Changing the Birth Culture through Evidence Based Birth with Dr. Rebecca Dekker | 134

I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby. Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom of the show notes.

And I was like, Oh my God. So today's guest is Rebecca Decker and she is Evidence based birth. That is her. And I am just so happy you're here. Thank you so much for coming on.

Rebecca: Yeah, thank you so much for having me and thank you for the work that you do educating parents around the world. It's just so exciting to talk with a fellow nurse who shares like the same mission.

It's

Rebecca: definitely the abundance mindset is what I believe in as well.

Trish: Me too. And the truth is, I started this because of what I was seeing at Bedside. And we, so Rebecca and I started to chat before I. started recording and I was like, no, let's talk about this. So first, I know everyone listening knows a bit about my story, but they may not know your story.

So I would love for you to, start, go way back and

tell us your story.

And I had to give birth at the university Where I was studying, and so I just assumed that I would get really good care because, you know, you think academic medical center, this is where all this cutting edge research is taking place, and in the College of Nursing where I was teaching and doing research, there's a lot of We were all about evidence based care.

You know, I was like, On strict bedrest, NPO, bedpan. They wouldn't even let me out of bed to use the bathroom. I was hooked up to all kinds of monitors and IVs. And I just all of a sudden found myself like as a sick patient. And so that really struck me because I knew if In my gut, in my intuition that I was not sick, that everything was fine.

So I was kind of confused as to what was going on, but I was willing to go with the flow because I didn't want to be one of those patients that they talk about. Oh, I say that all

Trish: the time. Those people. Those people. We all know who they

Rebecca: are. We all know about the gossip at the nursing stations and we all, all know that they don't tend to get the best care.

Like if you're difficult and you make the, the staff's lives more difficult, you know, so I just wanted to be nice. And that actually has been ingrained to me from a young age is to, to be pleasant, to be polite. You know, that was part of how I was raised in the South. Oh,

My mother's from Kentucky.

Rebecca: Yeah. So, you know, that was. An interesting experience in that I did try to push back on a few things, but I was really careful on what I pushed back on. And in the end, I ended up having every intervention except for a cesarean, you know, I had, pitocin epidural, continuous monitoring, IV fluids and a vacuum assisted delivery.

And then. You know, I, I went through all of that and I was okay with all of that, but then something happened that made me really question everything and that was, they took my baby away for three hours, even though her, her five minute Afgar was normal, even though she was crying and pink and everything, and I kept putting my call light on.

So when I finally got my baby back, she was exhausted. You know, I was exhausted. It had been a very long labor experience where I had not been allowed to eat or drink anything for 24 hours. And I had pushed for more than three hours, and I just felt like I'd been run over by a truck. And that was how I entered.

At the time, though, I had a glow. I was very much happy with how my birth turned out. And sometimes I think when people are really naive, they just assume I made it out alive. You know, that's the bare minimum. That's all I can expect. And it wasn't until about a year later that I started questioning everything that happened to me.

And because I was getting my Ph. D. and I was, you know, In all of the research, I was like, I'm just going to start looking at the research. So I made a bullet point list on a Word document with every single thing that happened from the moment I stepped into the hospital. And I started doing literature reviews on everything.

But, I found there's actual evidence showing it is really harmful as well, and, you know, I think humans, we are resilient. Moms and babies, we can overcome these challenges, we can still bond with our babies, but it, we shouldn't be making it harder, you know. So that was kind of what inspired me the second time to do things completely differently.

And the difference was so stark that I, I just felt like I had to do something. And so that's when I started taking the research I'd been gathering just for my own personal use. and putting it online, and that became Evidence Based Birth.

Trish: Which is so amazing, and I, I wanted to interject one thing. Yeah. As a, you know, a labor and delivery nurse, one thing that you said that I feel can go another way is being that person.

And what I, what I encourage my students is that, you know, and I teach them how to fire their nurse in a way that's how they might end up being super close to her. Because we as labor and delivery nurses might come to work bearing our own problems, and we don't even realize that we might be the best nurse in the world.

So I just want you guys to Who cares if they're at the desk talking about you? The nurses who really care about The birth process, the natural process, the mom's rights. We're at the desk advocating for you as well. Yeah, and I think

I think a lot of this was just in my own head. No,

Trish: it's, I think it's in all of us. You know, I

Rebecca: had to address my own you know, upbringing and cultural indoctrination of being that nice person who doesn't speak up. And, and I think also there are some really strong instincts I was feeling to, I was feeling vulnerable, so I didn't want to make waves.

And now I know you, you can't go through life You know, doing parenting that way, you have to use your voice. And so for what, one thing I'm really passionate about, and I think you are too, Trish is, is helping people find their voice because for a lot of people, having a baby is their first time in the hospital.

They strap you with all these things. They put a hospital gown on you. And put you in a bed. Yeah,

because

you've only maybe seen your grandma in bed like this with a hospital bracelet or, you know, when someone has been sick or had an accident. And like you said, for most women, it's the first time they've been a hospital patient.

But I, I really am. I do feel that the culture is changing somewhat, and I think a lot of that has to do with social media, because hospitals, nurses, providers are getting called out publicly, and, and I think it's causing them to have to question themselves as well in some ways.

Rebecca: True. I, I do think there is a developmental phase, in life, you get more comfortable with your voice.

Yeah. And just kind of want to fly under the radar and, you know. So, I think it, part of it is age, part of it might be your personality, your upbringing, but learning how to use your voice is, is critical. Not just for your own health, but for your child and your whole family. Because it doesn't end with birth, like you're going to have to pick up throughout the rest of raising this child.

Trish: Yeah, and learning how to do it in a way that brings change and not conflict. There's a different. Yeah. In that as well. Being bold, but doing it in a way that brings a good, positive thing, you know, so. Right. So, I love this so much. So, you started the blog, I'm assuming. Mm

Rebecca: hmm.

Trish: And tell us where it went from there.

And they were starting to be willing to speak up for it. And the other thing that happened was that doulas really latched on to evidence based birth because they were feeling really disempowered at the time and they were going with their clients, accompanying them to hospitals where their clients were not receiving safe care and feeling somewhat, you know, traumatized by this.

Like, you can access the same research that your doctor might be able to if they looked something up. So, that's something that, uh, was a really key part of it. And then we started a podcast, of course, and I have a book, but it just kind of kept growing. No, no, no, no. Stop. Yeah. Slow

Trish: down. Talk about that book.

Yeah, it's called. Because that book is amazing.

I was a nursing professor. I was really involved in teaching the next generation of nurses and doing research and getting large grants to do studies. And then I had to decide, like, this evidence based birth thing was just so. It's going crazy. It's exploding. So I do. Yeah. Yeah. And, and goes into more depth with my birth stories and those of my friends and family.

And yeah, that was, that was a key period of my life.

Trish: Yeah. I love your book. I recommend it all the time. It's a great book. And it's such a perfect title.

Rebecca: It was actually the title of a college class I was teaching. So I, I love college students. I just, people in, especially those who are younger, they're just so much fun to be around cause they're, it's so much

Trish: energy and

Rebecca: they're questioning everything.

Oh, I

Trish: would have been that one.

Rebecca: It was amazing how many people wanted to take that class. It, it really, and they still reach out to me. Sometimes they, they send me emails, Hey, Dr. Decker, you know, and they give you updates on their lives and they're going on to have. Pregnancies and babies now, so it's just fun to see.

That's amazing. Yeah, and some of them have turned into midwives and OBs

Trish: and Oh nice. Yeah. Well, I I love it so much and I I was just thinking when I started my blog I was so like I can remember and I tell my students and part of my story is and I can Almost smell her labor room the way I felt in the last straw, like I'm done, I've got to do something.

But when they're used, I always tell my girls, not out of convenience or curiosity. They're when they're needed, but you have to know, you have to understand, like when they are needed, when they might not be needed. And you have to be able to just ask questions and feel confident in that. So I'd love to ask you a few questions about different things that people, like my most common questions.

Well, give

Rebecca: me a second to pull that up because, you know, I don't want to

talk without having the facts in front of me, because So we do have an article all about that at Evidence Based Birth, if you want to send people to it or anyone to check it out. I have it linked in my birth class. Yeah. ebbirth. com. Yeah. Slash ebbirth. com. Inducing GDM and so gestatial diabetes comes up a lot because a lot of people have it now.

So it's pretty common to have an induction offered for gestational diabetes, but we don't have a lot of data on that. And I think the reason it's offered is because there is a higher risk of pregnancy complications with gestational diabetes. But we, we want to ask, what does the evidence say, does that help or not?

So we do have a Cochrane Review, which is where they take all the randomized trials on a subject and put them together. And they looked at a planned early birth at or near term. So, between 37 and 40 weeks, versus kind of waiting until. Labor starts on its own and there's actually only been one randomized trial on this subject so far that I know of it is called the Gen X mall trial, which is, I don't know why they picked that, but it was an international trial.

There are, there is one really large study that included more than 8, 000 people. They found that inducing labor at 30, 38 or 39 weeks for gestational diabetes is linked to a lower rate of caesareans. less or fewer cases of preeclampsia and higher rates of needing an epidural compared to waiting for labor to start on its own.

So if you have been able to manage your blood sugars and keep them in kind of a safer range, that has been shown over and over again to improve outcomes, both for you and for your baby. So it might be that maybe there's less of a need for an induction if you've been able to manage, let's say you've managed your blood sugars, they've stayed in a normal range with exercise and nutrition, then maybe the induction conversation isn't as relevant to you because your blood sugars have been normal, right?

So I think Individualized care is really important, and I think we're seeing more towards this leaning of 39 weeks instead of 38 weeks, but at this time, there's not really any definitive evidence on this. It really comes down to at EBB. We talk about evidence based care. Kind of being like a three legged stool.

But maybe you've had an induction in the past, and you really didn't like it, and you want to avoid it, so that also could play into it. So your preferences do matter, and unfortunately, we do see a lot of pressure to induce, even though the evidence isn't really clear.

Trish: Yeah, and I love that you said individualized, because that's pretty much what I tell my moms.

That, I, that's, that's her choice, but I do agree with just about all of it, that it needs to be an individualized, let's talk about her. Because even, you know, and we could go on and on with all the things, IVF, big baby, all the different things. And what I recommend to my students is that. They start having early and often conversations with their provider and ask them to base it on what's going on with them.

Because I also think the opposite side is, God forbid, something were to happen, because you and I both know, loss happens, it happens whether, You have anything else going on or not? I just had a student lose her baby 40 weeks in one day, two days ago. Um, we're all heartbroken. She had, you know, low risk, nothing.

So that can happen, but let's say your doctor is pressuring you to be induced, and then you just go balls to the walls, no, not doing it. not coming in for more tests, not doing all those things, and something were to happen. There's also that can play out as well. So I usually encourage my, my students to work with them.

Rebecca: I think one good question When you're having conversations with somebody who's pressuring for something, it's to say, I'd like, I'd really like to see like the guidelines from your professional organization on that. Um, because I hate to say it, but some doctors don't know the latest guidelines and it will force them or they manipulate

Trish: it.

Yeah, we always say, ask them to go print the study that is backing up what they're saying. And tell them you will take it home, not right there, take it home, and without attached emotions, read through it. And what happens a lot of times with my students is the doctor will highlight what supports them, but then when they read the whole study, they realize, wait, this does not support what you're saying.

And then when they come back and they have a discussion, they're not like, You know, amped up and emotional. So we, we definitely do that. We tell them, show me.

Rebecca: Yeah. Next time I come in, I really need to see that because I'm not going to schedule anything without, you know, seeing it in writing.

Trish: Yeah. And we have them printed out then in there and take it home.

That's a good idea. Let me take it home

Rebecca: and look at it.

spot now. So we're getting close to 30 minutes and like I told you, I usually like to keep these short and sweet because I know my mamas and they, they drop off. So I'd love for you to tell everyone where they can find you. And well, we've said already evidence based birth, but do you hang out on Instagram or any other social platform more than the other?

So just to keep that

in mind that the providers who prefer those earlier inductions or elective inductions, that's what they prefer. If you kind of go outside their realms of their comfort zone, they're going to get more and more anxious and they, you know, there's a lot of subjective decision making that happens in labor.

Trish: I love that so much, and that's why I tell them early and often, have these conversations. Don't wait until your third trimester, like, start, which again is why our, my birth classes start at the beginning of pregnancy, and we have people who join us when they're three trying to conceive.

They're not pregnant yet. We hang out with them every week on Zoom. Well, three times a month on Zoom. But that's what I say too. And watch their body language, like listen to what they're really saying. So if you're trying to talk about something that's really important to you and you're 22 weeks and they're like, Oh, we can talk about that later.

We don't need to be talking about that now. That is a red flag.

Exactly. Because

you don't know what they really feel about it, and, and in defense of these providers who are comfortable with that, I, I tell my girls all the time, these providers aren't evil. Like, I'm not saying, like, they're just horrible people.

Don't go in, like you have a right to go in and interview them across from a desk, like person to person, and make a really good decision that's aligned with you. The thing that scares me about that is that most of them don't know really what they want yet, or what's even out there. Available to them at the beginning of pregnancy.

So anyway, thank you so much for coming I am so happy that you came today. Thank you. Thank you, Trish.

The birth worker world and parents everywhere. Thank her for her invaluable resources. Don't forget to subscribe to the birth experience wherever you listen to podcasts. And if you love this episode, please leave a review. Take two minutes, two minutes, leave a review. Your support helps us bring more amazing guests like Dr.