EBB 400 – Best of Evidence Based Birth®
Dr. Rebecca Dekker – 00:00:00:
Hi everyone, on today’s podcast, we’re celebrating 400 episodes of the Evidence Based Birth® podcast with a special anniversary episode featuring some of the most popular episodes, as well as our team favorites. 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.
Hi everyone, and welcome to today’s episode of the Evidence Based Birth® podcast. So, reaching 400 episodes of the EBB podcast feels surreal. When we started this podcast nine years ago in 2017, our goal was to make evidence-based information on pregnancy and childbirth more accessible, compassionate, and empowering for families around the world. Over the years, we’ve had the privilege of sharing so many beautiful stories and conversations with researchers, advocates, clinicians, and parents, and this community of the Evidence Based Birth® podcast has grown beyond anything we imagined. So, for today’s special anniversary episode, our team selected some listener favorites as well as some conversations that have really stuck out to us on team EBB to celebrate how far we’ve come together. So, whether you’ve been listening since the beginning or just recently found this podcast, thank you for being here and helping us reach this incredible milestone. And if you ever feel called to leave us a review on your favorite podcasting platform, that would be super helpful.
Before we begin with our features of the most popular EBB podcast episodes, I wanted to start off this episode by honoring the memory of my dad, Vince De Young. For those of you who don’t know, my dad passed away this April of 2026 after a long and difficult struggle with a rare and fatal kidney condition. Not only was my dad a father to 6 children, he was a husband to my mom for 63 years, and he was a grandpa to 11 grandchildren. He was also a twin, and he and his twin brother were the youngest of seven children born to my grandparents Henry and Jemima, who were both immigrants. And my dad and his twin were a surprise to their parents, because back then, in the 1930s, ultrasound wasn’t a thing yet! So imagine thinking, “Wow, I’m almost 40, and I’m finally having my last child, and it’s my 6th,” and suddenly you have twins! And it’s your 6th and 7th child. That’s what happened to my grandparents when my dad was born.
One of the reasons I want to honor my dad on this episode is because he was a huge supporter of the work we do here at Evidence Based Birth®. One example I can give, my dad inspired me, many years ago, to make the transcripts of this podcast available, back before technology made them automatically available and when you had to pay someone to transcribe them by hand. You see, in my dad’s last decade, he was mostly deaf, and my dad subscribed to the EBB newsletter, and he kept getting the emails about the podcast episodes, but he had a hard time hearing the podcast conversations, so that’s why we started producing human verified transcripts of our podcasts back in the 20 teens, making them accessible to the deaf and hard of hearing, because my dad let us know there was an accessibility issue.
My dad was also over at our house all the time, working for free for Evidence Based Birth® assembling the Pocket Guides, putting them on the key rings, putting sticky notes in the EBB Childbirth Class workbooks, picking up orders for us from the printer, driving all of your orders to the post office and carrying them in—and this was in addition to all the help he gave us as a grandpa, helping shuttle our kids around to all their activities when we needed to work on Evidence Based Birth®. And even though my dad helped assemble most of what we sold in the EBB shop, and he did all this work unpaid, he still purchased every single product that EBB has ever sold in our shop. He would not let us gift them to him for free! My dad was a retired business lawyer, and he gave me lots of free and sound legal advice about Evidence Based Birth® over the years. Also being a lawyer, he was an excellent writer, and starting when I was in high school he was always helping edit my papers, and he’s a big part of why I’m able to write the way I can write today. My dad then spent his retirement authoring 4 books of his own, and we were even able to share the same book coach for my book, Babies Are Not Pizzas, and for his memoir, Beyond the Hayfields.
One of the reasons I wanted to share this info is because I don’t think people know a lot of what goes behind the scenes, but Evidence Based Birth® is truly a small business, and a family-run enterprise, and my dad did a lot of work to help us and he never asked for acknowledgement. He was hard working and humble and devoted to his faith, and really an amazing example of the Silent Generation, who grew up during the end of the Great Depression and through WW2. My dad really believed in equality and helping everyone get a fair chance, and he really believed in what we are doing here at Evidence Based Birth® in making birth better around the world.
My family and I miss him a lot, and at the same time, we are holding space for lots of mixed feelings, because my dad also experienced a lot of suffering, over many months, and his end of life was particularly difficult, challenging, and traumatic. To hold space for someone who is suffering is really hard work. And at the same time, Team EBB has been amazingly supportive, and I want to thank them all for giving me grace during these past few months. You as the listeners might not realize that we were sorta behind, because we usually stay about 6-8 weeks ahead on recording the podcast! And now we’re only 2 weeks ahead, which feels different. But they’ve been so patient and supportive, and our guests have been understanding, letting me reschedule when I was working with my mom and my siblings to care for my dad and going through everything else that we had to with recovering after he passed. So thank you to Team EBB. Thank you all who are listening who support Evidence Based Birth®. My dad was a really great person. He was proud of the work we are doing here, and we’re going to keep going. And also, someday soon, I want to bring a death and birth doula on the podcast, because as I went through this long and difficult and challenging death, it brought to mind a lot of similarities with birth. So it’s something I want to explore more in the future.
So thank you for letting me take these minutes to honor my dad, Vince De Young, and now I’m excited to share clips from seven of our most popular episodes and team favorite episodes from the podcast that my dad and I, and our whole family, and so many of you, love so much.
Dr. Rebecca Dekker – 00:07:04:
First up is one of our team’s favorite interviews with midwife and maternal health advocate Jennie Joseph in episode 136, Solutions for the Crisis in American Maternity Care. In this episode, Jennie explains the philosophy behind The JJ Way, which is a midwife model of care centered on access, connection, knowledge, and empowerment, and Jennie shares how relationship-centered care can dramatically improve outcomes for families.
I’ve read the research the papers that show how the method you’ve developed, The JJ Way®, can eliminate disparities, or greatly reduce them, including the preterm birth rate, and other statistics. Can you tell our audience how does The JJ Way® work? And then, also how practitioners can get trained in it?
Jennie Joseph – 00:07:54:
So, The JJ Way® has four tenets that hold it together. The model is based on access first, access to whatever it is that woman or that family are looking for.
They articulate what that is, and I want to provide access to it. So, access. Secondly, connections because once they have access, they will connect with you, they will trust you. Because for the first time, maybe someone’s listening to what they say they want, rather than telling them. In the connection, and in the trust, then you get a little bit more of a relief of angst, stress, pain.
And you begin to get real authentic conversations that can truly people disclose what’s going on for real. People are more willing to listen to the advice you might give, and are going to be more compliant because there’s trust. So, after the connections are made and strengthened, education, knowledge is easily imported.
Not everybody wants to come to Lamaze class and sit for six weeks with pillows and huffing and puffing with their husband. Others just want a piece of information, one piece. Oftentimes it’s very broad. Am I going to be okay? Yes. All right. Child birth class is finished. That’s all the knowledge that she needed.
That’s all she was looking for. Can you assure me that I will be okay? Yes. That’s it. That’s the third one, knowledge. Fourth one is empowerment, obviously. And not only is the mother in power, but guess what, the provider is too. Because suddenly, you’re providing care in a way where you’re not all trying to commandeer everything, and be in charge of stuff, and be the smart one, and knows this, that, and the other, no.
So, there’s an empowerment in being able to authentically be with somebody. Yes, you have to do some of your technical bits and pieces, obviously. You have a charge, and a scope of practice, and you’re supposed to follow those things. But obviously, everybody else is doing the same scope. They’re drawing the same labs. They’re poking the same bellies. How come their outcomes are so wretched? Do you see? So, The JJ Way® is just a bespoke model, a twist on the midwifery model that says these other things are as equally important. And so, therefore, the training I’m doing isn’t here’s how you technically measure the uterus better, or here’s how you hear the heartbeat, and discern X, Y, and Z foible.
No, it’s here’s how you step aside a minute, get out of the way, and look at what you can do to support, and fill in blanks, and gaps, where there’s potentially something that you would have totally overlooked if you were working from the opposite. So, I call it a gap management model, both provider and patient, where are the gaps? What don’t you know that you need to know to be able to get to the other side of this? What technique would work for this particular couple, which wouldn’t work for another? How do they learn? How do they hear? How do they trust? So, a lot of it is also navigation. The onus was on me, and my staff to learn, and understand, like I said, we went and made the effort for the collaborative care. We didn’t just say go on up there, and they’ll take care of you. No, we’re not sending sheep to the slaughter. We had to know that if they got there, they would be taken care of. We had to go and work with the staff where they were to understand what they needed.
JJ Way® works for both sides. The staff needed access to what we were doing to understand what we were doing to not be scared of what we were doing, and to recognize, “Oh, this isn’t what you were taught. We thought you’re talking about home birth? No, I’m not talking about home birth. Okay, let’s talk.” So, JJ Way® is finding tools, and avenues, opportunities to craft individualized care every time, be open to the need for the patient, woman, client, family led care, to step aside and move out of the way so that the full empowerment can come into play.
So, to this day, Rebecca, I cannot explain to you how come we’ve dropped our C-section rate to 20%, 25% every year without any midwife and sometimes, not even a doula setting foot in the hospital with these women, who left alone would be among the others getting 35%, 40% cut because that’s what happens.
So, what is it? We don’t do a C-section class. We don’t even do a VBAC class. What is it? The husbands don’t get tossed out the door. They’re not calling security every five minutes. The women don’t have a birth plan that’s written out and ready to go. They’re not taking lavender. What is it? So, they have an understanding from inception, from the access point.
It doesn’t matter what Medicaid you got, come on, we’ll figure it out. We have to get you seen. We want to get you started. We’ll help you find a way to get on that Medicaid, or to get that managed care plan, or to get your insurance to reduce the stupid deductible, or we’ll figure a way. We are here to make sure so your access is guaranteed. From there, there’s a sigh of relief. There’re tears. There’s a breakdown of, “Oh, are you kidding?”
Dr. Rebecca Dekker – 00:12:56:
So I hope you all enjoyed those powerful words from Jennie Joseph. And I know we spend a lot of time focusing on birthing people here at Evidence Based Birth®, but this next episode is a reminder that birth is a team effort, and that informed, supportive partners make a huge difference in how families experience birth and recovery. In episode 145, Fatherhood and Advocacy in Birth, JaMichael Perryman, the husband of our own Chanté Perryman from Team EBB, shared an important perspective on fatherhood, advocacy, and what it really means to support someone through pregnancy, birth, and postpartum. In this next clip, JaMichael talks about some of the biggest questions and anxieties that partners have leading up to birth, and why he believes partners need to understand that their voice matters, too.
JaMichael Perryman – 00:13:48:
It has been a mixture of some questions that I’ve gotten from them. One most recently has been about postpartum support for the mom, how…and a dad’s role. Do you actually support the postpartum timeframe? I really just told him it has to be about taking care of mom because her body has gone through a huge transition. And so she’s going to need that support whether it’s taking care of baby while she’s resting, making sure that she’s eating properly, making sure she’s drinking a lot of fluids.
To make sure that you’re there as a support person when she goes to her postpartum visits so that you’re hearing the exact same information that she’s hearing. And you can be there to understand, and if you don’t understand and need to ask questions, you can ask questions of the provider to say, “Hey, what do I need to do?” With each woman, there’s something different about their bodies and about their recovery and so you need to understand what it is for your partner that is going to be the key and the focus for her to be well on this road to recovery. So that portion of it and understanding that even during postpartum, that’s a bonding time for you as the dad with the baby. That’s the time for you to really be there, to have that skin to skin time and make that contact with the baby. Because all of that feeds into mom’s wellbeing.
If she’s got to do everything as far as getting up in the middle of the night to do the feeding and then try to be up with baby during the day and all of those things, then she’s not getting the rest that her body needs to be able to recover properly and in the timeframe that is going to be the best for her. So that’s one of the things.
But the thing that I think I get the most questions about in regards to it is just understanding that they have a voice. And I tell them that they need to have that one-on-one conversation with the mom before you’re headed to the hospital. You have to have an understanding of how mom has envisioned this birthing process going in her mind. I tell pretty much every dad that’s on the calls that there are two days that women think of where they just have it all planned out. The first one is their wedding day and the second one is giving birth to their child. Those are the two days that a woman will have planned out in her head that it’s got to go this way. Things are going to be great and you have to be there to support their vision no matter what.
You have to have the conversation with your partner to say, “What have you thought about? What have you planned on? We’re planning on going to this hospital or that hospital? Do you have any questions about the hospital? Do you have any questions about your provider? Are you comfortable with your provider?” All of those things are questions that the dads can ask to help trigger conversations that maybe the mom hasn’t asked a provider about having a VBAC.
Maybe she hasn’t asked because she’s just been told, “Hey, once a cesarean, always a cesarean.” And so I’m wanting to have the dads understand that no question is worth you withholding. Get it out there. It doesn’t matter what the question is. You have to remember that your provider, your hospital staff, they are there to provide a service to you. And so as you have questions, whatever comes up, ask those questions. That is really the biggest thing I think that they have the most anxiety, or I don’t really want to say the word fear, but being intimidated about being in the room and actually speaking up to say, “Yeah, I heard what you said, but I’ve got a question about that. Can we talk about that for a second?”
Even in the throes of the laboring process and the mom going through her waves of contractions to say, “Hey, I heard you come in. You said you wanted to do a check after she comes through this last wave. It’s in our birth plan that she doesn’t want to get checked so please remember that.” Having that understanding that you’re there as a support person, you have a voice so use it. Don’t withhold it. Don’t wait for the birthing mom to speak up for herself because she may not have that personality type. She may not feel like she can say something. Even with having doula support or midwife. Depending on what the situation is, you have to still understand that everybody in that situation, everybody that’s in that room really should be able to listen to you and the birthing mom as well. So you have to be on a united front, as you alluded to earlier, to understand that birth plan. Make sure that you can get everything that you desire out of this birthing process, as much as you can. Unfortunately yes, sometimes medical things do come up, but you want to understand what are our options before you just take their word for it.
Dr. Rebecca Dekker – 00:18:26:
REBECCA: Thank you, JaMichael, for sharing those words of wisdom and I know that a lot of birth partners have listened to your episode and found it really inspirational. So, it’s one of our team favorites at EBB.
This next episode was the final installment of our Protecting the Perinium Series, This one came from episode 221, The Evidence on Birthing Positions and Tried-and-True Midwifery Practices for Protecting the Perineum. We see this series and particularly this episode referenced all of the time on social media. For those of you who don’t know, t he perineum is a diamond-shaped area between the front of the pelvis and the rectum at the back. So when we’re talking about protect the perineum, we’re talking about protecting the tissue that’s the space between the vagina and the rectum. As you listen to this clip, think about what position you might prefer if you were giving birth to a baby. Most movies and television series depict people as giving birth lying on their back or semi-sitting in a hospital bed, but given the choice freely and instinctively, many people would choose a more upright position. So in this clip, I talk about some of the evidence on upright birthing positions. Enjoy!
Dr. Rebecca Dekker – 00:19:40:
So upright birthing positions include standing or squatting, often you’re being supported by a partner or a prop, kneeling, using hands and knees. And sometimes people don’t like to refer to that as an upright position, but in most of the research it’s considered upright and using a birth seat such as a birthing stool.
Researchers believe that giving birth in an upright position is beneficial for several reasons. In an upright position, gravity can help bring the baby down and out. Also, if you’re giving birth in an upright position, there’s less risk of compressing your aorta, the large blood vessel that carries oxygenated blood from your heart to the rest of your body which means that when you’re upright, there’s a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. MRI studies have shown that compared to the back lying position, the measurements of the pelvic outlet become wider in the squatting, kneeling, and hands and knees positions.
Finally, there is a lot of research showing that upright birthing positions increase satisfaction, decreased pain, and lead to more positive birth experiences. When we go to the non-upright positions, general terms that refer to lying on your back or side are called recumbent and semi-recumbent. So lying on your back with your pretty much flat on your back is called supine. If your feet are being held up in the air or are being held by stirrups, then that’s called the lithotomy position. If you are laying on your back, but they’ve raised the head of the bed so that you’re semi-sitting up in bed, that is still not considered an upright position in the research, that’s referred to as semi-recumbent so you’re laying back and you’re sitting up. And then there’s the lateral position which means side-lying.
Another way to classify birthing positions is whether or not your body weight is on or off the sacrum or the large tailbone at the base of your spine. When a position takes the weight off the sacrum and allows that sacrum to move, the pelvis can expand more easily for spontaneous birth. So I put a star next to the ones that are sacrum flexible. So the standing, squatting, kneeling, hands and knees, using a birth seat, and the lateral or side-lying position are all sacrum flexible. Even though the upright birthing positions and the sacrum flexible positions have been clearly documented as being more beneficial, most people giving birth in the US hospitals are still giving birth lying on their backs or in a semi-sitting lying possession with the head of the bed raised up.
Only a small portion of people in US hospitals give birth in other positions such as side-lying, squatting or sitting or hands and knees. In contrast, my own homebirth midwife told me that most of her clients spontaneously choose the hands and knees position. Other research from home birth settings confirms that when birthing people are free to choose the position of their choice, they do not usually choose to lay on their backs or semi-sitting in bed. In Europe, a study nearly 3,000 people who had planned home births found that the majority, 65% gave birth in either upright or side-lying positions. So if upright positions are so beneficial and the non-upright ones are the opposite, they’re harmful. Why are non-upright positions so common? Well, the truth is around the world, many caregivers, especially obstetricians prefer it when people are lying back or in the lithotomy position or semi-sitting when they’re giving birthing. It’s thought that most people are encouraged to push on their back because it’s more convenient for the care provider and it gives them a better view of what’s going on.
It’s also easier for them to access your abdomen for the electronic fetal monitoring and for other devices and interventions. Also, this is how most care providers around the world specifically obstetricians are trained. While lying in your back is not beneficial for normal vaginal birth, it is the most common way to position.
Dr. Rebecca Dekker – 00:23:51:
So if you wanna learn more, we will link to our protecting the perenium series in the show notes. You can also go to our signature article all about the Evidence on Birthing Positions at ebbirth.com/birthingpositions and download a free handout there as well.
Now it’s time for listener favorite EBB 264 – Top 3 Tips for Exercise in Pregnancy with Gina and Roxanne of Mamaste Fit. Gina Conley and Roxanne Albert are a sister duo from North Carolina who offer childbirth education, specializing in labor and pelvic biomechanics and pre and postnatal fitness programming. In this podcast clip, Gina shares their top tips for how using exercise in pregnancy can help prepare for birth and prevent pelvic floor issues.
Gina Conley – 00:24:39:
So for why exercise seems to help with labor, the biggest thing that I think is because you can maintain an upright position longer, it applies baby head to your cervix more, which helps with that feedback loop of the labor hormones. So that’s why I think exercise helps with labor specifically. And there’s a whole bunch of other stuff to it as well. But the top three things that I would say for using exercise in pregnancy to prepare for birth and prevent pelvic floor issues to be one, ensuring that your prenatal workouts include all sorts of different type of movements that open each level of the pelvis. And so this is going to include external rotation with both legs. So like squat tight movements where the knees are moving outwards, internal rotation with both legs and then also asymmetrical movements. So we need the hips to be moving in all sorts of different ways in order to create space in the different pelvic levels.
And then we also have to include thoracic mobility and rotation because the way that our ribcage is set up can also influence how we can open our pelvis. So you can be doing all of the hip movements, but if you’re thoracic spine is an extension, it’s going to really limit your ability to find that good internal rotation without compensation, which is what is going to open the bottom half of the pelvis. So within our prenatal program, we incorporate all that stuff for you in case anyone’s super overwhelmed and they don’t know what to do. We’ve got you.
The next thing in regards to pelvic floor preparation is we want to ensure that we can both lengthen and contract the pelvic floor. So Kegels are pelvic floor activation or contraction or shortening of the pelvic floor, but we need to be able to do so much more than just tighten our pelvic floor. And most importantly, the pelvic floor does not push your baby out. Because that’s sometimes while I’ll see folks say, “Do all the Kegels is to have a really strong pelvic floor so that you can push your baby out.” And then when I’m like, “Well, your uterus pushes your baby out, not your pelvic floor.” They’re like, “Oh no, I mean it makes your pelvic floor really strong so you can heal better postpartum.”
And so it’s important to understand that strength is not defined by a single range or a single point in the range of motion. So being super tight is actually a state of weakness. So being on either end range of motion is the state of weakness, just like being too long would be a state of weakness. And so we need the pelvic floor to be able to move through its full range of motion, which includes the contraction, the relaxation, and then also the lengthening or the stretching of it.
And so within our programmings what we do is we start all the workouts with breathing drills. And this allows you to learn how to move your pelvic floor as your pregnancy is progressing because it’s going to feel different. So first trimester pelvic floor movement is going to feel really different to third trimester pelvic floor movement where there’s so much more loading and just stuff going on with our pelvic floors at that point. So we want to learn how to move the pelvic floor. We can do that with breath, so inhales to move the pelvic floor down to feel it stretch and then exhales can be relaxation or exhales can be lift up, and then depending on the demand.
When we’re doing pelvic floor relaxation movements, we also want to do it in different hip positions because different hip positions are going to influence different pelvic positions. And the pelvic floor attaches to the pelvis. And so we need to do more than just deep squats and butterfly poses when we’re doing these pelvic four relaxation exercises. We also need internal rotation with the knees and ankles out. We also need asymmetrical type movement because the pelvic four has asymmetry, and so there’s different quadrants within the pelvic floor that are tighter than others. It’s not just front half back half. It’s also like left back half that tends to be a little bit tighter.
So really what we should be doing to help prepare our pelvic floor is focusing a little bit more on the internal rotation side to release that back half of the pelvic floor, which tends to be tighter for a lot of us, not just deep squats and butterfly poses for pelvic floor relaxation. We also need heroes pose, or our knees and ankles out pose, or a 90/90 position breathing drilling. And if anyone follows our Instagram, we’ve already posted all of these example exercises as well. If you’re like, “I have no idea what that means.” Then we also have tons of blogs that have… If you just type in pelvic floor relaxation, you’ll see a bunch of different movements that are more than just external rotation.
And then the last thing I would say for your prenatal workouts is supporting your prenatal comfort. So pelvic floor pain is not mandatory during pregnancy, nor is low back pain. Being in pain is not a requirement of pregnancy. I know during my first pregnancy I had some SI joint pain and I brought it up to my provider, and they said, “Hey, when you give birth that’ll go away.” And that was the only solution I was given. And this was even something that Roxanne believed before I was like, actually no, there’s a whole lot of research out there that supports that there’s things that we can do. And so ensuring that your prenatal programming includes things are going to help support your comfort is also really important.
Dr. Rebecca Dekker – 00:29:14:
So that’s our clip from Gina and Roxanne’s episode, and make sure you check out their website where they have tons of free YouTube videos with different exercise techniques.
Now, I want to talk about Cheyenne’s episode. Over the years, we’ve heard from so many families who used what they learned through EBB articles, from listening to this podcast like you’re doing right now, and taking EBB childbirth classes to help them make informed decisions in pregnancy and birth. In this next clip, Childbirth Class Gruduate Cheyenne Saenz reflects on how her EBB class helped her feel prepared to advocate for herself in the hospital setting and stay grounded in the birth preferences that mattered most to her. Cheyenne talks about everything from asking questions and declining interventions she didn’t want, to making the decision to leave the hospital shortly after giving birth so she could be more comfortable in her home environment. It’s an interesting and fascinating conversation about informed choice, support, and trusting in yourself during birth.
Dr. Rebecca Dekker – 00:31:19:
So can you talk a little bit like, do you feel like, do you have that kind of personality where you don’t take no for an answer, or do you feel like just knowing that you had the power to say no, what inspired you or what made you be able to stand up for your human rights?
Cheyenne Saenz – 00:00:00:
So I think that I’m kind of a stubborn person, which I think helped during this situation. Maybe other times in life, it’s not the best thing, but I think it was part of me being stubborn, as well as just kind of knowing my rights and just knowing, like, deep down what I. What I could and what I couldn’t do and just being firm in that. And I think that a lot of times you have to be firm in what you believe in and you have to just kind of stand up for what you believe in, whether that means the minority or going against the grain. I don’t think it’s ever the best to kind of like fold under pressure or comply just to comply. It’s just, you just have to be strong in what you believe. So for me, I knew that I had a lot of rights when it came to being at the hospital, and I had to just stand firm on what I knew, and I had to stand firm on being strong. And I had to just stand firm and not breaking or wavering, because that’s really what it comes down to in my mind.
I felt that if I could kind of overcome this and have a natural birth and being at the hospital and, and knowing my rights and saying no when it was appropriate, or saying yes when it was appropriate, then I can do anything in life, really, as long as you just kind of stand up for it and, and be firm in it. And so a lot of times I feel a lot of people don’t want to feel like they’re getting in trouble or they don’t want to get a lecture or they don’t want those type of things. And sometimes you just have to weather that storm of having that lecture or like you’re doing the wrong thing. And even though it kind of feels like wrong of someone else telling you kind of that you’re doing the wrong thing by leaving the hospital like the nurse is, like, you shouldn’t because it maybe puts your baby at risk or at harm, the only reason that that might hinder you is because maybe you’re then thinking that that’s true. But then in my opinion, that that leads to fear. And fear is a liar, basically. So if you know what you want deep down is the truth, then you just stay firm in knowing that.
And you don’t let the fear of others or the fear of, like, the what ifs kind of hinder you. Because my thing is that you could turn that what if into a positive, like, what if my baby is perfectly healthy and fine and can go home and. And be just as great if. As if we stayed here, you know, the 24 hours. And so I just really. A little bit of stubbornness mixed with knowing my rights and just standing firm with that and knowing that I wasn’t crazy with what I was deciding is kind of really what helped me, helped me stay grounded. It’s almost like faith. If you stay grounded in your faith, no matter what kind of people try to waver you, then you’ll be okay.
Dr. Rebecca Dekker – 00:33:15:
I hope you enjoyed Cheyenne’s clip and I highly encourage you to go back and listen to the full episode if you want to hear a really inspirational story about self-advocacy.
So moving on to our next clip, something special that we offer to EBB Pro Members is our ‘Ask the Research team’ service. Pro Members can write in with questions about topics in pregnancy and childbirth, and our research team will provide them an individualized research response that addresses their question. It is almost like getting your own mini-podcast or mini-signature article on the topics and questions you’re most interested in about pregnancy, birth, postpartum, interventions, and beyond. We get lots of questions from our members, and some of them are on topics that we know might appeal to our podcast listeners, so we share that research in our Q&A episodes. In this excerpt from episode 304 I am going to tackle a question on Pitocin and postpartum depression and what the evidence has to say about that.
Dr. Rebecca Dekker – 00:34:15:
So the first question that was asked of me was, I was wondering what evidence you can find on the relation between synthetic oxytocin administration, also known as pitocin, either in labor or postpartum, and its relationship with postpartum mood disorders. This seems like a huge public health issue that is being ignored, and something that I see often anecdotally. Hoping there is more out there than just these two articles that I found. Thanks. So, postpartum depression (PPD) affects about 10 to 15% of postpartum people. Known risk factors for PPD include your genetics, personal past psychiatric history, adverse life events, and not having enough social support. There is mixed evidence, meaning some of the evidence supports and some of it does not support epigenetics, different neuroactive molecules, other health history, substance use, demographic factors such as poverty, nutrition, and birth outcomes. The evidence is still not confirmatory on those topics yet. There is some emerging research that if you have higher oxytocin levels, meaning your own endogenous or your body makes your own oxytocin, if those levels are higher in late pregnancy and postpartum, that that’s actually correlated with a better mood postpartum and less anxiety and less depression. This makes intuitive sense because oxytocin is one of the feel-good hormones. It’s sometimes called the love hormone.
On the other hand, lower levels of oxytocin towards the end of pregnancy, so if your own natural oxytocin levels are low, that is correlated with higher levels of postpartum depression. Now, when you’re talking about synthetic oxytocin, this is chemically identical to our own natural oxytocin, but the main difference is synthetic oxytocin is given through your vein, so it does not pass through the blood-brain barrier into the brain, whereas your own natural oxytocin, sometimes called endogenous oxytocin, is produced and released from inside the brain, so it can have effects both in how you’re feeling as well as contractions. Now, most researchers and scientists think it’s really unlikely that synthetic oxytocin given in labor or immediately after you give birth could impact PPD, and the reason they think it’s unlikely is because it cannot cross that maternal blood-brain barrier, so it physically is not capable of getting into your brain. The person who asked this question did reference a systematic review published by Thull et al. in 2020, and that review was not able to find enough evidence to draw any conclusions on synthetic oxytocin in postpartum depression.
Now, synthetic oxytocin could theoretically send some feedback signals through something that we call down-regulation of receptors, although that would probably be a short-term effect. And the true answer is that we need more research on this subject, but so far it does not seem to be a quote-unquote cause of postpartum depression, and there’s no proof that it’s a cause of it. One study that people often will send to me and say, but what about this study, they said that there’s a link. This study is by Kroll-Disrosiers. It’s used as quote-unquote proof of a link between synthetic oxytocin and postpartum depression, and this study is of extremely poor quality. When I read that study, I was shocked by how bad it was. I couldn’t even believe it got past the peer review process, and I still can’t believe people are quoting it. So you cannot use that study. It was very low quality as proof of any kind. Now remember that both postpartum depression and pitocin or synthetic oxytocin are common, and just because pitocin was administered during labor or shortly after birth doesn’t mean that it caused the PPD. So you were mentioning anecdotal or individual stories that seem to line up to support this. This does not mean that one caused the other, and this is a really important lesson in philosophy that I learned in my philosophy class in college about all the different logical fallacies they call them or errors of thinking that we have.
So a really common error in thinking is called if this, then that. Its technical name is post hoc ergo propter hoc. That’s Latin for after this, therefore, because of this. It’s a misperception that since event Y followed event X, event Y must have been caused by event X. And when we see anecdotes, they can be particularly tempting because they let you draw conclusions based solely on the order of the events. But you have to step back for a minute and remember that there could easily be other factors that are causing the postpartum depression.
Dr. Rebecca Dekker – 00:39:24:
I hope you enjoyed that clip from our Q&A on postpartum depression and Pitocin. A fascinating topic. I still get that question all the time, and I’m glad that I can refer people to that podcast episode now.
However, one of our most popular podcast episodes and signature articles has been the Evidence on: Vitamin K for Newborns. In 2014, when this article was first published, the interest was so great—so many people tried to click the link and visit the website at once—that it actually crashed the website and people were telling us “Rebecca, you broke the internet.” Now, Vitamin K injections for newborns are an important way to prevent a rare but serious condition called Vitamin K Deficiency Bleeding. A lot of misinformation was circulating back then about Vitamin K it still is going around today. Because of this, we try to stay on top of this topic. We’ve updated the signature article on Vitamin K multiple times, most recently in 2025. So, this is a clip from the podcast episode that accompanied our most recent update on Vitamin K. And as you listen, you’ll hear me talk about what is Vitamin K Deficiency Bleeding, what are some signs that this bleeding might be occurring, and I’m also going to talk about something that a lot of people might not know: that Vitamin K deficiency bleeding is more common in babies who receive human milk instead of formula, and I’m going to talk about why this is.
Dr. Rebecca Dekker – 00:40:57:
So in this podcast and the Signature Article, we cover all forms of VKDB, but we’re really going to focus on late VKDB because it’s the most dangerous kind. Although it’s also the most rare type of VKDB, late VKDB has consequences that can be catastrophic. More than half of infants who develop late VKDB will have bleeding in their brain. The mortality rate is approximately 20%. One study found that of infants who survive late VKDB, about 40% have long-term brain damage. In low-resourced countries, many babies, with late VKDB, may die before reaching the hospital. And because their diagnoses and deaths are undocumented, these cases are not usually counted in any VKDB statistics. In high-resourced countries, where parental refusal of Vitamin K is on the rise, we really don’t have accurate reporting on how many infants are not receiving Vitamin K after birth. However, we do know that the trend of parents refusing Vitamin K is increasing. So before we go into more detail about giving Vitamin K, I want to talk about signs of VKDB that clinicians, birth workers, and parents should know about.
One of the biggest problems with VKDM is that it often occurs with no early symptoms. This means that you might not recognize signs of illness until it is too late. As we all know, newborns can’t really speak to us, and early symptoms of brain injury can be subtle. Symptoms include difficulty feeding, lethargy, fussiness, bulging soft spots on a baby’s head, unexplained bruising or pooling of blood under the skin, easy bruising, especially around the baby’s head and face, bleeding from the nose, skin, a circumcision site, gums, or the umbilical cord site, a paler than usual skin color, or for babies with darker skin tones, pale appearing gums, yellow eyes after the baby is three weeks old, blood in the diaper or stool, black tarry stool at three days of age or older, or vomiting blood. Now, as you might have guessed from me listing these symptoms, those first couple of symptoms, difficulty feeding, kind of sleepiness, fussiness, those can often be confused with other common newborn symptoms.
And that’s one reason why giving Vitamin K to all babies is important because it’s kind of hard to… Identify when this type of bleeding is starting. Some people may wonder why babies who are exclusively breastfed are at higher risk for VKDB. And I do have to acknowledge that human milk has very limited amounts of Vitamin K. Levels in human milk and colostrum, which is the first drops of milk, are similar, about one to nine micrograms per liter. So virtually all babies with late VKDB are exclusively fed human milk. Now when researchers look closely at infants who develop late VKDB, they found that lactating parents of these babies had the normal levels of Vitamin K in their milk supply, meaning that they are not lacking this nutrient in their milk compared to the average amount present in other breastfeeding parents. It’s thought that maybe some of these babies have a problem with absorbing that average amount of Vitamin K from their parents’ milk. On the other hand, there are virtually no reports of VKDB occurring in infants who are formula fed. This is because in contrast to human milk, formula has much higher levels of Vitamin K, about 55 micrograms per liter. I know that in the past, some people have been offended by our discussion of levels of Vitamin K in human milk. Some readers believe that human milk or breast milk is nature’s perfect food, and they may be surprised or upset by this conversation. Please know that at EBB, we always advocate for increased access and support and encouragement around lactation, and we also honor and support families who want, or need to use formula to feed their baby, evidence shows that providing sufficient amounts of Vitamin K to prevent the very rare cases of Vitamin K deficiency bleeding is a benefit of formula, but not human milk.
Dr. Rebecca Dekker – 00:44:56:
Phew, I hope you found that clip educational. I know it’s controversial, and whenever you bring up breastfeeding and lactation and Vitamin K, it brings out a lot of feelings from a lot of people.
Next up, though, I want to share a clip that feels especially meaningful to me personally, especially given on everything that we’ve been going through in my family. Over the years on this podcast, I’ve talked with many families about their birth stories, but this time, I want to share part of my own birth story—not the story of me giving birth, but the story of when I was born. Back in EBB 75, I sat down with my mom, Carol, to talk about her experiences giving birth in both the 1960s and the 1980s. So she experienced both twilight sleep births, where my dad wasn’t even allowed in the room and she was completely knocked out during the delivery and forceps were used, to later when my younger sister and I were born when things had slowly begun to change. So, in this clip, my mom is going to reflect on how much childbirth care evolved even between her different birth experiences.
Carol De Young – 00:46:08:
Well, of course, with my first two deliveries, my husband, you know, said, “Kiss me goodbye” at the elevator, and that was it. That was all the father was involved in. That was it. But, um, so with Rebecca, times had changed, and men were involved. And my husband said, N o way was he going to attend her birth. I said, “Well, you know, you are. You’re coming with me.” And I made him go with me to the Lamaze classes, and, you know, he was gonna be my coach, and so that was a huge change to have fathers be involved in, in the birth process. At the very last, I succumbed to having, uh, actually a spinal. They talked me into it ’cause they told me it was gonna be much, much longer, and I was…have you talked about the different stages of labor?
Dr. Rebecca Dekker – 00:46:49:
Mm-hmm.
Carol De Young – 00:46:50:
I was in transition, and I just, “Okay, you know, give me a spinal.” So I had a spinal with Rebecca. So finally…
Dr. Rebecca Dekker – 00:46:57:
How much longer till I was born?
Carol De Young – 00:47:00:
Immediately. Immediately. I said, “You lied to me.” So then with my last one, I was absolutely determined I was having no more medication, and I did have her completely without any anesthesia. And I was able to get up immediately after her birth and walk around, and I took her home the next morning. It was a totally different experience. It was, it was really wonderful.
Dr. Rebecca Dekker – 00:47:26:
How were you able to do that the fourth time?
Carol De Young – 00:47:28:
Determination. I don’t know.
Dr. Rebecca Dekker – 00:47:30:
But didn’t you say you had a really good nurse?
Carol De Young – 00:47:31:
I had a really good nurse, that’s right. You’re right. I had requested a Lamaze nurse. I had a terrific nurse, and she got me through it, so I was very grateful to have that kind of help.
Dr. Rebecca Dekker – 00:47:46:
So, if you’re curious about the topic of twilight sleep, I highly recommend you go back and listen to EBB 75 and hear about my mom’s experiences with twilight sleep and kind of the full range that she had, next having an epiduralized birth and then finally having an unmedicated birth with her youngest.
So, I hope you enjoyed these clips from seven of our team favorites and listener favorites. I was encouraged to start this podcast at Evidence Based Birth® nearly 10 years ago by someone who had a podcast in a different field, and I’m so glad we took that advice. It just felt right at the time, and it still feels right now. I feel like using this medium has really helped us reach so many more people around the world and to help us get evidence-based, empowering info out there about pregnancy, birth, and postpartum. I personally cannot wait to see what the next 100 episodes hold, and I do know that next week we will be celebrating pride month with a really special episode about perinatal mental health in the LGBTQ+ community. So, thanks again for listening to our 400th episode this special anniversary, and I’ll see you next week. Bye!
