Evidence Based Birth®

Electronic fetal monitoring is one of the most common interventions in hospital birth, but it's also one of the least understood. In this episode, Dr. Rebecca Dekker talks with board-certified OB-GYN Dr. Jennifer Lincoln about what continuous electronic fetal monitoring actually does, what the research says, and why it became such a routine part of labor care in the first place. With recent media attention shining a spotlight on this technology, they break down the history, the evidence, and the real-world pressures that shape how it's used today.
Learn why continuous monitoring can increase Cesarean rates in low-risk births, when it may be helpful in higher-risk situations, and how it can influence movement, comfort, and decision-making during labor. Dr. Lincoln also shares practical ways to ask questions, understand what terms like "reassuring" and "indeterminate" mean, and partner with your care team so you can make informed choices without feeling powerless or pressured.
(02:26) Dr. Jennifer Lincoln's updates: doctors' strike, leadership, and writing The Birth Book
(10:09) Why electronic fetal monitoring is in the spotlight and what it actually measures
(13:40) The history of fetal monitoring and what it was designed to prevent
(17:37) The biggest drawbacks: false positives, rising C-section rates, and medical-legal pressures
(23:18) How continuous monitoring can affect movement, comfort, and labor experience
(26:28) Artifact, wireless monitors, and challenges with accuracy
(28:27) Intermittent monitoring: what it is and how it works
(30:11) When continuous monitoring may be more beneficial in higher-risk situations
(37:53) Understanding "reassuring," "indeterminate," and "non-reassuring" patterns
(39:46) What care teams may try before recommending a cesarean
(45:15) Questions parents can ask when concerns arise about the fetal heart rate
(48:03) Continuous monitoring during VBAC and navigating autonomy and policy
(51:01) Why these conversations should happen before labor and how to advocate collaboratively
Resources
Hear about the new research on home birth with Dr. Dekker on Dr. Lincoln's "Let's Talk about Birth" podcast: drjenniferlincoln.substack.com/p/announcing-my-new-podcast
Get a copy of Dr. Lincoln's book, The Birth Book: An OB-GYN's Guide to Demystifying Labor and Delivery: penguinrandomhouse.com/books/785889/the-birth-book-by-dr-jennifer-lincoln/
Learn more about Three for Freedom: threeforfreedom.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.

In this episode, we explore how the traditional "game of telephone" model in hospitals can leave birthing people out of critical decisions about their own care and what happens when we redesign the system to center them instead.
Dr. Rebecca Dekker sits down with Dr. Amber Weiseth, obstetric nurse and Director of the Delivery Decisions Initiative at Ariadne Labs, to talk about TeamBirth—a simple, evidence-based communication model transforming labor and delivery units across the U.S. and globally. Learn how structured bedside "huddles," shared decision-making, and a visible planning board can improve trust, autonomy, and patient experience, with especially powerful impacts for Black, Native American, publicly insured, and higher-risk patients. Because communication failures in childbirth aren't just awkward, they can be dangerous.
(05:07) How the "game of telephone" model blocks patients from decision-making
(09:15) Traditional rounding and decision-making in U.S. labor units
(12:10) The added complexity of academic medical centers
(14:52) A life-threatening hemorrhage and the power of systems change
(17:57) What is TeamBirth?
(22:04) How the TeamBirth board works: team, preferences, plan, next huddle
(26:57) Implementation challenges and culture change in hospitals
(34:36) Privacy, speakerphone huddles, and navigating complex family dynamics
(44:15) Research results: Impact on trust, autonomy, and equity
Resources
TeamBirth resources, research, and implementation materials: ariadnelabs.org/delivery-decisions-initiative/teambirth/teambirth-implementation-resources/
WHO Surgical Safety Checklist initiative: who.int/teams/integrated-health-services/patient-safety/research/safe-surgery/tool-and-resources
Association of Women's Health Obstetric and Neonatal Nurses: awhonn.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.

Some of the most effective solutions for improving birth outcomes worldwide are rooted in relationships, not technology. In this episode, Dr. Rebecca Dekker speaks with midwife Stephanie Marriott of the International Confederation of Midwives about the global impact of midwifery care. She outlines what defines a midwifery model of care, why continuity of midwife-led care matters for both outcomes and experiences, and how trust and relationship-based care can influence Cesarean rates, trauma-informed care, and access to services.
Stephanie draws on her work across the U.K., Asia, and Africa to share how countries such as Indonesia and Bangladesh are strengthening midwifery education, regulation, and deployment, and what that means for maternal and newborn health. Together, Stephanie and Rebecca also discuss the essential role midwives play in humanitarian and disaster settings, the global shortage of midwives, and the growing call for One Million More midwives worldwide.
(04:58) What is a midwifery model of care? (08:00) Why relationships are central to better birth outcomes (10:27) Time, workload, and sustainability for midwives (12:20) Trust, disclosure, and safety during pregnancy (13:01) How continuity of care shapes labor and birth experiences (16:48) What is the International Confederation of Midwives? (22:05) Strengthening midwifery education worldwide (28:13) Rebuilding midwifery education where it was lost (34:53) Rising cesarean rates and the role of midwives (39:26) Why midwives are essential in humanitarian settings (42:35) The global shortage of midwives
Resources
Learn more about the International Confederation of Midwives: internationalmidwives.org
Support the One Million More campaign: millionmore.org
Explore UNFPA's work supporting sexual and reproductive health, maternal health, and midwifery systems: unfpa.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.

Gestational diabetes (GDM) is one of the most common reasons families are advised to plan for an early birth. But what does the evidence actually say about induction for GDM? Does it lower the risk of Cesarean? Prevent big babies? Reduce stillbirth? Or does the timing matter more than the induction itself?
In this episode, Dr. Rebecca Dekker and Dr. Morgan Richardson Cayama walk through the updated research on induction for gestational diabetes. You'll learn how outcomes differ before 39 weeks, between 39–40 weeks, and after 41 weeks, and why blood sugar control (diet-controlled versus medication-controlled GDM) can change the conversation entirely. They also review what major professional organizations recommend and discuss the role of extra fetal monitoring in the third trimester. Most importantly, they talk about informed consent, respectful maternity care, and how to navigate conversations if you're feeling pressure to schedule an induction.
(00:02:40) Background & research update
(00:05:34) What is GDM? Risks & induction rates
(00:08:34) Research challenges & study limitations
(00:15:36) Timing of birth: 38, 39, 40+ weeks
(00:19:26) Big babies & health risks
(00:24:27) Professional guidelines (ACOG, NICE, SOGC)
(00:27:14) Birth before 41 weeks: common recommendation
(00:27:54) Extra fetal monitoring in late pregnancy
(00:32:49) Navigating pressure & informed consent
View the full list of references here.
Resources
Read the updated Evidence on: Induction for Gestational Diabetes: ebbirth.com/inducingGDM
Get the free respectful care handout: ebbirth.com/369
Grab your Pocket Guide to Labor Induction here.
EBB 370 - Updated Evidence on Diagnosing Gestational Diabetes
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.

In this episode, the EBB Research Team is answering three questions we received from our Pro Members! We take a close look at the evidence behind doula presence in the operating room, the risk of experiencing another severe perineal tear after a previous injury, and what white coat hypertension in pregnancy can tell us about future risk.
Each question reflects real situations birth workers are encountering in practice, where guidance is often inconsistent, policies vary widely, and the research can feel hard to translate into day-to-day care. We walk through what the studies show, where the evidence is limited, and how this information can be used to support informed, individualized decision-making.
(06:15) Evidence on doulas in the operating room
(12:53) Participant experiences with doulas in the OR
(14:20) Risk of severe perineal tears in subsequent births
(17:30) Clarifying repeat tear severity and rates
(20:27) White coat hypertension vs. preeclampsia
(27:02) How blood pressure should be taken correctly
(31:10) Research on white coat hypertension and pregnancy outcomes
(36:20) Global trends and rising rates of hypertensive disorders
Resources
See the full list of references: ebbirth.com/387
Learn more about the EBB Pro Membership: ebbirth.com/become-pro-member/
Get the Evidence on: Skin-To-Skin After Cesarean: ebbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/