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In this episode, Dr. Dekker and EBB Research Fellow Sara Ailshire reflect on groundbreaking research published by Evidence Based Birth® in 2023. Dive into evidence-based insights on Group B Streptococcus (GBS) in pregnancy, Premature Rupture of Membranes (PROM), and skin-to-skin care after a Cesarean. Discover alternative approaches, vital statistics, and the intersection of birth with climate change and infection risks. Rebecca and Sara will also reflect on the year’s most popular episodes and give you a glimpse into exciting episodes and Signature Articles to come in 2024.

Content note: Preterm birth, interventions, climate change, infant mortality, serious infant illness, racism. 

The Top 5 most downloaded episodes of 2023:

  • EBB 166 [Replay] The Experience of a Powerful and MIiraculous Birth with Brooklynn and Hoang Pham

  • EBB 264: Top 3 Tips for Exercise in Pregnancy with Mamaste Fit

  • EBB 257: Updated Evidence on Group B Strep Part 2

  • EBB 256: Top 3 Recommendations for Preventing Pelvic Floor dysfunction after Birth with Dr. Sarah Duvall

  • EBB 254: Evidence on GBS in Pregnancy


Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk about the evidence we’ve published here at EBB in 2023, and we’re going to look forward together to 2024.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See for more details.

Hi everyone. My name is Dr. Rebecca Dekker, pronouns she, her, and I’ll be your co-host for today’s episode. Today, along with your co-host, Sara Ailshire, we are so excited to talk with you about all of the research we’ve covered this year on the Evidence Based Birth® podcast. We’re going to sum up for you the new and updated research that we’ve published here at Evidence Based Birth® podcast, as well as talk with you about what’s coming in 2024.

Before we get started, I wanted to let you know that today through January 3, we have a special sale just for you at the Evidence Based Birth®  Pro Membership. You can get 90 days access for 40% off to the EBB Pro Membership. So you get 3 month’s worth of continuing education, specialty calls, monthly trainings, our PDF library, and our doula mentorship program. And if you decide to stay after the three months is up, you can continue at this discounted rate. If you are a birth worker and you own your own small birth business in the U.S., and if you purchase before the new year, this is a great chance to get one last tax-deductible purchase in to save on your taxes next year.  

And if you’ve ever wanted to pick my brain or ask me or our team a research question, the EBB Pro Membership is the way that you can do that.

So go ahead if you want to take your birth career to the next level, visit now to sign up and make sure you do this by January 3, if you want to get the discount and immediate access to all of the best resources at EBB. 

As a content note for today’s episode, we will be mentioning racism, preterm birth, interventions, including cesareans, climate change, infection during pregnancy and birth, and statistics on infant mortality.

Sara Ailshire here is your co-host today.

Sara, pronouns she, her, is a doctoral candidate in anthropology, and she is an Evidence Based Birth podcast research fellow. Sara has a lot of experience looking at birth research. She was awarded a Fulbright-Nehru Doctoral Research fellowship to go to India in 2020, and she’s learned a lot from birth professionals there and had the opportunity to train in India as a doula. And I’ve loved having Sara with me all year. So Sara, we’re so happy you’re on the podcast again.

Sara Ailshire:

Thank you so much. I’m really happy to be here again.

Dr. Rebecca Dekker:

Yeah. Thanks again for joining us on this recording. So Sara is going to cover two of the topics we’re going over today. We have four topics that we want to sum up for you. We have the evidence on GBS, which we’re going to do a brief summary of the newest findings on Group B Strep, the evidence on premature rupture of membranes when your waters break before labor begins. We’re going to talk about the evidence on anti-racism, the evidence on skin-to-skin after cesarean that we recently published. We’re also going to give you some fun statistics about the most popular episodes from this year. And we’re going to talk a little bit about what we have planned for you next year. So make sure you listen all the way to the end if you want to hear a sneak peek at some of what we’re going to publish. So I’m going to go first, Sara, if that’s okay with you.

Sara Ailshire:


Dr. Rebecca Dekker:

Okay. So let’s talk about the updated evidence on Group B Strep in pregnancy. This is a topic we first covered at Evidence Based Birth® in June of 2014. And our most recent update was published in February of 2023. So we had several podcast episodes that came out about this topic. We had episode 254, the evidence on group B strep part one. And episode 257, the evidence on Group B Strep part two. Plus I did an Ask Me Anything about Group B Strep on episode 261. And we debunked the myths about GBS in episode 268. And then in 275, we had a Group B Strep and birth center transfer story.

So there’s a lot of resources that came out from EBB about GBS. But to kind of sum it up and make it easier for you, I thought I would go over some of the evidence on group B strep. Some of the most important updates that we made to our published article on this topic. And just as a reminder, you can always go to slash group B strep to access the full blog article, a one-page handout. The podcasts are linked there. And then also, if you’re a pro member, we do have a course with contact hours inside the Pro Membership at EBB. Sara, I’m going to give you a pop quiz question. Okay… flow with me here. Do you remember which alternative approach for Group B strep has the most supporting evidence?

Sara Ailshire:

I do not.

Dr. Rebecca Dekker:

Okay. Well, that is like, I think a pretty common response is going to be that. So that’s one of the reasons I wanted to include that. So, you know, the main treatment, at least in the United States, the main approach is testing everyone during pregnancy towards the end of pregnancy for group B strep, and then treating them with IV antibiotics during labor if they test positive, right? So alternative approaches would be things like chlorhexidine wipes during labor to kind of try and quote unquote sanitize the birth canal. Some people like to use garlic inserted into their vagina. Other people may use probiotics to try and improve their microbiome. And those actually have very little research supporting their use so far.

Probably the most evidence we have on an alternative approach is something called the risk factor approach. So that’s where done in places like the United Kingdom and some other countries that we list in the article. Where instead of screening people during pregnancy, they only give antibiotics during labor if they see other risk factors occur. And in those countries that use that approach, they have actually similar usage of antibiotics as countries that use the screen for GBS approach. What we do know is that although this can help lower rates of infection in the newborn, rates of early GBS disease in newborns are higher with the other risk factor approach. And higher meaning 0.5% risk versus 0.2% risk with what we call the universal screen approach where we screen everyone for GBS.

There are a few other things we talked about in the article in terms of alternative approaches, vaccines during pregnancy for Group B Strep and the use of human milk on the birth canal are things that are still undergoing experimentation. And maybe next time we have the article updated, we’ll be able to talk more about that.

But in terms of what’s new to this article on Group B Strep, we added an entire plain language section about the microbiome, which fascinates me because it’s a really big topic. And in the birth world, a lot of birth pros love to talk about the microbiome. But what I found is that when I talk to people who are not in the birth world or in the healthcare world, most of them have no idea. When I say, what’s the microbiome? If I ask the average teenager or college student, they don’t know what I’m talking about. So that was really fun to write up an explanation.

And I’ll go ahead and tell you our definition that we came up with from reading all the research is that the microbiome can be defined as the ecosystem of trillions of microbes, including bacteria, fungi, protozoa, and viruses that live and coexist with you in certain places in your body, such as your skin, your gut, which includes your intestines and rectum, your nose, mouth, and genital and urinary tracts. And the cool thing about the microbiome is that it’s not just a thing that you can do, we now know that it does get its start before you are born, that you will swallow tiny amounts of maternal gut bacteria floating in the amniotic fluid or the waters inside your amniotic sac.

But most of your microbiome is what we call seeded at birth when you’re exposed for the first time to your birthing parents’ genital tract and or skin. And in fact, one reason that newborns born by vaginal birth tend to have better health outcomes in infancy and childhood is likely because of the microbiome. Because a microbiome that’s seeded by a vaginal birth tends to have more beneficial bacteria at a young age when your immune system is developing than a microbiome seeded by a cesarean birth. And we give a link in the article on GBS about the practice of trying to seed the microbiome even at a cesarean, which is controversial. And we didn’t go into depth, but I did link to some resources about that.

And we also talk about how infant feeding methods have a strong influence on the microbiome, that human milk contains antibodies or immune properties that fight bad bacteria. And it also contains large amounts of oligosaccharides, which are complex sugars that feed beneficial bacteria. So by boosting beneficial bacteria through infant feeding routes, the oligosaccharides in human milk also positively can influence a baby’s immune system and their ability to fight infections. So we go into more depth in the article about the microbiome.

We talk about how antibiotics impact the microbiome. What are antibiotics? How long have they been around? Hint, for thousands of years. And also probiotics. What they are, how they work, how they might be helpful.

And then we go on to give updated global and US and UK statistics on group B strep. So I just wanted to share a little bit of that again with you. So in a global meta-analysis, researchers found that out of about 140 million live births in the year 2015, about 205,000 infants had early group B strep disease as newborns.

And when the researchers combined the numbers of stillbirths and early GBS disease and late-onset GBS disease, all of these are related to Group B Strep. Group B Strep led to more than 127,000 infant deaths and stillbirths in the year of 2015 alone. They were also able to calculate that giving IV antibiotics during labor probably prevented 29,000 cases of early GBS disease and prevented 3,000 deaths. Mainly in high-income countries that have access to group B strep testing and treatment with antibiotics. The countries with the highest burden of GBS are found disparately in low-resource countries where there’s no testing for GBS or it’s not available. And in labor, antibiotics are not widely accessible.

In the United States, which is considered a high resource country by researchers, despite the fact that we have a high number of perinatal care deserts, about 7% of full-term infants who catch early GBS disease will die from their infection, and death rates are higher in preterm infants. Those are about 19%. Although newborns in high resource countries are likely to survive even if they catch early GBS disease, their illnesses usually require long, expensive stays in the neonatal intensive care unit and may receive really heavy, massive interventions to treat their serious illness.

So speaking of illness, one of the things we did in this article that we added that was new, and I think is one of the most important things about this article, is we include the signs of early GBS disease in newborns, because it’s never going to be possible to completely eliminate early GBS disease. Even in countries where we screen everyone for group B strep and try to treat it with antibiotics during labor, there are scenarios where you cannot get the antibiotics, or you decline the antibiotics, or maybe the test results were incorrect. And they said you were negative for GBS, but you were actually positive.

So every parent and birth worker should know about the signs of serious infant illness. And we include a list of that in the article. And I’ll go ahead and read these again, because I think they’re really important. But a fast heart rate for the baby, more than 160 beats per minute, fast breathing, such as more than 60 breaths per minute, lethargy, meaning they’re just breathing, and a lot of breathing, such as more than 60 breaths per minute. Really tired and you can’t wake them up at all. Limp, having a fever of 38 degrees Celsius or 100.4 Fahrenheit or higher. Poor feeding, irritability, a high-pitched cry, grunting or nasal flaring, their skin pulling around their ribs or their throat when they breathe, repeated vomiting, temperature instability, bulging soft spots on their head, a brick dust color in their diaper, no wet diaper for 24 hours. Their skin changes to gray, blue or pale, or any other health concerns that the parent is concerned about. Also trying to integrate anti-racism info into every article that we published.

And in this article, we talked about how for anyone who has multiple layers of risk factors, such as being exposed to racism, prevention and extra wraparound care and attentiveness can be life-saving. So families, doulas, community advocates should know these signs and symptoms of GBS disease and infection in newborns. And parents and healthcare workers and birth workers should also be aware that low oxygen can look different on darker skin. It can look more grayish or whitish rather than blue. And that pulse oximeters, where they’re checking your baby’s oxygen levels, are more likely to have inaccurate results if your infant has darker skin tones.

And we link to some amazing handouts from the Association of Ontario Midwives. They have some printable handouts about signs of early GBS disease and what to do if you think your infant is sick. We also link to the Association of Ontario Midwives practice guidelines, which they have really thorough practice guidelines for midwives. They even have a groupie strep app that midwives can use, sample protocols and handouts for parents on GBS.

And another resource that I highly recommend is the Neonatal Early Onset Sepsis Calculator from Kaiser Permanente. This is a free online calculator where you put information about the birth, your groupie strep status, and the infant’s health condition into an evidence-based calculator that was based on research data through large, high-quality research studies. And the calculator will suggest different courses of action based on each infant’s individual scores. This is a free calculator. It’s publicly accessible. We link to it from the GBS article, Evidence Based Birth® podcast. And one benefit of this calculator is that it determines risk based on all kinds of infections that can happen to a newborn, not just Group B Strep. And this can be really a critical resource for families to use, especially if they feel a provider is not listening. Or if they’re not sure what to do. Or if a provider is not acting urgently enough to treat their child.

A few more things I’ll mention that we updated…we also talked about the evidence on self-swabbing for the GBS culture. And we summarized the most recent guidelines on GBS testing and treatment. So overall, this was like a really thorough update. And I encourage you to check it out at All right, Sara, it’s your turn.

Sara Ailshire:

All right, so in this next section, I’m going to discuss our updates for our signature article all about the evidence on premature rupture of membranes. This is when your water breaks before labor begins. And the acronym for this that we tend to use is PROM, just because it’s a little easier than saying premature rupture of membranes over and over again. So as I’m talking, I want you to take a moment and consider if you’re a birth professional, how many of your clients experienced PROM in 2023? And if you’re a birthing parent or birthing family, do you know somebody who has experienced this?

So the Signature Article for the evidence on premature rupture of membranes was first published by EBB in 2014. In July of 2023, we updated the signature article and the one-page handout. We added a course for EBB Pro Members to access to learn more about PROM to help support their clients. We released a couple of new podcast episodes and… In addition to everything that we did about PROM, we added a new section to the signature article itself to discuss the preterm premature rupture of membranes. And we’ll talk a little bit more about that in just a moment.

So the two podcast episodes that I wanted to highlight that we released this year, though there are episodes in EBB’s archives that covered a topic, are episode 277, the evidence on Induction waiting for labor with term PROM, and episode 281, which was a mini Q&A about the preterm premature rupture of membranes, or PPROM.

So what is PROM? PROM, the premature rupture of membranes, occurs when your water breaks before labor begins. And there’s two types of PROM, and I’ve already discussed them both a little bit, but here I’ll go into a little bit more detail. Term PROM is when your water breaks before labor at 37 weeks or more of pregnancy. So basically you’re at term, you could give birth anytime. So it’s not unexpected that you would go into labor, but the order of operations has kind of reversed itself. Whereas premature PROM or PPROM occurs when your water breaks before 37 weeks of pregnancy. Prom is pretty common. Term PROM happens to a lot of people. It occurs in roughly 8% to 10% of pregnancies or roughly 1 in 10 pregnant people.

Preterm PROM is less common and it impacts roughly 3% of pregnancies. However, we felt it was really important to add a section to our signature article about the premature rupture of membranes that addressed the preterm premature rupture of membranes because this is something that impacts a lot of pregnant people and because PPROM causes one-third of preterm births.

So a little bit more about PPROM. It’s really important for us to also highlight that not all communities experience the burden of PPROM equally. Black birthing people in particular in the United States are disproportionately impacted by preterm birth and PPROM due in part to medical racism, which underscores the need for anti-racist maternity care, including access to black doulas and black blood men free care. PPROM and PPROM are both cases where your membranes rupture before labor begins, but how they’re treated differs substantially based on the nature of when this is happening. 

PPROM is a very common cause of preterm birth. The approach to treatment really depends on when it occurs during the pregnancy. A lot of the research on PPROM is focused on prevention, but there’s a lot of work that needs to be done still to figure out why this happens and if there’s anything that people can do to prevent it from happening in the first place. Just like with PROM, there’s a lot of instances where the things that cause PPROM are not super well-defined.

And we go into a lot of detail in the article about what the research says about what are possible risk factors, what are possible things that could maybe help prevent PROM. What does the research have to say about the causes of this event? So some of those things that researchers are interested in or are currently investigating in order to better understand risk factors for PROM include the microbiome, like we talked about a little bit earlier with GBS, as well as cervical exams, different dietary supplements, as well as… the impact of exposure to extreme weather temperatures and air pollution. So there is some limited evidence that certain microbes in your vagina can put you at a higher risk for PROM. And there’s also some limited evidence that suggests that maybe a healthy microbiome can help keep your membrane strong by lowering your risk of infection or inflammation.

There’s some evidence that cervical exams can increase your risk of term PROM, and there’s no evidence that routine cervical checks may offer any benefits. So in addition to that, cervical checks after your membranes have ruptured can possibly increase the risk of infection. As you’re introducing something into the vaginal canal with your membranes ruptured, you’re introducing potentially outside bacteria into the amniotis, into where the baby still is, possibly increasing the risk of infection.

Diet can have a pretty variable effect on your risk for having your membranes rupture before labor. There’s some early evidence that suggests that certain fatty acid supplements might help lower the risk, whereas taking other supplements either has no effect or, in cases where people took very, very high doses of supplements, possibly increase the risk of PROM.

There’s also some evidence that we’ll go into a little bit more detail here in a moment on that found that being exposed to very hot or very cold weather and air pollution could increase the risk of both term PROM and PPROM. 

So I wanted to take a moment here just to talk a little bit about the microbiome and prom, just because that was something that was so important to Group B Strep. And just because there’s a lot of research that demonstrates that the microbiome could have a really important role to play in a lot of elements of birth. So as we said before, your microbiome is this ecosystem of microbes that live in and around your body. And the vaginal microbiome, which is what I’ll be talking about here, is the ecosystem of microbes that lives in your vaginal and urinary tract. And this fluctuates throughout your lifespan.

So some of the recent research on this and how it relates to the premature rupture of membranes was interested in the balance of bacteria, whether the presence of good bacteria in the genus Lactobacillus, so you might have heard of that, it’s like a healthy bacteria, whether the presence of this type of bacteria could play a protective role in pregnancy by preventing infections from harmful strains of bacteria. Basically, this bacteria helps keep a balance that is beneficial, whereas a presence or overpopulation of other bacteria could create the conditions that cause infection or disease.

Climate change and PROM was the one thing that really surprised me as I was helping update this article. There were three studies, one from 2018, one from 2021, and one from 2023, of pretty large groups of people from within the United States as well as in Taiwan that was investigating the impact of climate change and air pollution on PROM.

So a 2018 study of over 15,000 people in the U.S. found that a 1 degree Celsius increase in average temperature during the warm season, so our summer, was associated with a 5% increase in PROM and a 4% increase in PROM. And this doesn’t just mean that the temperature went up one degree, and this happened, but one degree above average, one degree over what you would expect the temperature to be in a given month.

A 2021 study from Taiwan found that people who were living within three kilometers of a petrochemical plant had an increased risk of PROM and PPROM. And a 2023 study from California tracked the weather around delivery dates for roughly 16,000 people who had PROM and PPROM. And they found that the risk of PROM increased by 9 to 14 percent among those who are exposed to heat waves during their last week of pregnancy, so that was something that really stuck with me this year as a researcher, that we know that climate change impacts all sorts of different things, all elements of our life. And it can also impact people’s pregnancies and births by potentially increasing the risk for PROM and PPROM.

Some of the other new research that we covered this year in this article was the new evidence on vaginal birth after cesarean or VBAC and the premature rupture of membranes. A lot of people who have the premature rupture of membranes are typically induced after this occurs just to kind of help spur them along, protect them from the potential risk of infection. But if you’re interested in pursuing a vaginal birth after cesarean and you have term PROM, you might be curious, is this even going to be an option for me or has PROM taken this off the table?

There are two new studies that came out, one in 2020 and one in 2022, that found that people with PROM were overall safe to try for a vaginal birth after cesarean. They did not find evidence of a higher risk of infection. People who are pursuing a VBAC after prom. And while these are smaller studies, hopefully the next time we update this article, we’ll have a little bit more information and more research that we can include about the safety of vaginal birth after cesarean for people with prom. So that’s just a little highlight of what we were able to include in this new update. There’s a ton of new resources. There’s a ton of new research about Foley bulb, about all sorts of different elements of birth with PPROM and with PROM. And it was really exciting just to see what was out there and what innovations researchers are finding on this topic.

Dr. Rebecca Dekker:

Awesome. And thank you so much, Sara, for your hard work on that update and for adding the whole new section on Preterm PROM, which, as you said, is really important. As a reminder, you can just go to, and you can find the full signature article, the one-page handout, and the podcast episode that focuses on both of those topics, PROM and PPROM. And our EBB Pro members have that updated course on Group B Strep and PROM, inside their EBB Pro Membership. So up next, what I want to talk with you about is a Signature Article that we finished publishing in 2023.

And I want to acknowledge the lead author on this paper was Ihotu Ali, who was a research editor here at EBB and is currently elsewhere focusing on her studies. But we are so grateful to Ihotu for all her amazing work on Signature Article, The Evidence on: Anti-Racism in Health Care and Birth Work.

So the two most important podcast episodes that go along with this signature article were episode 199, where Ihotu was on the beginning of the journey of writing this article and talking about kind of the effects of racism. And then in episode 265, Ihotu came on the podcast to talk about how we shifted to focus on solutions to anti-racism. Ihotu kept saying, “I’m tired of talking about the problem. Let’s talk about solutions.” Right.

So part one of this article is called Solidarity and Soul Family. And Ihotu started this part of the article off by talking about how the idea of giving everything only to your spouse and your biological or adopted children is not a universal practice. And that indigenous communities around the world often use terms like all our relatives or our mother. And across many generations and cultures, the idea of family has been large and inclusive and included entire communities or neighborhoods of cousins, grandparents, aunts, uncles, nieces, nephews, niblings, neighbors, and longtime friends. And historically, resources, time, and security and protection have been shared across the entire extended family or community.

And Ihotu wrote about how, you know, it may not be a biological family, but over the years, you can develop a relationship with someone that is like soul family. And you can think of yourself, who are people in your life who are part of your soul’s purpose, preparing and raising you and elevating you to achieve your purpose, dreams, or calling in life. And that this is a mutual support of each other. And so we ask the question, how can we expand our resiliency? You know, many of you listening to this, you’re already advocates. You’re advocates and change makers in your own way. And we know that advocacy is unpaid work that can be labor intensive, emotional, and draining. We see a lot of burnout among activists. And many white allies ended up turning away from anti-racism practices during the trials of the pandemic. And you see these competing priorities like climate change, economic crises, warfare, genocide, gun violence, the overturning of Roe v. Wade.

And what Ihotu wrote in this paper I love is that the most effective and resilient advocates understand that the work of collective liberation is intersectional. All social justice issues are intertwined. And as the issues seem to pile up year after year after year, it becomes even more important to work at the root causes rather than chasing the symptoms of disease. And so part one gives action ideas.

How do we expand our effectiveness? And we use a framework of Dr. Barbara Love. She has a four-step framework called awareness, analysis, action, and accountability. And we kind of define each of these using Dr. Barbara Love’s writings and give examples and checklists and ideas of how you can expand your resiliency and expand your effectiveness as someone who is an advocate in this area.

Part two, I wish Ihotu was here to talk about. Because it was just such an amazing part of the article that she proposed writing. And I was so excited that she did. It’s called Afrofuturism in Birth. Afrofuturism is also known as Black Futurism. It’s a cultural philosophy and movement led by Black science fiction writers, artists, and musicians. And it’s both a spin on science fiction, putting Black characters at the center of the story. And a philosophy embraced by those who are not. And those who dream of a Black utopia that is both futuristic and ancestral.

Ytasha Womack, author of the book “Afrofuturism, the World of Black Sci-Fi and Fantasy Culture,” explained this at a 2017 lecture in Amsterdam. She wrote, “Afrofuturism is a way of looking at the future and alternate realities through a Black cultural lens. It is an artistic aesthetic, but it is also a method of self-liberation or self-healing. It can be a part of critical race theory. And it can be an epistemology as well. It intersects imagination, technology, Black culture, liberation, and mysticism. As a mode of self-healing and liberation, it’s the use of imagination to help people transform their circumstances. Because imagining oneself in the future creates agency.”

And Ihotu also summed it up with one of my favorite lines of hers. “What would birth and parenting look like in Wakanda?” And if you’re not familiar, Wakanda… Wakanda is the mythical African country featured in the movie Black Panther. So in the article, Ihotu wrote… “We invite you to join us in a visionary space where Black birth is not known by its mortality statistics, disparities, or fear or conflict in the birth room. In this vision, we center Black and Brown safety, dignity, informed choices, abundance, family support, healthy children, and joy. This is different than colorblindness, toxic positivity, or downplaying our current realities of pain, rage, and the challenges and risks that come along with speaking up and making change.”

One of the things that we focused on in this part of the article was supporting the visionaries who are already doing the work. And so we also encourage people to support the National Association to Advance Black Birth, known as the NAABB, and the Black Birthing Bill of Rights that they created.

You can read the entire Bill of Rights at the NAABB website. It’s Download a PDF and learn more about this powerful visual. And with permission from the NAABB, we selected six principals from their full Black Birthing Bill of Rights® to adapt into a table and a handout that includes research, advocacy, and action items for each of those six items from the Black Birthing Bill of Rights®.

And we’re hoping that when you look at a problem that’s so huge and overwhelming, that this would give some people a little antidote against analysis paralysis or being frozen in trauma and fear and help you identify small, manageable parts of advocacy that, again, trying to focus on that resiliency and effectiveness.

We also used part two of the anti-racism article to feature some visionaries, including Michelle Browder, her work of honoring the mothers of gynecology. We celebrated Black Grand Midwives, those who have already transitioned and those who are still physically present with us. Kimberly Seals Allers, creating the Irth® App to hold hospitals accountable. And how Black midwives, doulas, and obstetricians are using social media to expose and organize. And I’m going to link in the show notes to about seven interviews we did this year alone with Black and brown visionaries in the birth field. And so I’m really excited to link to those.

And I encourage you to, you know, as you’re looking at the show notes, to go ahead and next year, make sure you go back and listen to at least two or three of these incredible interviews.

Part three of the anti-racism article focused on evidence-based equity tools. And this is like, it’s what we do best at EBB is we look at the research. And so we looked at the research on what we call the evidence-based equity triad, the three things that we think will make the biggest difference on outcomes. And number one is the midwifery model of care. Number two is community-based full-spectrum doulas. And number three is reparations, accountability, and transformative justice. And we covered the evidence on these equity tools in one of our EBB Pro Member monthly trainings this year at EBB.

In terms of resources for the public, if you go to, you will see a link towards the top to our free resources. We created a getting started handout for anti-racism and birth work with lists. A checklist of resources, podcasts, books, etc. We created a quiz that you can take and you can print off and share with medical professionals or birth professionals about your knowledge of anti-racism in medicine. We created that handout I mentioned earlier where we created a table and looked at how the Black Birthing Bill of Rights® can be implemented. And we also created an equity tool handout looking at anti-Black implicit bias and how, you know, it manifests in a labor and delivery unit. So what it looks like in a labor and delivery unit, what racism looks like, where that comes from, where those racist beliefs come from. And we give scripts and tips for ways healthcare workers and birth workers can speak up to interrupt that cycle.

So I’d love for you to think, you know, which of those resources do you want to go and download for free today? The getting started. You want to take the quiz. Look at the Black Birthing Bill of Rights® handout or that anti-Black implicit bias and how we can interrupt that in labor and delivery. And just think about which one you’re going to get and then go grab that and look at it. So next up, Sara is going to talk about Cesarean care.

Sara Ailshire:

Absolutely. I also just wanted to mention that in both the updated Signature Article on skin and skin care after Cesarean, as well as the updated article on PROM, we drew a lot from your and Ihotu’s work, Rebecca. On the anti-racism article, that article was a resource that we linked in both of these signature articles. It’s so, so important.

So the evidence on skin and skin care after Cesarean, the original articles for this were published by EBB in 2012 and 2013. The most recent update we just released this October and November, and we updated the Signature Article. We created a new handout and we have a couple of new podcast episodes. Those are episode 291: Evidence on skin and skin care after a Cesarean. And then there’s a slightly older podcast episode you can go back and listen to where it’s a birth story, planning a Cesarean after an unmedicated first birth, where one of our guests was able to talk about their experience of skin and skin care after a Cesarean.

So what is skin to skin care after a Cesarean? Skin-to-skin care, also called kangaroo care, is a natural process that involves placing a naked newborn on their parent’s bare chest shortly after birth. And typically you’ll see that they are covered by a blanket to help keep them warm and dry, but they’re not dressed, they’re not wrapped in a blanket. They’re having a lot of skin-to-skin physical contact with their birthing parents.

Kangaroo care is something that was first developed in Colombia in the late 1970s as a low-cost, low-tech intervention to support low-birthweight premature babies. In the hospital where this was first developed, there was a shortage of incubators and necessary machines to help support these babies. And the doctors thought, why don’t we just try and mimic what we see animals do, kangaroos, marsupials, to keep their young in their pouch, close to them, to help them develop. They placed these babies on their parents’ chest and they found that they had a lot of success, that these infants stabilized and were able to grow. This got a lot of attention from doctors around the world, and it was so successful that the World Health Organization began promoting it as part of their strategy to lower infant mortality, I think in the late 1980s, and that really hasn’t stopped.

The research on skin and skin care after Cesarean shows that a lot of the time, babies are separated from their birthing parent after Cesarean, and they’re not able to get that care.

But why are they being separated? Well, it’s often because the hospitals need to provide routine care, not typically because there’s any specific reason, there’s any intervention or crisis that would necessitate separating the baby from their birth parent.

So what does the research on the benefits of skin-to-skin care after Cesarean say? Well, one thing is that it might help reduce the numbers of transfers of babies to the neonatal intensive care unit after birth if they’re given time to spend skin-to-skin with their parents, even after they’ve been born via Cesarean.

There’s been some research that shows that skin-to-skin care after Cesarean might even be beneficial to very preterm infants, babies who are born between 28 and 31 weeks of gestation, because it can help them avoid hypothermia and increase the likelihood that they would be discharged sooner when they compared those babies who received skin-to-skin care with another control group who had the standard treatment were taken and placed in an incubator and immediately began receiving interventions due to their preterm birth.

And then recently, in a 2020 review of 13 different observational studies, they found that it was safe for babies to receive skin-to-skin care and that there wasn’t really any negative impact on their temperature, their APGAR score, oxygen level, or heart rate.

So having skin-to-skin care after a cesarean seems to have a lot of benefits without any drawbacks. The benefits of skin-to-skin care seem to be so clear that the World Health Organization recommends that all newborns receive skin-to-skin care after birth, including low birth weight in premature babies, including babies who are born by a Cesarean. They recommend that skin-to-skin care begins immediately after birth and continues uninterrupted for at least an hour or until the first breast or chest feeding session of birthing parents who are breast or chest feeding.

So in this article, we also talked a little bit about the question of access to skin and skin care after a Cesarean. The research demonstrates it’s pretty beneficial, but what does this look like in reality? Research on Cesarean rates shows that overall, it seems to be rising globally. And we also found that the longstanding practice of separating babies from their parents after Cesarean is still quite common and isn’t really changing.

In 2022, 70% of U.S. hospitals said that they practiced routine uninterrupted skin-to-skin care contact for most babies born vaginally, but only 50% of those same hospitals said that they provided any type of routine skin-to-skin care for babies born via Cesarean. So we know that skin-to-skin care is beneficial, and we know that there are barriers to this, particularly for parents who give birth via Cesarean. But are there things that researchers and doctors are doing to change that? And there is.

So I wanted to talk for a moment about a new topic that we cover in this article, the gentle Cesarean and its relationship to skin-to-skin care. The gentle Cesarean is a type of cesarean birth that’s performed with pauses that allows the birthing parent and their companion to see the baby emerge. And that also, you know, ensures that the baby is placed on the birthing parent’s body, barring any serious complication. So to facilitate gentle Cesareans, researchers and facilities who are trying to include this practice in order to support bonding, to support breastfeeding with their parents who birth by cesarean, they found that they might need to adjust the temperature in the OR, adjust how they place the leads or the little wires that help monitor you while you’re going through the Cesarean surgery. And also maybe change their practices to ensure that the birthing person is able to move their arms. So it was really interesting to see… the new research just emphasizes that skin-to-skin care is really important for all modes of birth, whether vaginally or by Cesarean. And also really interesting to see what practitioners, hospitals and nurses are doing in order to facilitate this and to support families in early bonding with their baby. Thank you.

Rebecca Dekker:

Yeah, I think people were really excited to see that article updated. And if you want to view the research for yourself, get access to the podcast, the handout, just go to, and that should take you straight to the article.

So in addition to these four Signature Articles that we were just talking about, we also published updated evidence on nitrous oxide that Sara helped with. And I won’t go over that today, but there is an episode all about that.

We offered two free webinars to the public. We did the evidence on GBS prom and waterbirth in April of 2023 and the evidence on breech birth, which is a topic we haven’t covered before (the evidence on vaginal breech birth, at least from EBB’s perspective) that came out in October. And if you are an EBB Pro Member, you can still get access to those webinars and their contact hours inside your archives.

Our Pro Members were also really busy this year. We have a different training each month, either with an internal guest speaker from EBB or an external speaker. We covered the evidence on postpartum hemorrhage and what birth workers can do to advocate for their clients if they see a hemorrhage happening. Understanding secondary trauma as birth workers, we talked about obstetric violence as a public health crisis. And we had a guest teacher talk about pelvic floor health in two trainings.

We also launched a new doula mentorship in 2023 inside the EBB Pro Membership. So if you join, you get access to that inside the EBB Pro Membership. It is a group doula mentorship model. So we meet regularly, discussed marketing, legal agreements, referrals, interviews, social media.

And we also started a monthly midwifery brunch and learn session with Ms. Charlotte Shilo-Goudeau , a Certified Professional Midwife and an EBB Instructor who has agreed to host those conversations by Zoom with midwives and midwifery students.

So we have a new podcast listening guide here at EBB. So it is a spiral bound workbook that you can use to kind of self-educate yourself on topics related to pregnancy, birth, and postpartum. And we now have a digital version as well. So a super easy way to get started.

So we are super thankful to Divine, Haley, and Ali who worked really hard on that all year. And speaking of the podcast, Sara, you went and found the stats to tell us, you know, what were the most downloaded episodes of 2023? So do you want to share the top five with our listeners? They can know, you know, what everybody’s going to listen to this year.

Sara Ailshire:

Absolutely. Yeah, it was really interesting. I got some help from Jeana with this, which was great. So the top five episodes, most downloaded episodes of 2023 here at EBB:

  • #5 was episode 166, the experience of a powerful and miraculous birth with Brooklyn and Hoang Pham.
  • #4 was episode 264, top three tips for exercise and pregnancy with Gina and Roxanne of Mamaste Fit.
  • #3, Episode 257, the updated evidence on Group B. Strep part two. 
  • EBB 256 was number two– this was the top three recommendations for preventing pelvic floor dysfunction after birth with Dr. Sara Duvall, founder of Core Exercise Solutions.
  • And the number one episode downloaded in 2023 from EBB was episode 254: Evidence on Group B Strep in pregnancy (part one), which makes sense that both 254 and 257 would be in the top five.

Rebecca Dekker:

Yeah, part one and part two of Group B Strep strip were number one and number three, respectively. And the evidence topics still seem to be really popular. And it’s also fun to see that that Powerful Miraculous Birth Story was number five. You know, that was a replay. And just people love some of these positive, empowering birth stories.

And this year, we had over 1.7 million unique downloads of our podcast episodes this year alone. And Jeana Gomez joined our team helping with the podcast. And we partnered with Earfluence to produce our podcast and coordinate with guests. So we’ve been really excited. And we’re also thankful to Andy and Joseph, who do all the audio visual editing. And they’ve done an amazing job this year. And thanks to all our guests. We loved all our guests this year.

So a sneak peek of plans for next year. So one of the most important announcements that we have that we’re going to be talking more about next month is that we have an Evidence Based Birth® Virtual Conference coming in March of 2024. And we already have people signed up to attend who got in on the Black Friday deal, but we will be making tickets available very soon in January. And you can get on the waitlist by going to If you want to get tickets, we will have one day focused for parents, one day focused for birth pros and healthcare pros, but both days will be unique and have great complimentary info.

And next year for our pro members, we are looking at doing trainings on supporting IVF clients, preeclampsia, the ARRIVE trial, twins, and more. And we’re starting a new perk for EBB Pro Members where they get access to new 1-page handouts that are for pro members only. The very first handout for Pro Members only will be the evidence on vaginal breech birth and Cesarean breech birth. And we also are planning some handouts on common shots in pregnancy, such as the RhoGAM shot for being Rh Negative.

So just a quick note on how the PDF library works. So we do have those one page handouts that are free on the website. But if you want the full length Signature Articles and a really visually stunning printable PDF, that’s what’s inside the library alongside with other extra handouts. Another handout that is in the library only for Pro Members or PDF Library members, is the nitrous handout. But it’s a really cool library. We can just go, you click on the topic you want and immediately download all of the PDFs that we have and you can use them with your clients.

In terms of research that’s going to be published at EBB in 2024, I’m excited to announce that the updated evidence on waterbirth is coming out on a very special day very soon. So keep your eyes peeled for that.

Sara is working on the updated evidence on doulas, which is one of our flagship articles that people depended on us for many years to host that article. And we are really excited about that update.

We are also planning, drum roll please…

The updated evidence on the The ARRIVE trial. So looking at follow-up studies to the The ARRIVE trial, looking at induction at 39 weeks.

And I’m still debating what to do next after that, but we might tackle the updated evidence on fetal monitoring and or diagnosing gestational diabetes. There’s always research coming out on these different topics and it’s so hard to choose. So once we get past the waterbirth, doulas, and the ARRIVE trial article, then we’ll select our next one. So yeah, and we have translators working on the Induction Pocket Guide. If you would like to see our pocket guides translated into Español, the first one of those will be coming out this year.

So I’d love to know on social media, or you can email us and let us know what you’re most looking forward to next year.

We appreciate our listeners, everything you do just from, you know, listening to the content and learning to telling your friends about EBB to joining our programs. If you’re able to do that, the costs of publishing the research are supported by our Pro Members and our PDF library members, people who want access to those additional resources. And they support all of the free research that we put out on the podcast on YouTube and the blog. So Sara, I’d love to know what are you most looking forward to in 2024 out of all of these projects?

Sara Ailshire:

You know, I have to say I’m super excited, of course, about the doula article. That’s the research that I do for my own dissertation, as well as when I’m really passionate about the role that doulas can play. I’ve learned a lot and been mentored by a number of doulas in my life. I’ve been very lucky in that way. So I’m super, super excited to keep working on that. I’m also really excited about the The ARRIVE trial. That’s something that I’ve seen a lot of people talking about. There’s a lot of conversation, and I’m really eager to dig into the research and see what there is to see about that.

Rebecca Dekker:

Yeah, I know for me, it’s hard to pick. I know that there’s a secret project or two I’m working on that I’m not going to tell you about just yet, but I just love geeking out about the research on different topics. So I am excited to see that doula article, the waterbirth article and more. I love the breech handout for pro members. That was fun putting it together. I’m excited about the RhoGAM handout for our members as well.

And I’d love to know from you, our listeners, what do you want to see from EBB in 2024? I would love it if you could celebrate the end of this year, the beginning of the next by leaving us a podcast review, maybe share one thing that you’ve learned from EBB and one thing that you’d like us to cover in the future. And I hope to be able to read your comments and select our favorite requests to respond to next year.

So go to your favorite podcast platform, whether you use Spotify, iTunes, or somewhere else, and you can find us on there. And I hope to see you in the next year. Leave a review and let us know one thing you learned and one thing you’d like to learn more about. And I look forward to personally answering some of your questions.

So thank you, Sara, for coming on the podcast today with me.

Sara Ailshire:

Thank you so much for having me. It was really fun.

Rebecca Dekker: 

I hope everybody is having a peaceful and restful holiday season, and we will see you all next year. Bye everyone.

Today’s podcast was brought to you by the Signature Articles at Evidence Based Birth® podcast. Did you know that we have more than 20 peer-reviewed articles summarizing the evidence on childbirth topics available for free at It takes six to nine months on average for our research team to write an article from start to finish. And we then make those articles freely available to the public on our blog. Check out our topics ranging from advanced maternal age to circumcision, due dates, big babies, Pitocin, vitamin K, and more. Our mission is to get research evidence on childbirth into the hands of families and communities around the world. Just go to, click on blog, and click on the filter to look at just the EBB Signature Articles.

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