Evidence Based Birth®

In today's episode, I'm revisiting a deeply important conversation with Tania Silva Meléndez and Tamara Trinidad González, two inspiring birth workers and Evidence Based Birth® Instructors based in Puerto Rico.

Tania and Tamara share their personal journeys into birth work and what led them to become changemakers in Puerto Rico's birth community. They speak candidly about the immense challenges families face, from one of the world's highest cesarean rates to the ongoing impacts of colonialism and systemic barriers within maternal health care. You'll hear what it's like to provide midwifery services in an environment where midwives aren't officially recognized, and the impact this has on those seeking safe, respectful, and dignified care. We also dive into the powerful grassroots and community-led efforts Tania and Tamara are leading, including legislative advocacy, innovative education, and direct, compassionate support for families striving to improve birth outcomes and claim reproductive rights on the island. Together, we explore both the heartbreak and the hope shaping Puerto Rico's current birth landscape, and highlight meaningful ways listeners can join in solidarity with these efforts. Content note: obstetric violence, colonialism, infant death, abortion, poor outcomes, maternal health deserts, gender based violence

(03:03) Midwifery Leadership and Collaboration (07:27) Journey to Home Birth Choices (12:32) Puerto Rico Birth Control Campaign Impact (13:57) Obstetric Violence and Doula Integration (17:36) Midwife-Doctor Collaborative Care Solutions (20:04) Hospital System Communication Challenges (23:48) Puerto Rico: A Modern Colony (27:46) Puerto Rico Investment Gentrification Issue (33:30) Community-Led Family Support Initiative (34:50) Youth Engagement Through Visual Education (38:46) Puerto Rico Midwives Day Law (44:14) Birth Summit Collaboration in Puerto Rico (46:05) Midwife-EMT Collaboration Curriculum (51:19) Puerto Rico Birth Rate & Hospital Crisis (53:50) Supporting Midwifery and Access in Puerto Rico

Resources

• If you are interested in joining with Tania and Tamara and volunteering your time or skills to help them reform the maternal health system in Puerto Rico, they are currently looking for volunteers with experience in law, public relations, funding, data collection, research, and writing. OR if you have resources, or access to connections that could help fund their work, please email [email protected].
• Learn more about Caderamen, a nonprofit organization that has a service program that is called SePARE, which offers education and doula services, midwifery services and naturopathic medicine services, social workers, mental health by clicking here.
• Learn more about the Asociación de Parteras of Puerto Rico here.
• Learn more about Alimentación Segura Infantil, a community-based organization born after the impacts of Hurricanes Irma and Maria in 2017 to support breastfeeding and chestfeeding families in their lactation journeys by clicking here.
• Learn more about Observatorio de Violencia Obstétrica in Puerto Rico here.
• Learn more about Las Mingas de Aborto, an abortion doula collective that offers free support in Puerto Rico here.
• Check out the work by Puerto Rican journalist Biana Graulau here.
• Read more about the history of Puerto Rico:
  • How to Hide an Empire by Daniel Immerwahr
  • Puerto Rico: What Everyone Needs to Know by Jorge Duany

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

Dr. Nikia Grayson, nurse midwife, family nurse practitioner, and anthropologist, joins us to share how she's helping reclaim and restore Black midwifery in the South. As Chief Clinical Officer at CHOICES Center for Reproductive Health in Memphis, TN, Dr. Grayson has led groundbreaking efforts to open Memphis' first and only birth center, launch the nation's first Black Midwifery Fellowship, and provide full-spectrum, justice-centered reproductive care. In this episode, Dr. Grayson reflects on the challenges of dismantling systemic racism in health care, the impact of the Dobbs decision on abortion access in the South, and the importance of investing in doulas, midwives, and community-based care. Dr. Grayson also offers advice for birth workers on building new systems rooted in justice, joy, and liberation.

Content note: Discussion of infant mortality disparities as well as difficulties in accessing abortion care post-Dobbs decision.

(02:33) The Vision Behind CHOICES (04:44) Obstetric Racism and Health Care Barriers in Memphis (07:21) Building Memphis' First Birth Center (10:34) A Calling to Midwifery and Restoring Black Traditions (13:41) Early Work in Home Birth and Community Care (15:19) Growing a Midwifery Team in Memphis (17:57) Launching the Black Midwifery Fellowship (20:11) Pivoting Care After the Dobbs Decision (24:26) Sustaining Joy and Practicing Self-Care in Justice Work (30:51) Partnering with Doulas and Growing Community Support (34:27) Investing in Workforce Development and Training (35:41) Advice for Birth Workers: Build Boldly, Do It Afraid Resources Learn more about CHOICES: www.yourchoices.org | @yourchoicesclinics Explore the Black Midwifery Fellowship: www.yourchoices.org/fellowship-for-black-midwives 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.

Gestational diabetes (GDM) is one of the most common health issues during pregnancy, and diagnosing it is more complicated than you might think. In this episode, Dr. Dekker is joined by EBB Research Team member Dr. Morgan Richardson Cayama to cover the newly updated evidence on how GDM is diagnosed. They walk through the physiology behind GDM, current testing methods, and why there's still international disagreement about how to screen. Together, they examine the results of large randomized trials comparing the one-step and two-step screening methods, the research on early screening with hemoglobin A1C, and the evidence on alternatives to the Glucola drink, including candy and home blood sugar monitoring. They also review the risks of skipping screening entirely, and how weight bias and other systemic factors can impact diagnosis and care. (02:28) What is Gestational Diabetes and Why Is It So Common? (06:30) Risk Factors, Size Bias, and the Role of Race and Ethnicity (10:40) Why We Screen and the Origins of the Controversy (13:17) Comparing the One-Step and Two-Step Methods (19:55) What New Research Says About Health Outcomes (23:45) Should We Screen for GDM Earlier in Pregnancy? (28:11) Can Hemoglobin A1C Replace the Glucola Drink? (32:44) Alternatives: Candy, Food, and Home Monitoring (40:04) What International Guidelines Recommend (43:07) Declining GDM Testing: What the Evidence Shows (47:47) Is Sperm Linked to Gestational Diabetes Risk? (51:29) Takeaways and the Future of GDM Diagnosis Resources

• Download the free two-page handout in English or Spanish: ebbirth.com/370
• Explore Real Food for Gestational Diabetes by Lily Nichols: realfoodforgd.com
• For a full list of resources, visit: ebbirth.com/inducinggdm

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

Dr. Morgan Richardson Cayama, public health researcher, doula, and member of Team EBB, joins Dr. Rebecca Dekker to explore the critical issue of mistreatment in maternity care. Drawing from her doctoral research—including interviews with Black women in Florida and data from the Giving Voice to Mothers study—Dr. Morgan shares what respectful maternity care really looks like, and how the lack of it can negatively impact birth outcomes and future healthcare decisions. She also opens up about her own preterm hospital birth, offering insight into how even the most informed parents can feel disempowered by coercive hospital systems. Together, they break down the systemic roots of obstetric violence and offer community-driven recommendations for change. Content Note: Discussion of obstetric mistreatment, medical trauma, discrimination in maternity care, and stillbirth. (04:35) How a Global Health Class Sparked a Career in Public Health (08:17) From Dissertation to Delivery: Dr. Morgan's Birth Story (15:57) Reflecting on the Power of Language and Provider Ultimatums (19:40) What Mistreatment in Maternity Care Looks Like in the U.S. (24:08) Florida's Unique Birth Landscape (26:10) Researching the Lived Experiences of Black Birthing Women (28:13) What Respectful Care Really Means to Patients (35:29) Participant Recommendations for Healthcare Providers and Parents (40:01) How a Single Birth Interaction Can Shape Lifelong Views on Healthcare (42:00) Centering the Voices of Birthing People to Create Change Resources Access the FREE 2-page handout: ebbirth.com/rmc Read the Giving Voice to Mothers study: birthplacelab.org Listen to EBB 338 – Respectful Maternity Care with Dr. Jessica Brumley 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.

Rikki and Nova Jenkins join Dr. Rebecca Dekker to share the personal and powerful story of their second birth: a planned home VBAC that ultimately led to a hospital transfer. Rikki, Evidence Based Birth® Instructor Coordinator, doula, and IBCLC, reflects on the trauma of her first Cesarean birth and the deep healing she found through midwifery care, doula support, and intentional preparation. Nova, a Grammy-nominated music producer and proud girl dad, shares his emotional journey from feeling powerless in their first birth to becoming a protective presence throughout this redemptive experience. Together, they offer a vulnerable, moving conversation about reclaiming birth after trauma, processing grief, and creating a peaceful bubble of support for their family, even when things don't go as planned. Content Note: This episode contains description of obstetric violence from (14:05) to (18:55) and of unexpectedly losing consciousness during a Cesarean from (40:54) to (45:43). (04:36) Why They Chose a Home VBAC After Trauma (08:46) Dual Care with a Midwife and OB (11:22) Processing the First Cesarean—Seven Years Later (19:09) Prepping for a Home Birth and VBAC (21:40) Including Their Daughter in Prenatal Care (24:10) Amora's Labor and When Things Stalled (30:12) Making the Empowered Decision to Transfer (34:11) A Healing, Respectful Cesarean Experience (45:02) When Language Hurts: "Failed Home Birth" (51:04) Planning for Postpartum and Accepting Support (52:49) Advice for Those Planning a VBAC or Home Birth Resources Follow Rikki: @sacredjourneylv Follow Nova: @novablessed Explore Heart & Soul Collective: www.heartandsolcollective.org | @heartandsolcollective Check out Flor Cruz's "Badass Motherbirther:" www.badassmotherbirther.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.

Jennifer Anderson, RN, experienced doula, Evidence Based Birth® Instructor, and member of Team EBB, returns to the podcast to join Dr. Rebecca Dekker in unpacking a new trend in labor induction protocols—starting Pitocin at higher doses and incorporating early artificial rupture of membranes (AROM). Drawing from her work with high-risk clients and firsthand experience inside hospital systems, Jennifer highlights how policies aimed at "optimizing" labor often prioritize speed over patient-centered care. Together, they examine what's in these new induction bundles, the evidence behind faster-moving protocols like dual-method cervical ripening and 4x4 Pitocin, and the importance of informed decision-making at every stage. (04:10) A Client Story That Sparked Concern Over High-Dose Pitocin (07:27) What "2x2" vs. "4x4" Pitocin Protocols Mean (09:41) Hospital Protocols: What the Nurse Can (and Can't) Do (12:25) Inside the New Induction Policy: What's Changing and Why (18:40) Balloon Checks, Membrane Sweeps, and Patient Comfort (23:43) "Timely AROM" and the Push for Early Artificial Rupture of Membranes (30:54) Does Early AROM Shorten Labor Without Increasing Infection? (45:19) Alternatives to Shorten Labor Without Breaking the Water (52:04) Why a "Failed Induction" Policy Can Prevent Unnecessary Cesareans (55:43) How to Push Back on High-Dose Pitocin or Early AROM Resources Explore Jen's work: birthfusion.com | @birthfusion Take the Evidence Based Birth® Childbirth Class: ebbirth.com/childbirth-class/ Watch the EBB Crash Course on YouTube here Get the EBB Labor Induction Pocket Guide here EBB Failure to Progress Resource Page: ebbirth.com/failuretoprogress EBB 155 – Pelvic Floor Health in Pregnancy and Postpartum with Dr. Juan Michelle Martin EBB 118 – How to Have a Healthy Postpartum Transition with Dr. Alyssa Berlin 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.

What happens when a nurse finishing up her PhD in evidence-based practice becomes a parent and realizes her own birth care was anything but evidence-based? In this episode, Dr. Rebecca Dekker take us back to the very beginning and shares how her first birth experience set her on a mission to change maternity care. She reflects on her two contrasting birth stories: one marked by unnecessary interventions and separation from her newborn, the other defined by empowerment, autonomy, and midwifery care. Opening up about how these experiences shaped her purpose, Rebecca shares how these experiences led her to launch Evidence Based Birth in 2012. Since then, the platform has grown from a simple blog into a platform for sharing evidence based info that is trusted by families and professionals around the world.

(00:55) Why Dr. Dekker Re-Recorded This Episode in 2025 (05:03) Trying to Be the "Good Patient" (10:00) Separation from Her Baby and Delayed Bonding (13:45) Questioning the Evidence Behind Her Care (16:10) A Second Birth, Reclaimed (19:55) The Birth of Evidence Based Birth (24:20) How EBB Bridges the Gap for Families and Providers (27:40) What's Coming Next on the EBB Podcast 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.

Welcome to a special announcement episode of the Evidence Based Birth® Podcast! This August, we're celebrating the incredible people who make up Team EBB. Each Wednesday, you'll hear directly from team members as they share their experiences and expertise. Listen on your favorite podcast app or watch full episodes on our YouTube channel, and be sure to follow us on Instagram (@ebbirth) for even more behind-the-scenes stories and updates throughout August.

• Watch full episodes on YouTube
• Follow us on Instagram @ebbirth for behind-the-scenes stories and team updates

For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. 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

Curious if prenatal perineal massage actually works to prevent tears during childbirth? In this episode, Dr. Rebecca Dekker examines the evidence on perineal massage in late pregnancy, separating fact from fiction and sharing what the research really shows. You'll learn what major studies say about perineal massage, why some commonly cited research may not be trustworthy, and whether this practice is truly necessary, especially if you're in a birth setting with low episiotomy rates. You'll also hear some surprising insights on other ways to protect your perineum and reduce your risk of severe tears.

Content note: Discussion of perineal tears during childbirth, severe tears, and episiotomy.

(06:14) Evaluating Perineal Massage Evidence (08:32) Comprehensive Perineal Massage Meta-Analysis (11:20) Perineal Massage Study Bias Concerns (16:04) Double-Blind Study on Episiotomy Rates (20:09) Perineal Massage vs. Control Outcomes (24:44) Study Bias and Participant Dropouts (28:11) Research Fraud: Doubts on Dönmez Study (33:53) Trial Bias in Perineal Massage Study (35:57) Perineal Massage Study Bias Concerns (40:43) Effectiveness of the EPI-NO® Device Resources

• For a full list of scientific references, see the blog post that goes along with this episode: https://ebbirth.com/216
• Check out Episode 206 of the EBB Podcast to learn about Perineal Tears and Avoiding Episiotomy and Episode 210 to learn about warm compresses and hands on vs. hands off techniques.
• Learn more about the Evidence Based Birth® Childbirth Class: https://ebbirth.com/childbirth-class
• Take a continuing education class on this topic (and earn a contact hour) by joining the EBB Professional Membership here: https://ebbirth.com/membership
• Check open access journals to see if they are on beallslist.net (https://beallslist.net/standalone-journals/) as a potential predatory journal.
• Resource for authors to determine whether they should submit to an open access journal: https://thinkchecksubmit.org/

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.

Sophie Walker, host of the Australian Birth Stories podcast and author of The Complete Australian Guide to Pregnancy and Birth and The Complete Guide to Postpartum: A Mother-Focused Companion for Life After Birth, joins Dr. Rebecca Dekker to explore what it really takes to plan for a nourishing postpartum experience and the challenges and strengths of the Australian birth system. Sophie shares how a traumatic first birth sparked her passion for informed decision-making, why continuity of midwifery care matters, and how her country's publicly funded postpartum home visits and mothers' groups create critical support networks. Together, Sophie and Dr. Dekker unpack the postpartum cliff that so many new parents face, discuss how to prepare mentally, emotionally, and physically for life after birth, and offer tips on everything from pelvic floor recovery to sleep expectations to navigating newborn feeding. (02:28) Sophie's Birth Story and What She Learned from Trauma (06:07) Why Listening to Birth Stories Can Be a Powerful Tool (09:25) Models of Maternity Care in Australia (13:10) Strengths and Gaps in the Australian System (17:33) Midwifery Burnout and Access Issues (20:32) Rise of Doulas and Student Midwives (25:03) Postpartum Home Visits and Maternal Health Nurses (29:51) Mistakes to Avoid When Planning for Postpartum (35:01) Pelvic Floor Recovery, Lactation Support, and Mental Health (42:04) Infant Sleep: Expectations vs. Reality (46:49) Balancing Birth and Postpartum Prep (48:26) Making a Mental Health Safety Net (51:33) Listening to a Range of Birth Stories—Even the Hard Ones Resources Explore Sophie's podcast and books: australianbirthstories.com Follow Sophie on Instagram: @australianbirthstories EBB 155 – Pelvic Floor Health in Pregnancy and Postpartum with Dr. Juan Michelle Martin EBB 256 – Top 3 Recommendations for Preventing Pelvic Floor Dysfunction after Birth with Dr. Sarah Duvall, Founder of Core Exercise Solutions EBB 118 – How to Have a Healthy Postpartum Transition with Dr. Alyssa Berlin 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.