Ep 18: Evidence Based Birth Founder Rebecca Dekker

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It’s a sad but true fact that the current culture of care for pregnant women needs improvement.

If you’ve been following me for any period of time, you know I’m passionate about educating women on their options, and always encourage you to educate yourself and be prepared.

My guest on this week’s episode of the podcast is Rebecca Dekker, the founder of Evidence Based Birth. Like me, she’s passionate about ensuring women have the knowledge, tools, and education to have a great experience giving birth.

This interview is definitely a must listen to for any pregnant woman, whether you’re a first time mom, or you’ve had kids but are pregnant now. The knowledge you’ll gain is immeasurable!

And if you’re a childbirth educator or doula, she shares some information regarding how she built Evidence Based Birth that I know you’ll find helpful.

Listen in to this episode as Rebecca shares how Evidence Based Birth got its start, why she does what she does, and her top tips for pregnant women.

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Speaker 1: Super excited to have Rebecca Dekker on the podcast today. She is the founder of Evidence Based Birth.

Speaker 2: Welcome to the All About Pregnancy and Birth podcast. I'm your host Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation Course. An online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

Speaker 1: Nicole: Hello. Hello. Hello. Welcome to another episode of the podcast. I am so glad you're spending some time with me today on the podcast. Today we have Rebecca Dekker. Rebecca is the founder of Evidence Based Birth. It's a great website and the mission of Evidence Based Birth is to promote evidence based care by putting the research evidence about childbirth into the hands of families and professionals and to help change maternity care from the inside out. Rebecca received her master of science in nursing and her doctor of philosophy in nursing from the University of Kentucky. She earned her bachelor of science degree in nursing from Calvin College in grand rapids, Michigan. Now Rebecca has built a really strong reputation in the maternal and infant health communities for her really pioneering work as the founder of Evidence Based Birth. I love Evidence Based Birth. It's a great resource that I recommend to pregnant women.

Speaker 1: Nicole: They use a very rigorous process to come up with unbiased summaries of topics and she's going to talk a little bit about that process in the episode, but it's a great resource for information so for sure check it out and I'll link to the website in the show notes. Now in this episode today, she talks about a little bit of everything. In the first 10 or 15 minutes or so I asked her some questions about what it was like to start Evidence Based Birth and I think that information is going to be particularly helpful for the Doulas and the childbirth educators that I have in the audience. She talked about how she started it and some challenges she encountered and then the rest of the time it's advice for expectant parents. I think you're really going to enjoy this episode, so for sure stick around.

: Nicole: Now, before we get into the episode, let me give a quick listener shout out. This is from Haneen, h, a, n, e, e, n dot l, I, c, s, w. And she left me a review in iTunes and it says "so lucky to have found this podcast. I love the content that is shared, so genuine, honest, and relatable. Thank you for this." Well, thank you for that very kind review. I absolutely love this podcast and I am glad that you love it too. All right, so without ado, let's get into the episode with Rebecca Dekker from Evidence Based Birth.

Speaker 1: Nicole: Hi Rebecca. Thank you so much for being here. I'm a huge fan of your work and really excited to have you on my show.

: Rebecca: Thank you Nicole for having me. It's an honor.

: Nicole: Yeah, thank you. So tell us a little bit about you, your family, maybe a little bit about your work and we'll get more details about your work with just kind of an overview.

Speaker 3: Rebecca: Sure. So I live in Lexington, Kentucky with my husband, Dan and our three kids who are ten, seven and five years old. And I am a registered nurse and I have my phd and after I got my phd, I started working in the tenure track as an assistant professor. And I was primarily doing research in cardiovascular health, but I was very heavily involved in running clinical trials and collecting data and writing research papers and that sort of thing. So then I had my second baby about two years into that faculty job and that experience was really life changing for me. At my first birth, I had really, kind of had a bad experience and had a lot of things done to me that I found out later were not evidence based. And so with my second baby, I really set out to get evidence based care. But what I ended up discovering was so much more and that was that I had a passion for helping other families get that kind of evidence based care.

Speaker 1: Nicole: Awesome. So, I'm taking that that's what led you to start your organization Evidence Based Birth?

Speaker 3: Rebecca: Yeah. So I started Evidence Based Birth in the spring of 2012 when I was freshly postpartum with my second baby and I was on maternity leave and I thought, mmm, maybe I could start posting the information that I had been collecting. Because I'd been collecting a lot of research, writing some research summaries, mainly for my own benefit. And I thought, well maybe other people would find this useful. So I started posting the research. They're basically literature reviews but written for the public online and it just kind of took on a life of its own. People were really gravitating towards what I was doing and sharing it and telling all their friends. And all of the sudden Evidence Based Birth became this huge thing where all these people were reading the articles I was writing. But it was just a hobby. Like it was something I did every evening, every weekend I was working on it. And during the day I was doing my regular day job.

Speaker 1: Nicole: It's funny how like a hobby can blossom into something so much more.

Speaker 3: Rebecca: Yeah. And I don't know if hobby is the right word for it because to me it really felt like I was driven. It was almost like I couldn't not do it like something, there was this driving force that was like, I have to do this and I couldn't stop. Like I was constantly reading research, writing about research. It was like I found my purpose in life.Aand so I next interned, you know, the next four years were really difficult because I was doing both. So I was doing my passion in the evening and weekends. I was working for a university during the day and putting most of my energy towards my university job obviously. And so eventually I was able to make the leap and do Evidence Based Birth full time. And so I've been doing that full time since the summer of 2016 and just loving every minute of it.

Speaker 1: Nicole: Hmm. So for four years you were working full time and doing Evidence Based Birth?

: Rebecca: Yes.

: Nicole: Wow. That is a lot. And then now just for the past, almost, I guess two and a half, three years you've been doing it full time.

: Rebecca: Exactly.

: Nicole: Okay. So what is evidence based birth today? What is the, cause it's an organization now. It's like a big thing. What is it?

Speaker 3: Rebecca: Yeah, so, first of all, I want be really transparent. It's not a nonprofit. It is an LLC. So it's a company. And one of the reasons I chose to do that is because I like to have control. And you know, the thought I toyed with the idea of turning it into a nonprofit and then I was like, well, but then I would have to give up control to a board of directors and I really just wanted to, you know, I wanted it to be, it was my baby. It felt like my baby. And I'm like, I need it. It's like a fourth child. Really. So I organized it as an LLC and I'm the owner or CEO. And, today we have, I believe a total of nine people who work regularly for Evidence Based Birth, including me and my husband.

Speaker 3: Rebecca: And then we have other people involved and we have like a graphic designer. We have an audio and visual editor or video editor. We have somebody who handles all of our customer service. We have people in charge of the different programs that we run also. Yeah. So there's about nine people. And together we are a force to be reckoned with because what I found is like, as a single person, I could only do so much before I started to burn out and, you know, getting hundreds of emails a day from all over the world. I was like, one of the first things I did was hire somebody to help me respond to all of the communication because I was drowning in emails. And, you know, it's just the cool thing is, is we don't want to grow any bigger really than we are right now.

Speaker 3: Rebecca: But the people that we have allow us to do so much more than if it was just myself. So, for example, right now I have a research editor, Anna Bertone, who's been working for me for about two years now and she's really been essential in helping me write more articles and keep our articles updated because we post all of these literature reviews on our site. We don't want them to get, grow outdated. So, her work has really been invaluable. So it's things like that that help kind of extend the work that I do by bringing more people onto the team.

Speaker 1: Nicole: Right. And, and you know, and I hear a lot of lessons in your story, like one thing that jumps out is that, you know, you said, do I turn it into a nonprofit? Do I not? But you also have to like eat and pay your bills and things like that and you deserve to get, everyone deserves to get paid for their work. And I think sometimes women, especially, did you ever have any tension feeling like, you know, making money with this thing and kind of going through that in your mind?

Speaker 3: Rebecca: Not really. From the very beginning, I knew that if it was going to be sustainable in the long run, I had to figure out a way to make it self sustaining. And for a while that involved, you know, being able to bring in money to pay for the website hosting and to pay for the different, you know, to have someone design a logo. Like there's all these little expenses that add up. To hire people to help me. And so at first it was just about making it sustainable and then I realized that part of that sustainability is being able to pay myself a modest salary so that I can like feed my family. And so I don't really feel guilty about the fact that I, that I do pay myself because this is my job. Like if I didn't, we wouldn't be able to pay our bills. And I don't think people really mind that because they know we're in it, you know, we're really in it to help improve maternity care and to help families get evidence based care.

Speaker 3: Nicole: Right. So, if I didn't pay myself, I couldn't do the work, you know, I'd have to get a job and then I wouldn't be able to do Evidence Based Birth. So I'm happy to be my own boss. It's something that I never really expected in my life. But looking back now, it makes it crystal clear that I'm perfect for being my own boss. I don't like being told what to do anyways. It ended up being the perfect fit for me. Yeah, it was unexpected. I always, you know, I never imagined anything other than a traditional life of being an employee. And it is very scary to jump out on your own and start a business and be the sole source of income for your family. But, it's worked out in the end. And not only that, but I get to grow a business that we can hire people and help. Most of our team members are, you know, stay at home moms who work from home for us. And so it's really cool that they are also supporting our families because of the work that we do.

Speaker 1: Nicole: That is awesome. So you're really just coming from a place obviously of service. Like that's the foundation of what you're doing.

Speaker 3: Rebecca: Yeah. And I think people can tell that like we genuinely, that's why we do it. Like that's why I'm driven to do this because I can drop it in a heartbeat and go get a, you know, better paying job. This is what we were meant to do with our lives. You know, so we're here to serve everyone and so much of what we do provide is free. So that always makes me feel good too, that we're putting out all this information for free. But we've still found way to support our families for everybody who works for Evidence Based Birth.

Speaker 1: Nicole: Yeah. That's awesome. And then, you know, one of the other things as you were telling your story that popped up is like being comfortable with asking for help when you need it. Especially, at least for me as someone who's a little bit of a control freak, also. Asking for help sometimes can be difficult, but eventually you just need to do it.

Speaker 3: Rebecca: Yeah. Well, yeah. And I always say, there's a saying, hire when it hurts. Right? So when it started to hurt, then I knew I needed to hire somebody. So for example, when we had all of these articles and they all needed to be updated with the latest research evidence, I was hurting because I was like, when am I going to find time to do this? This is when I was still working full time and now it was really hurting. And so I, I hired someone like, because you in the end, we all only have a certain number of hours in a week, right? So I can't, I have to do the math in my head real quick. What is it, 40 times seven? Or no, no, no, not 40. You see, I can't even do math right now. Had to hire someone to do my math 24 times. We all have 168 hours in a week. Right? Right. And if I can't get something done and that 116 hours and it needs to be done to grow Evidence Based Birth so that we can do more good work, then that means I need to hire somebody part of their hundred 68 hours. So I kind of look at it like that. So yeah.

Speaker 1: Nicole: Yeah. So is there anything that you would've done differently as you built Evidence Based Birth?

Speaker 3: Rebecca: I don't think so. I'm a very analytical person as you can probably guess from talking with me. I like to think things out and plan and really figure out the best path forward. And so every step of the way I was analyzing each decision and, and making the decision that seemed best. And I was also educating myself the whole time. So constantly reading and listening to podcasts and talking to people and just learning and soaking up as much information as I could so that I could make informed decisions every step of the way. So I don't know if there's anything I'd do differently. I mean, there were obvious, there are definitely things that surprised me.

: Nicole: Like, what, what do you think surprised you?

: Rebecca: Definitely the reaction to the vitaminK article a couple years ago, well I guess that was about four, four or five years ago now. But when I launched the article about the evidence on vitaminK and the statistics on, on the shot, including the benefits and the safety record and comparing it to oral vitamin K and no vitamin K, there was a huge backlash. People were very angry with me for even suggesting that an intervention could be a good thing and that it should be used routinely. And I mean, I remember there was somebody from outside the US who was so angry with me that she actually called my university, the college where I worked, and yelled at the secretary, what is going on? Like she didn't even know that I did have Evidence Based Birth. She's said this lady called and like, she's like yelling at me. She said you are a tyrant. And it was like, yeah, she was just spouting off all these horrible things to the administrative assistant at, at the college where I worked. And yeah, that's how angry some people were. But at the same time, I'm glad, I'm glad it all happened so I wouldn't take it back. It was just a surprise.

: Nicole: Are the, are there any other challenges that you feel like you faced as you've built Evidence Based Birth?

: Rebecca: You know, just the regular stuff that everybody deals with in their life, you know, personal challenges, health challenges. I suffer from chronic migraines and especially while I was working full time and doing evidence based birth, I, I probably had 20 headaches a month. And I tracked them. So I can tell you how many I had. So those are like the main challenges was just, you know, that kind of thing. But thankfully, like I said, there was a fire lit under me from, you know, my two very different birth experiences, and then I had a third baby after a couple of years after I started Evidence Based Birth. And her birth just really affirmed that, you know, I'm doing this for my children and for other families so that they don't have to go through what I went through that first time.

Speaker 3: Nicole: Yeah, absolutely. So why don't we talk a little bit about what you would, some advice that you would give to pregnant women or pregnant families I guess. What are the top two or three issues that you feel like women face when they're trying to have an evidence based birth?

: Rebecca: Yeah. First of all, I don't think there's any such thing as like having an evidence based birth. Because it's not a cookie cutter thing, right? It's like every family goes on their own path. Correct. With their own decisions, their unique situations. So I would say there's so many things that that parents face that they don't know what to do. Like if you test group B strep positive or you don't know if you're going to circumcise your baby or you don't know if you're going to do this or that. Like probably the biggest barrier is education and not knowing where to turn for accurate information. Because even when I'm teaching parents and the evidence based birth class, there's just like never ending questions.

Speaker 3: Rebecca: Like, my doctor said this or my midwife said this and now I don't know what to do. And so I think that that whole information overload, not, you know, not knowing where to go for information, not knowing how to process information. It's just a lot of things that parents have to educate themselves about. And then you have so much fear related to birth. Parents are so afraid of childbirth in general that a normal human reaction, it's not necessarily a good reaction, but a very common human reaction to fear is avoidance. So a lot of parents a lot who are so afraid of birth that they don't educate themselves. Because they say, well, I'll just let my doctor handle everything. And then they end up with that first typical birth experience. You know, that we all know, things happened that they didn't want and they're upset or disappointed or maybe they're not really sure what happened and they're processing everything.

Speaker 3: Rebecca: So yeah, the, I think the whole concept of education is a big thing that they face. It's education and fear and fear, they're kind of combined in that fear. Makes people like not educate themselves.

: Nicole: Yeah. And I see that, I mean, I'm an Ob Gyn, so I definitely see that, that women aren't, they don't necessarily have as much education and they don't know where to turn. They go to Google. And the quality of information that you get is questionable. It's just hard to know. So I, I love your site in the sense that it's very unbiased. You present both sides of the information in a very thorough and unbiased way. So it's a great source for women.

: Rebecca: Yeah. Thank you. Yeah, that's, you know, one thing that in the beginning when I wrote my first couple of articles, I was like, oh, maybe I'll be lucky if like 10 or 12 people ever read this. And now, we get like hundreds read it and it's, it's, it's really amazing.

Speaker 3: Rebecca: I really believe in the democratization of information. I don't think it should be locked away in medical journals where nobody can read it or understand it. And so I really feel like I'm in a unique position because I'm a clinical researcher. To be able to download those articles, read them, interpret them, analyze them, and then translate it for regular people because I believe that research isn't doing any good if it's locked away.

: Nicole: Very true.

: Rebecca: And researchers spend their whole lives conducting research, but then nobody ever sees or reads. So I really feel like I'm just kind of like a conduit between that whole research world and the parent world. And it's been really fun and it's something that I think was really needed.

: Nicole: Yeah. That's awesome. I think of myself in a similar way of trying to take doctor speak and turn it into normal language through some of that.

Speaker 3: Rebecca: Well there's a big gap there for sure.

: Nicole: So let's talk about maybe like a couple of solutions. So what are things that women can do to help educate themselves and overcome that fear? Obviously your website is a great resource. What other resources do you think are good for women?

: Rebecca: Yeah, so I, I get this question a lot, especially from students who, when I go speak with college students or university students about birth, they all want to know, well, what can I do? You know? And so I usually tell them the same three things every time. The first I've already kind of talked about is educating yourself, you know, through a good childbirth class that's going to be really comprehensive and really teach you how to speak up for yourself, teach you about your options, but then also teach you how to get your options. Because a lot of childbirth classes are very descriptive and say, these are your options. You can pick whatever you want. And they don't really explain that. That's not exactly how the healthcare system works, that the healthcare system is set up to support one type of birth. And if you want anything different, you're going to have to really learn how to use your voice. So educating yourself and your partner because they have to be on board and just as educated as you.

: Rebecca: And then the second thing is I usually tell them to hire a doula because that doula can kind of be that mentor and walk you through that process. Plus we know the outcomes are so much better when you have one. So I think that sets you up for success. And then the third thing is just really making sure that you have picked the right provider and the right birth setting. And ideally, you know, do your research. Look at the statistics like in terms of the safety of care at where you're thinking of giving birth and really think carefully about who you hire to be at your birth. Because you can educate yourself and hire a doula. But if you walk into a situation where the odds are stacked against you because the providers or the hospital staff are not supportive of your wishes, that can be a big problem.

: Rebecca: And the cool thing is is that there are great hospitals and providers who can be supportive of different types of birth plans, but you've got to know, you know where to look and you can't be afraid to switch if you find yourself in a bad situation. Of course, the problem is some people are pigeonholed into where they give birth. Like I was for my first baby, I was only allowed to give birth at one facility and not everybody can afford to opt out and just like hire a home birth midwife out of pocket or something like, like I did for my second baby.

Speaker 1: Nicole: Yeah, that's true. That's true. I can't emphasize enough from a provider perspective how much your provider and the hospital will influence your birth and you have to get to know those two things by asking questions during the prenatal period. You do not want to walk into it at the very end, like, oh, here's my birth plan without having had some discussion and knowing those things ahead of time.

: Rebecca: And it's really hard for, especially for first time parents, but even parents who've had babies before, if you get at the end of pregnancy and all of the sudden your care providers using fear tactics with you or coercing you and it's very scary to be at the end of pregnancy and have, you know, fear tactics used against you because you don't know, are they telling me the truth? Is this really a complication or are they just trying to, for their own convenience, get me in for an induction. And so that's why I think it's really important to, if I were pregnant for the first time, I'd ask every doula and town, where should I go? They, they've seen so many different providers and clinical practices that they know, well this group of physicians or this group of midwives are really respectful and you'll be in good hands. This group, you don't know who you're going to get on call and they have a couple of bad eggs, you know, like, so that's what I would do.

: Nicole: Exactly. Exactly. Excellent advice. So let's just to wrap things up, just a few sort of more personal questions. What do you think is the most rewarding part of your work?

Speaker 3: Rebecca: I think it's probably twofold. I would say personally I find things rewarding and professionally, personally I love that I get to work from home. So I love that my youngest child who's now five, like doesn't remember a time when mommy wasn't home during the day. So that's been really amazing. And then I get to work with my husband. We share an office and we work, and our youngest is still in preschool, so when she's in preschool, which is just in the mornings, we get to work together, which is just really amazing and something.

Speaker 1: Nicole: So you're in the same room?

: Rebecca: Yeah, it's right across from mine.

: Nicole: I love my husband and we've been married for 13 years, but I don't know if we can work in the same room.

: Rebecca: My husband and I have always been like that. We've always been like best friends, you know, so we just love hanging out together. So it's just awesome and a joy. So that part of my life has just been really joyful and so I'm really grateful that I've been given this opportunity to be able to do this work. Professionally, I think my favorite part about Evidence Based Birth is working with the instructors and our instructor program. So we have about 150 instructors, who've trained to become evidence based birth instructors from all over the world. And I get to work really closely with them, get to know them and they are just true change agents. So they are doulas and childbirth educators, nurses, midwives, and we even have an obstetrician, who joined last year. Our first obstetrician, Evidence Based Birth Instructor. And it's just been so rewarding getting to know them and it helping them get educated so that they learn different change strategies for improving care in their communities.

Speaker 3: Rebecca: And it's just so amazing seeing like the work that they're doing. So I really feel like that's probably my favorite part of Evidence Based Birth is getting to know the instructors and seeing all the amazing work that they're accomplishing. It gives us a real sense of community and hope to see all the change that's happening and how we're all making a difference in our communities.

: Nicole: And it's really awesome. That's awesome. So what about on the flip side? What's the most frustrating part of your work?

: Rebecca: Probably the fact that we still are working with parents. So me and the other instructors, when we work with parents, you know, many of whom may be listening to your podcasts, probably the fact that they're still having to go through pregnancy and birth and what I consider a broken healthcare system in America. And it's really, really hard to work so closely with parents and they work so hard and then something happens to them during their pregnancy or birth that I would consider to be obstetric violence.

Speaker 3: Rebecca: So things like forced vaginal exams, and the parents know how to speak up for themselves, but it's still happens anyways because they're in such a vulnerable situation and I can't be there at every birth and at every appointment to like guard them. It just really hurts to see that there's still, it's still very, it's too common to treat women disrespectfully during birth. And I think that breaks my heart more than anything. And it's something that I'm really determined to be a part of the change. So, you know, the thing is I don't let things get me down too much. I'm more take it and I turn it, I'm like, well, what can I do with this energy? Cause I get this kind of, you know, this negative energy problem, from hearing stories from people we care about who experienced things in our broken healthcare system. Well what can I do with this angst? And I just try to turn it back into my work. So right now I'm writing a book about my experience starting Evidence Based Birth and, working both inside an institution and outside an institution. And just about my journey with that and I'm hoping that to use it to spread the word to other nurses and doctors that it's not okay to force women or pressure or coerce them into things.

: Nicole: Yeah. It's not okay at all. And it's, we definitely have some work to do in our Ob system for sure. I mean, the obstetrics as a specialty is founded on controlling what happens in women's bodies. So that still lingers to some degree.

: Rebecca: It's hard to give up that control, but I think if we can raise awareness of it, I think we can stigmatize it and make it so that it's like everybody realizes it's not okay because the problem is right now it's normalized, right? Like you don't have to ask permission to do something to someone because you're in charge of their labor, you're managing their labor or their pregnancy and you see them more as a birth canal and less as a person. And so I'm really hoping to do some work in the next couple of years to really focus on students like medical students and residents. Because I think they're so impressionable. You know, as a former professor or assistant professor, I worked with students all the time and they always never cease to amaze me with just their flexibility and their ability to soak up and absorb information. So it's a very formative time in their careers and I want to be a part of using my book and other resources to really, help shape the next generation of medical students especially, but also nursing students so that they feel empowered to like kind of start a different type of care.

: Nicole: That's really exciting to hear because it really does go back to that training. I mean, thinking about my own training, you know, it was never emphasized that. I had this conversation with some friends who are also physicians. Like nobody ever told us like you should stop and ask a woman if it's okay before you put your fingers in her vagina. You know, we don't get that sort of training training. It's not, it's not. And when you think about it, it makes absolute perfect sense that oh my God, of course we should be asking women this. And you know, when I've recently, I'm ashamed to say, but also happy to say that I've started doing that in the last couple of years, being more intentional about asking. And it broke my heart when I had a patient say, do I have a choice? And it's like, whoa, whoa, whoa, what in the world is going on if we're in the system where that's what women are thinking? So we definitely have some work to do. And I agree that that training phase is a great place to, to help kind of change the culture. It's really a cultural shift that needs to have.

Speaker 3: Rebecca: It is. And the cool thing is, is that as you've seen firsthand yourself, you know, people's beliefs and behaviors can change. You know, like now you believe in the importance of gaining consent, whereas you didn't use to. So I only can have hope that most other obs, once their awareness has been raised and their attention shifted to this issue, will also change their minds and their behaviors. And it's not that they're bad people, it's just that they've been, it's the behavior has been normalized. It was passed down to them and that's how they were trained. So I think raising awareness, I'm really excited to do that. Been working on a book for like a year and a half, so I'm hoping to finish it this year and that hopefully it can make a difference. That's always been my focus whenever I'm frustrated or something's really getting me down or upset, I try to just turn it back around and say, well what can I do with this energy? So that's what I'm doing right now is writing a book.

Speaker 1: Nicole: All right, awesome. So you're writing a book personally, what's in the future for Evidence Based Birth?

Speaker 3: Rebecca: Wow. So last year was a big year for us. We launched our podcast, which is doing amazingly well and we piloted the Evidence Based childbirth class, in about six different communities in the United States. And now we have it in 50 communities this year. So for the future, I'm hoping to continue growing that childbirth class and train more instructors on how to teach it and get it out into more communities.

Speaker 1: Nicole: And for the listeners, I believe it's a hybrid class, right? Where part of it online and part of it is in person.

Speaker 3: Rebecca: It's really designed for today's parents who have a really busy schedule and don't have a lot of time to go to in person classes. So I still believe it's important to meet face to face at least once or twice. So we've built that face to face meeting and the first class and the last class. But everything else you do is totally online and it's been really, really fun to see that, to teach it myself, to see other people teaching it and to start hearing the birth stories. So we're featuring a birth story from people who have taken that class once a month on the evidence based birth podcast. So that is something big. We're also planning, our first conference in September was on our first one. We did a smaller one two years ago, but this is our first like big conference where we're going to have about 300 birth workers in Lexington, Kentucky in September.

Speaker 3: Rebecca: And the conferences already pretty much sold out and we, we might have a few tickets available later. Yeah, it's now it's just a matter of getting it all together. It's a huge project. So for this year I'm trying to focus on writing my book and organizing this conference, getting it already so that everybody has an amazing experience in September are we're really want to take care of everyone and, and make everybody be like, that was awesome. So it's also an interprofessional conference. So we have, you know, nurses, doctors, midwives, doulas, childbirth educators, and I really wanted to create something where all the professions could come together. So that's in September. And in terms of the far future, I really have no idea what we'll be doing, but I just focus on one goal at a time. We do want to, we're putting out a few new articles this year.

Speaker 3: Rebecca: We have one all about induction for gestational diabetes and that has just gone through the review process and we'll hopefully be publishing that soon. We've been working for the past six months on an article all about circumcision, which is a huge article that covers the history and the physiology and the procedure itself and the ethics and the research. So, that's gonna be a big project to put out because, it's so controversial we have to be prepared to deal with, you know, backlash. Yeah. Lots of heated conversation. To put it mildly. So I used to say I would never touch topics like that with a 10 foot pole, but I've decided like I think it's time. We're going to go for it, see what happens. So if you're watching this, you can get out the popcorn and watch the comments section.

Speaker 3: Rebecca: So there's very strong feelings on both sides. But what we want to do is bring, you know, a perspective. We feel like parents in the past have really struggled with finding information on that that isn't very agenda focused. And so, we're hoping to become, you know, to really shine a light on not shine a light that doesn't, that sounds too positive. More like be really transparent about this is what's happening and this is what the procedure is and this is what the history is and why we're still doing it today. And these are the ethics and this is what the researchers are saying. So we're hoping to put out a big article on that and it'll be curious to see how that turns out. So cross your fingers that we don't burn down in the process.

: Nicole: And I guess real quickly if you don't mind just before we end, how do you choose your topics and what's your review process like?

Speaker 3: Rebecca: Yeah, we only put out a couple of new articles a year now just because they take so much time and effort to produce. And you know we do one at a time. So we finish one and we start the next one. And the gestational diabetes, we just put one out on diagnosis and we're doing the one on induction. Those used to be like informal kind of casual blog articles that I wrote a long time ago when I started Evidence Based Birth. And so I really thought it was our responsibility to turn them into what we call a signature article where it goes through a peer review process. And so that was a big job. So we did that. So that was more of like an item on my old to do lists that we just had to get done. Circumcision is something that parents have asked us about for years.

Speaker 3: Rebecca: So really when we do a new topic, it has to do with how often are people requesting, how often people are requesting stuff. So for example, another topic that I would like to do, but haven't done yet, I haven't started the process yet, is like active management versus passive management of the third stage of labor. So that Pitocin shot, A lot of parents are really afraid of that, you know, I thought it would be interesting to cover the research on that. So that's like something that like, but we get a lot of questions. So anything that we can get a lot of questions, we just kind of keep a mental tally of like, oh, people really seem to be asking for this. And knowing that we can only do like two or three new topics a year, um, we have to be very careful about like, well, what do you think is most needed?

Speaker 3: Nicole: Okay. And I'm sure you have a very rigorous process of searching for articles.

: Rebecca: When we choose a topic, Anna Bertone, we sit down and we decid on our keywords and what our search limitations are going to be. And then she does a big literature review. She downloads every article that meets our search criteria and then we just start going through it and we start with usually the highest levels of evidence, like systematic reviews and meta analyses. If there's a ton of randomized controlled trials, we'll often pull just kind of like the biggest ones to show. Like this is the foundation of what went into these bigger systematic reviews. And after we draft the article and I go through it and she goes through it and then I go through it again, then we send it off to reviewers. Then Anna helps me pick who are often the top researchers in their field, but we also always pick clinicians as well because we want the information to be like clinically relevant and appropriate.

Speaker 3: Rebecca: And the clinicians often will give good feedback about how well this is done in practice this way or you know, so it's really interesting to hear their feedback. And then, um, we also have a medical editor, Kristen Pascucci of Birth Monopolies. She's an amazing editor and she's really good with grammar and so she always goes through it with a fine tooth comb to make sure that it's all well written and easy to read. Then we publish it. So yeah, so after the reviewers give us their feedback, like right now, the diabetes induction article, Anna has gotten all the feedback from all the reviewers. I'm now it's my turn to take a look at it. She made some changes based on what they requested. I'm going to go through it one more time and give my final like changes and then we'll send it back potentially to Kristen for one more edit to make sure everything looks good.

Speaker 3: Rebecca: And then we'll post it on the website and our graphic designer will create the handouts that are members and our child birth students get. So yeah, it's a very long process. You can see that's why we, we can only do two or three new ones, a year long process.

: Nicole: But that's exactly why I recommend your site because it's very rigorous and thorough.

: Rebecca: Yeah. And the cool thing is once we do it, then every couple of years we can go back and do an updated literature review and make updates or tweaks. But at least the bulk of it has already been done. So, yeah.

: Nicole: So let's, let's end with what is, if you could give one piece of advice that you would like to give to expect it moms, what is one piece of advice that you would give an expectant mom.

: Rebecca: Oh, that's so hard. I mean, in real life, if I sat down with an expectant mom, I wouldn't be allowed to just give one piece.

: Nicole: Then break the rules. You can give a couple of things. What are the things you would say?

: Rebecca: Probably sit down and have a conversation with them about what are their fears, what are they afraid of? And then I would encourage them to build a support team, find a doula, find a childbirth class, and just really educate themselves, but also to face their fears, not to hide from them. So there's so much fear related to birth and it starts at a young age and when I work with college students, some of them are so afraid of childbirth that they tell me that they aren't going to have children because they're so afraid of having a tear.

Speaker 3: Rebecca: Yeah, it's very common when I talk with young, they call them generation Z, right? Young called students in generation z and that makes me sound old by calling them young. But they seem young to me now as I'm sure they would to you.

: Nicole: Yes they do.

: Rebecca: And they tell me how afraid they are. It makes me wonder, you know, we're seeing this decrease in birth rates among millennials and generation z and it makes me wonder how many, you know, often they say they don't want to have children because they don't want to have that responsibility. But I think some of it has to do with just the fear related to pregnancy, childbirth and parenting. And so I'd want to talk with them about, that's probably what I would do is talk with them about what they're afraid of and how can we help them face their fears.

Speaker 3: Rebecca: Because courage isn't a lack of fear. Like courage, having courage means facing your fears. Like even though you're afraid. And you know they might be surprised the more they educate themselves, less fear, they're probably going to have.

: Nicole: And it doesn't help that like TV and movies and different pictures of birth are just so unrealistic.

: Rebecca: Well there's so many kinds of trauma stories, like because we have a kind of broken system, traumatic birth stories are like a dime a dozen. Like you can get them everywhere. And so facing fear and getting educated is probably what I would talk with an expectant parent. Like what are you afraid of and how can I help you, like get past that?

: Nicole: Yeah. Well that makes perfect sense. Given your work did, that would be what you would focus on one. So where can people find you?

: Rebecca: Yeah, of course you can follow us, www.evidencebasedbirth.com is our website and we have a free crash course for both parents and professionals on what is evidence based care and how to get it. And that's right on the front page of www.evidencebasedbirth.com so you can sign up and get that email course sent to your inbox. And then we're on Instagram @evidencebasedbirth and we have a thriving Instagram page there. And we're on facebook @evidencebasedbirth and of course if you have any questions for us directly, you can always email us at info@evidencebasedbirth.com.

: Nicole: And don't forget the podcast.

: Rebecca: Oh my gosh. Well I mentioned the podcast. You can find us on iTunes, Stitcher and Spotify, for the Evidence Based Birth podcast.

: Nicole: And thank you for having me as a guest on your podcast.

: Rebecca: I'm excited.

: Nicole: All right. All right. Thank you so much Rebecca for being here. I really appreciate your time.

: Rebecca: Thank you Nicole.

: Nicole: Okay, take care. All right, bye.

: Rebecca: Bye.

: Nicole: Okay, so that was great. Now after every episode I give something called Nicole's notes, which are just my top three or four takeaways from the episode. So what are my takeaways from this episode today? Number one, in the beginning when she talked about building Evidence Based Birth in her business, we talked about hiring help and this is a reminder that we should all ask for help when we need it, whether it's in business or if it's your pregnancy, especially after your pregnancy when you're home and you're trying to figure out how to do all the things. Don't be afraid to ask for help if you need it so that you can focus on the things that only you can do, whether that's building your business or being a mom. So ask for help if you need it.

: Nicole: Number two, she talked about the importance of educating yourself. An interesting perspective that she put forth is that a common reaction to fear is avoidance. So encountering women who say, oh, you know what? I'm just going to go by whatever my doctor or midwife says, and not really taking the time to educate themselves. That actually may be a manifestation of fear and the best way to overcome that fear about childbirth is to educate yourself and there are different ways to do that. This podcast of course, is one way. There are books you can read, a childbirth education class is also a great way to do that. There are lots of options available to you and you can find one that works for you. It may be an in person class, it may be an online class.

Speaker 1: Nicole: Rebecca talked about her hybrid option, which is part in person, part online. Of course, I'm going to give a plug for my own childbirth education class, The Birth Preparation Course. I am super duper proud of The Birth Preparation Course. It took me almost a year to make this thing and it's got, you know, eight hours of content covers everything from your mindset to what happens in labor to postpartum period. So definitely take a look at it. If you're interested in finding a childbirth education class, an online option, it's www.ncrcoaching.com/birth-course. But again, even if you don't choose my course, I want you to choose something in order to educate yourself about birth so you can not be afraid.

: Nicole: And then the last thing she talked about is, and something this is I talk about as well, the importance of your provider and your hospital, how they highly influence your birth. So educating yourself about those things as early as possible are really important. You don't want to wait until the last minute. Now a doula can be helpful to talk to. They see different people and different providers and how they do birth. I don't see that. So a doula is a great way to kind of get the lay of the land and get some recommendations. Then of course, their support during birth as well. And I also talk about questions you can ask to really understand your provider and your hospital. I talk about those questions in the free mini course will be webinar that I have on how to make your birth plan. And you can check that out at www.ncrcoaching.com/birth-plan.

: Nicole: Okay. So that's it for my takeaways from this episode. What were your takeaways? Let me know what you think in the All About Pregnancy and Birth Podcast Community group on Facebook. If you're not a member of the group, then definitely come on and join us and I'll put the link to join us in the show notes. Now be sure to subscribe to the podcast in iTunes or wherever you listen to podcasts and if you feel so inclined I would really appreciate you leaving an honest review in iTunes. It helps other women find the show and I may give you a shout out on a future episode.

: Nicole: Now next week on the podcast I'm talking about what happens if your baby is breech. This is going to be a good episode, so come on back next week. Until then, I wish you a healthy and happy pregnancy and birth.

Speaker 2: Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan, as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident and empowered going into your birth. Head to www.ncrcoaching.com to learn more.