 

And after she was born, they showed her to me briefly and then whisked her away to be suctioned and then observed. And that was probably the hardest part of my birth story because I was healthy. My baby was healthy. There were no health issues. There was really no good reason for us to recover in separate rooms. And even though I wanted to be a good patient and do as I was told, at that point, I knew something was wrong with the care that was being delivered to me because I knew intuitively you don’t separate a healthy baby from a healthy mom. And that even goes for animals. You wouldn’t take away freshly born kittens from a mama cat or freshly born puppies from the mother dog. So I knew that you don’t separate the baby from the parent. Your priority should be on helping establish breastfeeding if they’re intending to breastfeed and spending time together, skin to skin. So I kept asking for my baby over and over.

 

Now this was, you know, late at night on the following night. And in fact, I was told about two hours into this process when I asked again if I can have my baby and they said over the intercom, oh, I’m so sorry. Her hair is wet. She just got a bath. So you have to wait for her hair to dry. And, you know, silly me, I was kind of in a daze from not having sleep for so many nights. I thought, oh yeah, she was born with a full head of hair. So that makes sense. It wasn’t until later that I was actually able to hold and nurse my baby. And by that point, she was very sleepy and it made it difficult for us to get that first latch done correctly. So for many years, I thought a lot about those lost hours, those first few hours of her life. And every time I tell this story, people tend to get upset, you know, because I don’t think it’s necessarily because they feel sorry for me in particular, but it’s because this kind of experience has happened to so many families, both in the United States where I live and all around the world. And for a long time, it was hard for me to put a finger on exactly what went wrong because my baby and I both survived, right? We were not yelled at. I didn’t experience verbal or physical abuse that seemed like abuse. And so it was hard for me to understand that what I experienced was traumatic.

 

What I found later is that my story is not my own. My story belongs to so many other people who also have a similar experience giving birth. And it also belongs to some of us who experienced birth trauma as infants. When our own parents gave birth to us, right? So that’s one of the amazing things about birth is that it’s universal. All of us were born at some point or another, one way or another. We all came into this world through birth. And that birth can have a ripple effect through the parent’s life as they are the ones giving birth, through the baby’s life, through their eventual birth experiences, through the ensuing generations. For better or for worse, our births do have an impact on our lives. After I got home from the hospital, I did have a pretty rough recovery in the beginning. I was very swollen with edema from the IV fluids. And I was really uncomfortable from that swelling. And I had a lot of trouble breastfeeding because of it. But overall, even with those recovery difficulties, I was still satisfied with my care. And I wrote in my journal that I wouldn’t have done anything differently because we made it through, right? We made it to the other side. It wasn’t until about a year later that I really started processing what had happened to me and my family. And I began asking the question, what was the evidence for everything that happened to me? What was the evidence for not being allowed out of bed? What was the evidence for not being allowed to drink or eat or even have a tiny sip of water while I was in labor? What was the evidence for all of the monitors I was hooked up to? What was the evidence for our postpartum care and our immediate recovery for even suctioning my baby? All those little things that happened to us.

 

Well, I knew that something was off, and I was determined to find out what exactly had happened. So basically what I did is I made a bullet point list of everything that happened to me as a researcher. I set a goal to personally look at the research on everything that happened during that birth as I pulled the research. And there was a lot of research on a lot of these things. I was surprised to find that almost everything that happened during my labor and birth has been shown by research evidence to either be not helpful or in some cases to even be potentially harmful for healthy people giving birth to healthy babies. So a couple of years passed after I made this discovery and I had several miscarriages. It took me a while to get pregnant again. And although this was a really sad time for me, it did give me a lot of time to think and plan and dream about the kind of birth I wanted to have the next time around when I would be able to carry a pregnancy to term. So I ended up deciding to pursue the midwifery model of care to seek care from a midwife because I felt like having a midwife would give me a better shot at some of the evidence-based things that I wanted to have during my next birth. One of the most important things that I wanted is I didn’t want to have to fight for evidence-based care. I wanted it to be the routine. I wanted to be the things that I desired to be a given, just something that happens routinely without you having to request it.

 

Unfortunately, it was a lot harder than you might think to find a midwife in Kentucky in the United States. Even though Kentucky is the birthplace of nurse midwifery in the United States, even though we have the largest and most well-known school of nurse midwifery in the country, there’s a huge shortage of practicing midwives in Kentucky. There still is today, years later, at the time I’m recording this in 2025, I have friends who have trouble getting in to see a midwife and clinics who won’t see them. Because they’re full. But back with this pregnancy, my husband and I did manage to find a midwife who we trusted, and we found that she truly believed in helping inform me about all my options. And she always stressed that I was the decision maker, and she was there to simply help support and inform my decision making. So when my second baby was born, it was the complete opposite experience from my first. From the very beginning of the whole process, I was respected. I was the one making the decisions. Evidence based birth was the standard, and I didn’t experience any pressure or coercion. So there’s two quick stories I want to share from this birth. The first is that after my baby was born, I asked the midwife, so when do we give him a bath? And I’ll never forget this. She looked straight at me, and she said, Rebecca, he’s your baby. You can give him a bath whenever you want. And I was like, you’re right. He is my baby. I get to make these kinds of decisions. And it was one of those first decisions that you get with your children, right? When does your child get their first bath? That was taken away from me when I gave birth the first time in the hospital. And it was given back to me by this midwife at my second birth.

 

The second quick story I have to share has to do with how much this baby weighed. So when he was born, everybody was trying to guess what his weight was. My first child was, you know, seemed small to me. She was six pounds, eight ounces when she was born. And this baby was obviously bigger. He looked pretty chunky. And I think the biggest guess came from my brother-in-law who guessed eight pounds, 10 ounces. Then my midwife weighed him and we discovered that my son weighed nine pounds, two ounces. And I was like, I did that? My body did that? I know it’s cliche, but I’ve heard so many people say after giving birth, if I can do that, I can do anything. And for me, this was really true. It was a pivotal moment in my life. I was literally infused through my fingertips with the feeling of power that I could do whatever, I put my mind to. And a few months later, while he was still a newborn, I was invited to speak with a group of physicians and residents in family medicine who were trying to learn more about the midwifery model of care. So they invited me to come talk about my two very different birth experiences, the first one in the medical model of care and the second one in the midwifery model of care. They also mentioned before I came, they were like, hey, we’re always looking for research to inform our practice. If you have any research about the practices you were seeking in your second birth, please feel free to bring it along.

 

So I made up about four short handouts. I believe they were the evidence on eating during labor, the evidence on IV fluids during labor, the evidence on maybe it was bed rest or not being allowed to get out of bed during labor, and the evidence on being hooked up to the continuous electronic fetal monitor. And afterwards, as I handed these out, they were looking at them and they were saying, wow, we love these handouts. Can we have more? And I had an aha moment. I thought, if these physicians find these handouts helpful about the evidence, how many more people could? So I came home that night and I googled Evidence Based care during labor and delivery. I found a couple of websites, but nobody seemed to be doing it the way I envisioned it could be done. I was imagining a repository where you could find the evidence on any practice that you wanted. So I mentioned to Dan, I was like, Dan, I’m starting a blog. And he’s like, okay. And I started searching for domain names. I still wish I had that list of website names that I brainstormed. And I know this story may sound a little silly now. Back in 2012, though, if you said I’m starting a blog, that was kind of a whole thing. We didn’t really start podcasts back then and social media was still in its infancy. But for a website, the name Evidence Based Birth® seemed perfect. So I started posting my first articles on the site.

 

These articles are basically reviews of research that I had already been collecting while I was preparing for my second birth. And my initial thought was, wow, what if I could inspire 10 people to find evidence-based care or to be able to use this information? I would be so happy if 10 or 12 people ever visited this website. Then after a few months, I was continually surprised by the statistics. The number of visitors to the website was doubling every month. I was seeing exponential growth. And I also started getting emails from people all around the world. Leaders in the field started reaching out to me. Every time I posted an article, it would go viral. And within a few months, I realized this is going to be a really big deal. So I basically sat down and decided to raise my standards. I made a list of quality control mechanisms that I would use moving forward for my articles. This is really important because I realized this is not just 10 people. This is going to be like waves and waves of people using this information. It needs to be really good quality. So one of the things I did is I started recruiting people to peer review my articles. We invited obstetricians, physicians, midwives, researchers, scientists. They all volunteered to help review the articles before they were published.

 

So that all began in the year 2012 when Evidence Based Birth® was born. And over the past more than a decade, I’ve just been continually awed at how everybody has responded to this project. I really feel like we’ve built this together. Every time I dive into a new topic, I really look at it with fresh eyes. And I do think that, especially in the beginning, it was helpful that I didn’t have a background in labor and delivery nursing because I didn’t have any underlying biases of what hospital care should look like. I was never indoctrinated into any one way of doing things. I just am really curious. I want to learn the facts and then share the facts with other people. And that was actually a big part of Dan’s contribution to the website. From the very beginning, Dan said, Rebecca, just stick to the facts. You can’t give people your opinion. Just take your opinion out of it and only look at the evidence. People don’t want to be told what to do. It’s their body and their birth. Just give them the information and don’t worry about telling people what to do. So that was incredibly formative. Another thing that was unique about EBB was from the very beginning, I started using a technique that I had learned when I was studying for my PhD. And it was a technique called framing. So framing is a practice that helps you recognize your underlying biases before you start a research project. So that by keeping your biases in mind, you can work as hard as you can to avoid letting that bias sneak into your work. So my hope and my vision was that Evidence Based Birth® would become a trusted resource where people could get no fluff, just the facts, information about hot topics in the birth field.

 

One of my goals from the very beginning was to help people dialogue and have conversations with their care providers about the information that’s posted on Evidence Based Birth®. I’m going to talk more about what evidence-based care is truly made up of in a later episode. But one of the parts of evidence-based care is your care provider’s clinical expertise and guidance. So if you’re the one giving birth or you’re the family who’s having a baby, it can be so helpful to have a care provider who acts as a guide to help you interpret the evidence and make sure it applies to you. Like all of us are unique and having that expert guidance can really help us apply the evidence or maybe even decide if it should not be applied to your unique situation. Unfortunately, not all of us have easy access to that kind of expert guide in a healthcare provider. But I love how EBB levels the playing field. So the info that’s posted by Evidence Based Birth® can be accessed both by parents and healthcare providers. And then birth workers, doulas in particular, have been instrumental in bridging that gap by providing EBB resources to the families they work with. Here at EBB, we just love doulas and appreciate everything you all do to improve maternity care, both for your individual clients and for your communities.

 

And doulas in the beginning were some of the main people who got Evidence Based Birth® started. You know, at first it was doulas and yoga instructors and midwives and childbirth educators who supported our work. And then within a couple of years, we started hearing that more and more labor and delivery nurses and postpartum nurses were adopting EBB resources. And that was a huge shift for us as well to have nurses championing our work. And then there have always been a select few physicians and obstetricians who have supported us along the way. And as the years went on, we saw more and more chiropractors, massage therapists, physical therapists, lactation consultants, nutritionists, dietitians, exercise trainers, professors, so many people in so many different fields who follow and support the work that we do. And this whole time, it’s felt like an amazing exchange of energy. Our team here at EBB, we’re out here doing what we love, making the research on childbirth publicly accessible. And then birth workers and parents around the world reciprocate by telling other people about the work that we’re doing, by sharing the information, by supporting us and joining in our programs when they can. And it’s just been an incredible opportunity to be part of something that has just flows. And another thing I really haven’t talked a lot about is the opportunity for you all, our listeners, that you support our work in a way that gives us the ability to create a workplace that fosters a positive culture and values.

 

So here at EBB, we want to be a workplace that is truly supportive of working parents. We honor balance and rest for everyone and teamwork. I get to work with the most amazing people on team EBB. And that was probably the biggest surprise of all. I never intended for any of this to happen. It just kind of happened. And then I started EBB to get information in the hands of families. And now I get to work with the most amazing coworkers in the whole world. So how cool is that? So in a future episode, I’m going to go back and rerecord EBB 2, episode 2 of the Evidence Based Birth® podcast, where I talk about what is evidence-based care? Is it a certain way of giving birth? Is it a checklist? You know, what is evidence-based care and what is it not? In the meantime, while you’re waiting for that next episode, I’d love it if you could do me a favor. Since we launched this podcast in 2018, we’ve had more than 7 million downloads on platforms around the world and more than 900 reviews posted on iTunes. If you’ve never left us a podcast review before, this is a way you can really help out at EBB. We could really use your help adding more positive reviews to both iTunes and Spotify. And it would mean a lot to me if you could help us with this. What I’m going to do is for those of you who give kind feedback, I will be sharing it with our team. We have a channel just for our team called hashtag Customer Love. And it’s those kind and helpful comments from you that really keep us going even when times are hard in this field.

 

So that wraps up this podcast all about introducing you to Evidence Based Birth® and how EBB was born. I’m looking forward to talking to you again in a future episode all about evidence-based care and what it really means. Thanks everyone for listening. I’ll see you next week. Bye. Today’s podcast was brought to you by the Evidence Based Birth® Professional Membership. The free articles and podcasts we provide to the public are supported by our professional membership program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories. We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit ebbirth.com/membership.