Evidence Based Birth®

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

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

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

Resources

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The ways we feed and care for babies are shaped not only by research, but also by family traditions, cultural values, and generations of shared wisdom. In this episode, Dr. Rebecca Dekker talks with Yogyata Wadhwa, an IBCLC, childbirth educator, birth doula, sleep consultant, and infant feeding specialist based in India. Drawing on her experience supporting more than 10,000 families, Yogyata shares how parents can honor cultural traditions while making informed decisions about breastfeeding, introducing solids, and navigating the postpartum period. They explore common breastfeeding challenges, cultural beliefs surrounding infant feeding, and how parents can balance evidence-based recommendations with meaningful family customs. Yogyata also shares postpartum traditions in India, including the Jappa period, family caregiving practices, and the cultural significance of introducing a baby's first foods. (00:00) Introduction and overview of cultural perspectives on breastfeeding and infant feeding in India (05:34) How Yogyata became a childbirth educator, IBCLC, doula, and infant feeding specialist (08:38) Common breastfeeding challenges: milk supply concerns, latch difficulties, and tongue ties (10:24) Cultural beliefs that influence breastfeeding (16:18) Traditional infant feeding practices in India and the Annaprasan ceremony (21:32) First foods for babies and introducing solids (23:45) What baby-led feeding looks like (28:04) Signs that a baby is ready to start solids (33:41) Maternity leave, workplace accommodations, and postpartum support systems in India (36:20) The Jappa period and postpartum recovery practices (39:09) Balancing evidence-based recommendations with cultural expectations (43:43) Advice for Indian families living abroad and navigating feeding without traditional support systems (47:04) Yogyata's final advice for first-time parents Resources Connect with Yogyata on Instagram: @thebirth.life Learn more about The Birth Life: thebirthlife.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.

Research shows that queer and trans parents face significantly higher rates of perinatal depression and anxiety, but affirming and community-centered support can make a big difference. In this episode, clinical psychologist and researcher Leiszle Lapping-Carr joins Dr. Rebecca Dekker to talk about the unique mental health challenges 2SLGBTQ+ parents may experience during pregnancy and postpartum and what providers, birth workers, and communities can do to create safer, more supportive care. Dr. Lapping-Carr shares how stigma, discrimination, isolation, and lack of affirming healthcare spaces can affect mental health outcomes for queer and trans parents. She also explains how evidence-based approaches like cognitive behavioral therapy can be adapted to better support 2SLGBTQ+ families, especially when distress is rooted in experiences of discrimination and loss of safety. Learn how protective factors that support mental health, chosen family and community, and inclusive healthcare providers can make perinatal spaces more affirming for all parents. (01:43) Dr. Leiszle Lapping-Carr's background and research journey (04:31) Perinatal depression rates among queer and trans parents (07:19) Minority stress, discrimination, and mental health risks (11:08) Protective factors and the importance of community support (12:52) What is the Mothers and Babies intervention? (15:17) Adapting Cognitive Behavioral Therapy (CBT) for queer and trans parents (20:09) Common thought patterns and challenges for LGBTQ+ parents (22:57) Behavioral strategies and "pleasant activities" for mental health (28:58) Barriers to affirming perinatal mental healthcare (32:42) The role of doulas and community recommendations (37:33) Common mistakes providers make when caring for queer and trans parents Resources Learn more about Dr. Lapping-Carr and her research: feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=49272 Postpartum Support International Online Support Groups: postpartum.net/get-help/psi-online-support-meetings/ Mothers and Babies preventive perinatal depression intervention: mothersandbabiesprogram.org/providers/ 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.

Happy EBB 400! In honor of this milestone, Team EBB is looking back on some of our and your favorite episodes of the EBB Podcast from the past nine years. From advocacy in birth and improving maternity care to exercise in pregnancy, postpartum support, Vitamin K, and upright birthing positions, this anniversary episode highlights the stories and evidence that have shaped the EBB community since 2017. Whether you've been here since episode one or just recently found the podcast, this episode is a celebration of evidence-based information and the families and professionals who make this work meaningful.

(07:04) Jennie Joseph on The JJ Way® and Improving Maternity Care (12:56) JaMichael Perryman on Birth Advocacy and Supporting Your Partner (18:26) Evidence on Birthing Positions and Protecting the Perineum (23:51) Exercise in Pregnancy with MamasteFit's Gina Conley (29:14) Cheyanne Saenz on Self-Advocacy and Knowing Your Rights in Birth (33:15) Q&A: Pitocin and Postpartum Depression (39:24) Updated Evidence on Vitamin K for Newborns (44:56) Rebecca's Mom Shares Her Experiences with Twilight Sleep and Changing Birth Practices (47:46) Looking Back on 400 Episodes and Looking Ahead to the Future of EBB

Resources

EBB 136 – Solutions for the Crisis in American Maternity Care

EBB 145 – Fatherhood and Advocacy in Birth with JaMichael Perryman

EBB 221 – Evidence on Birthing Positions and Tried-and-True Midwifery Practices for Protecting the Perineum

EBB 264 – Top 3 Tips for Exercise in Pregnancy with Gina and Roxanne of Mamaste Fit

EBB 208 – Advocating for Your Rights in Birth with EBB Childbirth Class Graduate, Cheyanne Saenz

EBB 304 - Q & A on PPD/Pitocin, Delayed Cord Clamping, Nubain, and Placental Encapsulation

EBB 347 - Updated Evidence on Vitamin K

EBB 75 - Birth in Twilight Sleep – the Experiences of Rebecca's Mom

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.

Pregnancy fitness advice has changed dramatically over the last few decades, but many parents still receive outdated recommendations rooted more in fear than evidence. After receiving outdated advice during her own pregnancy, exercise physiologist and prenatal/postnatal wellness practitioner Ashley Reid was inspired to help moms stay active through every stage of motherhood. In this episode, Dr. Rebecca Dekker talks with Ashley about the latest evidence on exercise and strength training during pregnancy and postpartum.

Ashley shares why old recommendations like keeping your heart rate under 140 beats per minute are outdated, what the research actually says about lifting weights during pregnancy, and how to safely build strength in ways that support your changing body. She also explains her "Core, Function, and Fitness" framework and how to approach postpartum recovery as a gradual progression instead of a rush back to exercise.

(03:55) Outdated pregnancy exercise advice and the "140 beats per minute" rule (06:27) Fear around heart rate monitoring and exercise intensity in pregnancy (08:42) What the research says about exercise safety and pregnancy (13:20) Ashley's "Core, Function, and Fitness" framework (17:20) Why core strength matters during pregnancy (20:47) Is lifting weights during pregnancy safe? (25:25) Signs it may be time to modify or pause exercise (27:23) How pregnancy exercise supports postpartum recovery (30:01) Returning to exercise postpartum and the new 2025 guidelines (36:27) Ashley shares what readers will learn in her book Active Mom (37:56) Sample workout progressions and making exercise work for you

Resources

Learn more about Active Mom Fitness: activemomfitness.com/

Get your copy of Ashley's Book, "Active Mom": activemomfitness.com/books

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.