o Signature Article on the Evidence on Birthing Positions
o Signature Article on the Evidence on Eating and Drinking in Labor
o Signature Article on the Evidence on IV fluids
o Signature Article on the Evidence on Freidman’s Curve and Failure to Progress + 1-page handout on Debunking Pelvic Shapes
Thanks for tuning in and supporting Evidence Based Birth® in 2022! Because of you we were able to surpass over 4 million downloads –putting us in the top 5 percent of all podcasts! Thank you for helping us to uplift birth workers and empower families with evidence-based knowledge.
Content Warning: abortion & medical interventions
Resources and References
Find the updated Signature Article on the Evidence on Birthing Positions here
Listen to the associated Podcast episodes on Birthing Positions:
- 196 – Pelvic Biomechanics and Movement in Labor with Brittany Sharpe McCollum
- 221- Evidence on Birthing Positions and Tried-and-True Midwifery Practices for Protecting the Perineum
- 241- The Updated Evidence on Birthing Positions
Find the updated Signature Article on the Evidence on Eating and Drinking in Labor here
Listen to the associated Podcast episodes on Eating and Drinking:
Fina the updated Signature Article on the Evidence on IV fluids here
Listen to the associated Podcast episodes on IV fluids:
- 235 – Evidence on IV Fluids with Dr. Rebecca Dekker
- 208 – Advocating for Your Rights in Birth with EBB Childbirth Class Graduation Cheyanne Saenz
- 104 – The Evidence on Saline Locks
Find the updated Signature Article on the Evidence on Freidman’s Curve and Failure to Progress here
Listen to the associated Podcast episodes on Failure to Progress:
- 224 – Failure to Progress or Failure to Wait with Ihotu Ali, Erin Wilson, and Rebecca Dekker
- 196 – Pelvic Biomechanics and Movement in Labor with Brittany Sharpe McCollum
- 75 – Birth in Twilight Sleep – the Experiences of Rebecca’s Mom
Debunking Pelvic Shapes Handout and the Abortion Research guide can be found here.
Free Public Webinars:
Rebecca’s Favorite Projects:
- Protecting the Perineum Series
- 221 – Evidence on Birthing Positions and Tried-and-True Midwifery Practice for Protecting the Perineum
- 218 – The Evidence on Perineal Massage During Labor with Dr. Rebecca Dekker
- 216 – The Evidence on Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker
- 206 – Evidence on Perineal Tears and the Importance of Avoiding Episiotomy with EBB Founder, Dr. Rebecca Dekker
- Abortion Research Guide
- Reproductive Justice
- 217 – Disability Justice in Birth and Parenting with Stefanie Lyn Kaufman-Mthimkhulu
- 234 – Tackling Fatphobia in Lactation with Kristin Cavuto
- 243 – Importance of Kick Counting for Preventing Stillbirth with Stephaney Moody, Health Equity Ambassador of Count the Kicks
- 227 – Amplifying the Need for Intersectional Birth Support for QTBIPOC Birthing People with Xian Brooks of the Dandy Doula
- 238 – Black Fatherhood and Fighting Anti-Black Racism with Brandon Diggs Williams, Licensed Clinical Social Worker
- 228 – Uplifting Radicalized Birth Work with Anna, The Pocket Doula
- 229 – Evidence on Doulas: Community-Based Models, the Pandemic and Reimbursement with the Research Team
Most downloaded Episodes in 2022
- #5 – 235 – Evidence on IV Fluids with Dr. Rebecca Dekker
- #3 – 224 – Failure to Progress or Failure to Wait with Ihotu Ali, Erin Wilson, and Rebecca Dekker
- #2 – 221 – Evidence on Birthing Positions and Tried-and-True Midwifery Practice for Protecting the Perineum
- #1 – 241 – The Updated Evidence on Birthing Positions
Watch Bringin’ in Da Spirit Trailer here
Hi, everyone. In today’s episode, we’re going to review all the research we published at Evidence Based Birth® in 2022 and look ahead to 2023.
Hi, everyone, and welcome to today’s episode of the Evidence Based Birth® podcast. My name is Dr. Rebecca Dekker. My pronouns are she/her, and I will be your host for today’s episode. Today we’re going to talk about 2022, a year in review. We’re going to look forward to 2023. But before we get started, I want to let you know that we are offering a special year end sale on the Evidence Based Birth® Pro membership. So if you join at the annual subscription between now and December 31, you not only get a fantastic discount off the Pro membership, but you’ll also receive a physical copy of our newest intervention pocket guide. It retails at $50 and it is currently sold out in the shop.
This is also a fantastic way if you own your own birth business in the United States to get a tax deduction before the end of the year. To learn more and join today, visit ebbirth.com/membership. And remember, you have until midnight on Saturday, December 31 to take advantage of this opportunity. So in today’s episode, I’m going to focus on the research that we publish in 2022 and let you all know about the different resources that are available to our podcasts listeners. And then at the very end of this podcast, we’ll move on and we’ll give you a sneak peek as to what we are working on for 2023. All right, you ready to get started? Let’s go. So here at Evidence Based Birth this year we worked really hard on updating four of our research-based signature articles in 2022, the evidence on birthing positions, the evidence on eating and drinking and labor, the evidence on IV fluids and evidence on Friedman’s Curve and failure to progress.
We also published one new handout for you all, the debunking pelvic shapes handout. So let’s start with the evidence on birthing positions first. This article was originally published in 2012. That was the landmark year that I started publishing at Evidence Based Birth®. And we had updated it in the past, but we updated it in 2022. So the full length peer reviewed signature article was updated, as well as the one page handout that goes along with that article. We also released several podcasts about birthing positions. So in episode 196, we talked about pelvic biomechanics and movement in labor with the special guest speaker, Brittany Sharp McCollum. And then in episode 221, we talked about the evidence on birthing positions and tried and true midwifery techniques for protecting the perineum. In fact, that was a huge series we did in the first half of this year here at Evidence Based Birth®, all about protecting the perineum and preventing tears.
So we narrowed in and focused on birthing positions and how those protect the perineum during the pushing phase. And then in episode 241 of the Evidence Based Birth® podcast, I go into detail about all of the latest research on birthing positions and exactly which updates we made to the signature article on this topic. So as we’ve discussed here before in the Evidence Based Birth® podcast, giving birth in upright positions is beneficial for several physiologic reasons, and physiologic means that it’s helpful for maintaining a normal birth. So upright birthing positions use gravity to help bring the baby down and out. There’s less risk of compressing the aorta, which is the large blood vessel that brings oxygenated blood to your body and to your baby. But uterus can contract more strongly and efficiently, the fetus can be in a better position to pass through the pelvis and research shows it’s less painful when you use upright birthing positions, it’s much less painful than lying on your back.
We also talk about how MRI studies have shown that the pelvic outlet becomes wider when you’re using squatting or kneeling as compared to lying on your back. And researchers have also found that upright birthing positions increased satisfaction and lead to more positive birthing experiences. However, despite all these benefits, most people who give birth in many hospitals around the world do not use upright positions and instead they are coached to push on their backs, 68% in the United States, or in a semi sitting lying position where the head of the bed is raised up, you’re kind of still in bed, leaning back, that is 23% of people giving birth in the United States. And only a small number of people birthing in US hospitals use other positions like sideline, which although it’s not upright, it is sacrum flexible.
So it allows the pelvis to expand for the birth of the baby. That’s used to only 3% of births in the United States. And only 4% of people giving birth in hospitals in the United States push and deliver while squatting or using a birth stool. And only 1% push and deliver in a hands and knees position. This is in contrast to research on home birth and freestanding birth centers where most people have given the choice will push and give birth in a more upright position where the pelvis can be flexible. Research is consistently shown that when you take the weight off the sacrum and the coccyx that allows the pelvis to expand, makes spontaneous birth more likely, meaning it makes birth without the use of surgery, forceps or vacuum more likely. And we added a computer modeling research study to the 2022 update that shows that when the coccyx is allowed to move freely, it can move almost 16 degrees.
And when non flexible sacrum positions are used, meaning you’re semi-sitting in bed or lying in bed in the lithotomy position, the coccyx can only move about four degrees. If you want to learn more about the updated research on birthing positions, I strongly recommend that you go back and listen to a summary of what’s new in Evidence Based Birth® podcast 241, the updated evidence on birthing positions. In that we give definitions, we explain what the coccyx is, we talk about why people give births on their backs. We have a pretty strong section all about why people are pressured into back line or semi sitting positions. We added research from countries all over the world. I have a new section that includes myths about protecting the perineum and a new section about the symbolic importance of the hospital bed. There’s a brand new systematic review that makes up the evidence section on giving birth and upright positions without epidurals.
We wrote the section on birthing positions with epidurals. We added info about how the lithotomy position, which is lying on your back with your feet in stirrups, how it’s actually really harmful, especially if you have an epidural. And we gave example language of how some doctors, nurses, and even midwives, might use pressure or coercion to get someone to lie in a back line position for the delivery. We wrote new action statements for nurses, doulas, childbirth educators and parents, added tons of resources and links and updated the one page handout. And you can get all of this information at free by going to ebbirth.com/birthingpositions.
Next up, let’s talk about the updated evidence on eating and drinking in labor. The EBB signature article on eating and drinking during labor was originally published in 2013. It was updated in 2017 and then we updated all of it again in 2022.
I love writing and teaching about this topic because this is one of the things that led me to start Evidence Based Birth®. One of the things that bothered me most about my first time giving birth was that I was not allowed to eat or drink anything for 24 hours during the birth of my first baby. And that led me down the path of questioning everything that happened to me. So we covered the overall evidence on eating and drinking during labor in episode 198 of the podcast. And then in episode 233, we go into detail about the updates on the research on eating during labor. The most recent data that we have shows that, people who are giving birth in US hospitals, 60% do not drink any oral fluids and 80% do not eat anything during labor. However, similar to birthing positions, when people are free to eat and drink at birth centers and at home births, very few choose not to.
Only 5% of people giving birth at home choose not to eat during labor or maybe don’t have a chance, because labor goes so fast. Very little research has been published on nutritional needs during labor, but research in sports nutrition has found that taking in carbohydrates during exercise improves your performance and protects against fatigue. And during times of starvation or carbohydrate restriction, your body has to turn to burning fat for energy, which results in the release of ketones. Some people may choose to eat a keto diet at certain times in their life, but we don’t really have any research on whether ketosis during labor is normal or harmless. Researchers in the field of nutrition and energy performance and eating during labor say that your calorie needs during labor are similar to those of marathon runners. Some advice online for marathon runners is to aim for about three grams of carbohydrates per kilogram of your body weight before the race.
What we do know is that research shows that people are dissatisfied and often anxious and stressed when they’re told they’re not allowed to eat during labor. So in our updated article on eating and drinking, we chose to refocus this article to focus on the fact that it’s normal to eat during labor. It’s good for your body to maintain your body with nutrition. So far we don’t have any research evidence on specific foods or drinks that can be recommended for consumption during labor, but doulas on our team here at Evidence Based Birth® suggest that you eat foods that are affordable and culturally grounded for you. We also commonly hear doulas recommend coconut water and honey sticks. Our doulas here at EBB added these recommendations, roasted okra, tortillas with honey or tahini spread, tostones, and fried plantain bites and light oil, along with other suggestions that you can find in our article.
We also decided to use this article as a chance to call out when doctors or nurses perceive some foods as being, quote, unquote, “unhealthy” for people in labor, saying that they’re strong smelling, spicy, heavy, greasy. All of us who have attended births here at Team EBB have seen healthcare workers literally on their faces make disgusted facial expressions or make remarks when they see a patient eating food that the healthcare worker disapproves of. We’ve also witnessed labor and delivery staff make judgmental and classist statements about people who like to eat fast food during labor. In our updated article, we urged nurses, doctors, and midwives, to address their own implicit biases about food and question their assumptions about what makes something healthy or unhealthy to eat during pregnancy and labor. I think one really useful part of the updated article on eating and drinking is that we summarize and link to all of the different professional guidelines around eating and drinking during labor.
So there are organizations that recommend that you eat or drink as desired during labor, including the World Health Organization, the American College of Nurse Midwives, the NICE clinical guidance in the United Kingdom and the Society of Obstetricians and Gynecologists of Canada. There are only a couple of organizations that I know of that have recommendations written in English that recommend that people avoid solid food during labor, but be, quote, “free” to drink clear liquids, and that includes the American College of Obstetricians and Gynecologists, and the American Society of Anesthesiologists. The American Society of Anesthesiologists, or ASA, says, quote, “There’s insufficient evidence to draw conclusions about the relationship between fasting times for clear liquids or solids and the risk of aspiration during delivery.” So what are they talking about with aspiration? Well, the reason many obstetricians and anesthesiologists recommend that you be nothing by mouth during labor. These policies came about in the early to mid 1900s when anesthesiology methods were crude and unsafe.
There’s actually been several major changes since those policies were created. Back then almost everybody who was giving birth in a hospital was knocked out with general anesthesia during their birth, whether or not they were giving birth vaginally or by C-section, they put a mask with gas onto their face and put them under general anesthesia. When you go under general anesthesia, you can no longer protect your own airway. So that’s what they were worried about, that you might vomit unintentionally while you’re asleep and aspirate down the wrong tube. Well, today we have proper anesthesiology tools to protect the airway. They do something called intubation, and that tube protects your airway along with other tools and skills. Also, general anesthesia is rarely used in birth anymore. It’s typically only used in emergency cesareans or cesareans where it’s not safe to use an epidural. A Cochrane review of five randomized trials did not find any evidence of harms when low risk people were eating or drinking during labor.
A larger more recent review found that laboring people under less restrictive eating and drinking policies had slightly shorter labors and no other differences in health outcomes. Other research has shown that patient satisfaction is much higher when you’re, quote, unquote, “allowed” to eat during labor. We also added info about the safety of eating, whether you have an epidural or not, which is often used, by the way, as an excuse to tell people they cannot eat. And then it’s also worth noting that often they say low risk people can eat during labor, but not high risk people. And sometimes people who have a body mass index of 30 to 40, or greater, are mentioned in the research as being at high risk for aspiration. So this time around when we were updating this article, we were curious if this was evidence basedor due to fat phobia. We cannot find any research that plus-size people are more likely to experience aspiration during childbirth.
And research has shown there’s no substantial difference in the difficulty of intubating someone based on their body size to protect their airway during surgery. And we talk more about that in the article. So when it comes to the evidence on eating and drinking, you would think in the year 2022, we wouldn’t have to talk about this anymore, but every time I teach a childbirth class or talk to parents, I run into this issue, where maybe they’re told, “Yeah, you can eat and drink during labor, but you can’t if you have an epidural, you can’t if you’re having an induction, make sure you eat before you come to the hospital because you’re, quote, ‘not allowed once you get here.'” End of quote. And it drives me crazy because the research does not support fasting during labor. And here at Evidence Based Birth®, we’re trying to give you all the tools that you also can help educate others about the evidence on eating during labor and that it’s a human right to eat and drink fluids during labor if you wish to.
So up next, the evidence on IV fluids, which is closely related to the evidence on eating and drinking during labor. This article was originally published in 2012 and the article and it’s accompanying handout were updated in August of 2022. I published our first podcast on this topic, episode 235, the Evidence on IV Fluids, and you can also look back in time at episode 104 where we talk about saline locks, which is a related topic. In episode 208, we talk about advocating for your rights in birth with an EBB childbirth class graduate, Cheyanne Saenz. And she talks about that issue of trying to advocate for not having IV access during birth because that was her wish. In the United States, most people who give birth in hospitals receive IV fluids. In the Listening to Mothers III study, they found that 62% of people received a continuous strip of IV fluids.
And in a 2020 survey of California hospital births, they found that IV use was about 76% of midwife attended births and 87% of obstetrician attended births. The reason for IV fluids is because of the nothing by mouth policies that are still in place in many birth settings. You have to stay hydrated, if they’re not going to allow you to drink fluids orally, they give them to you by IV. But just going back to the eating and drinking topic that we were just discussing, that nothing by mouth policy is not evidence based. So the IV fluids we discuss in this article include normal saline, which is salt water, Ringer’s lactate, which is another solution with minerals, and then dextrose, which is a type of sugar that can also be mixed into IV fluids. So there is very little evidence comparing IV fluids alone to oral fluids alone. And this is very telling, because IV fluids have become so common that when they do look at IV fluids in randomized trials, it’s usually to compare one amount of IV fluids to another amount.
There have only been three trials where they compared IV fluids to no IV fluids and people who were free to drink oral fluids. And in both groups people could drink oral fluids, it’s just that one group got IV fluids and the other didn’t. Two of these studies found that when you have IV fluids, plus you’re drinking oral fluids, that leads to shorter labors by about 30 minutes, compared to the group that only got oral fluids. Another study compared three groups, those that drank oral fluids plus IV fluids, those who had oral fluids plus IV fluids that contained dextrous, the type of sugar, and those who drank oral fluids alone. And they found that the group that had IV fluids with dextrous had shorter labors by nearly six hours. Now it’s possible that shorter labors could also occur if laboring people were encouraged to drink oral fluids that contain sufficient amounts of carbohydrates. But more research on this is needed and hasn’t been done yet.
In 2017, researchers combine the evidence from seven trials with about 1200 people, and most people in this study were not allowed to drink oral fluids at all. They found that when you received a higher rate of IV fluids, 250 milliliters per hour, which is a little over one cup of fluids per hour versus 125 milliliters per hour, which is around a half a cup of fluids per hour, found that those who had less IV fluids had longer labors by about one hour and a 30% higher risk of having a C-section. These findings suggest that if you’re not allowed to drink or not able to drink for some reason, that you might benefit from the slightly higher rate of IV fluids, about one cup or 250 milliliters per hour. However, the fact that they were restricting people from drinking fluids was not evidence based in the first place.
There also can be possible side effects from receiving too much IV fluids. In 2012, researchers found that when people received more than 2,500 milliliters of IV fluids in labor, their babies were more likely to lose weight after birth. This is because that fluid was also on board the baby’s bodies. And so, after the babies were born, they had to correct their fluid status, urinate off the extra fluid and that makes it look like they lost weight on the scale. This can lead to anxiety among healthcare workers and parents, which can then lead to formula supplementation. So if you’re planning to exclusively breastfeed or chestfeed your baby, IV fluids can create a little bit of confusion. Researchers suggests that if you do have to receive a large amount of IV fluids, that you could use the baby’s 24 hour weight as their baseline, or use a 10% cutoff to define weight loss instead of the normal 7% cutoff.
So when we’re talking about IV fluids, I want to remind you that they are a tool that may or may not be needed, but eating and drinking fluids during labor is normal or physiological. It’s not evidence based and it’s not ethical to require someone to fast during labor. And the main reason that most people are given IV fluids in labor is because they’re not allowed to eat or drink. Another common reason why they’re given IV fluids is if you have an epidural that drops your blood pressure. We talk more about these different pros and cons and how to weigh the benefits and risks in the pocket guide we released this year on interventions. We got a lot of really great comments on social media for people who read our IV fluids article or listened to the podcast. A lot of people told us that they loved learning about the different types of IV fluids and why it’s important to stay hydrated in labor.
And it’s a good reminder that IV fluids can be one good option for staying hydrated if you’re not able to do so with oral fluids. Say you’re nauseous, or it’s just too intense for you to keep drinking fluids. One of my favorite parts about writing this article is that we decided to simulate an hour of labor. So I put a timer on my phone and I pretended like I was having a contraction every five minutes, which could be like early active labor or late in the early phase. And so, you start the timer from one contraction to the next, was five minutes, and I tried taking one gulp or two sips of liquids after each fake contraction. So during this frequency of contractions, one coming every five minutes, I was able to maintain a fluid intake of about one cup or 240 milliliters per hour.
But obviously, I was not vomiting. So if I was vomiting, I would need to drink more. Another way you could make sure to stay hydrated during labor is for a support person to make sure you’re drinking one cup of liquids at the start of the hour, seeing if you can finish it by the end of the hour. Or you could have a water or fluid container that measures it in milliliters or cups. You can also watch your urine, if you’re regularly urinating and you have clear or pale yellow urine that can let you know that you’re staying hydrated. And we talk more about that in the article, which you can access at ebbirth.com/ivfluids. The fourth article that we updated this year was the Evidence on Friedman’s Curve and Failure to Progress. This article was originally published in 2013 and updated in 2017. And the article got a major update in 2022, as well as an updated two page handout.
We also created a new handout to go along with it called Debunking Pelvic Shapes. If you want to do a deep dive into the evidence on failure to progress, we did publish a podcast on it, episode 224, with myself, Erin Wilson and Ihotu Ali. You can also find a video of that podcast with all of us teaching on with PowerPoint slides on our YouTube channel. Some other related podcasts include episode 196 where we talked with Brittany Sharpe McCollum about pelvic biomechanics and movement and labor. And episode 75, where my mom comes on the podcast to talk about her birth experience with Twilight Sleep, which is what they were doing to people when they created Friedman’s Curve. So failure to progress traditionally has been diagnosed when a healthcare provider thinks that labor is not progressing as quickly as it should. This can be very subjective. Failure to progress is a vague diagnosis that can mean many different things to different healthcare providers.
Some providers have ideas of how long is too long. Other providers may be more patient, others are impatient. We’ve heard many nurses and doulas who witness many different practice styles from doctors and midwives, refer to failure to progress as sometimes being a failure to wait. For many years, what we knew about failure to progress was based on Friedman’s Curve, a historical study from the 1950s that still affects birthing people all around the world today. In 1955, Dr. Friedman of Columbia University in New York City published a study that described the average amount of time it takes to dilate per centimeter based on his observation of 500 white patients at a single hospital in New York City. The graph that he created, it was hand drawn from these people giving birth for the first time, and later in a similar study with people who were giving birth to a subsequent baby, went on to become known around the world as Friedman’s Curve.
Back then, Twilight Sleep was common practice for white birthing patients. It was usually not offered to Black women. And so basically 96% of the people in the study were sedated with drugs. 31% were deeply or excessively sedated with Demerol and scopolamine. The average length of time it took for these sedated patients, who were essentially asleep, to get from zero to four centimeters was 8.6 hours. Once they reached active labor, labor sped up, and at that point, they dilated an average of three centimeters per hour, which is very fast, until they reached nine centimeters. At nine centimeters, there was a slight slowing down before the patients reached 10. And the average length of time it took to get from four to 10 centimeters dilated was about five hours. And the average length of the pushing phase, or delivery, was one hour. These graphs still live on as the partograph, which is used around the world to track the speed of labor.
Now using today’s standards for research, Dr. Friedman’s study would be considered unethical, because of the many invasive pelvic exams performed on sedated or sleeping patients. The sedation may have also substantially sped up labor and the common use of forceps while the baby was still up in the pelvis shortened the length of the delivery. Also, none of the patients in the study had an epidural, which is known to slow down the process. It’s pretty much agreed upon by most researchers today that we should no longer apply this curve to labor because too many things have changed since 1955. Epidurals are commonplace, sedation is not used, Pitocin is used much more frequently, people giving birth today are older, intend to weigh more on average, and it’s rare to see forceps-assisted births in some countries. Current guidelines are based largely on a study from 2010 by Zhang et al. Where they looked at more than 62,000 people in labor.
And the numbers from that study have replaced the vague term of failure to progress. In the Zhang et al. Study, active labor began at six centimeters, not four centimeters like with Dr. Friedman’s study. And it was normal to have long periods without any progress in early labor. Today, the timelines are supposed to be longer and you’re supposed to have more flexibility for factors, like whether or not you have an epidural. If you go to evidencebasedbirth.com/failuretoprogress, you’ll find more info on this topic. And the free two-page handout that goes along with this article has a really nice table that shows the average length of labor for the different stages, for people who’ve given birth before and those who have not had a baby before. Now while researching this new update on failure to progress, we were reading lots of outdated racist information about pelvic shapes and the perceived impact of pelvic shapes on birth.
So Ihotu Ali, one of our research editors at Evidence Based Birth®, decided to create a brand new handout to address this directly. The research shows there are no specific categories of pelvic shapes. Pelvimetry is the study of pelvis size and shape, and this practice led to the belief that certain people cannot give birth vaginally. Digging in a little bit deeper, scientific racism is the use of flawed data to, quote, unquote, “prove” that there are distinct races and to justify unequal treatment of others. But this info has already been debunked. In 2015, a study out of Australia debunked the theory that there are different pelvic shapes, and show that there’s a nebulous cloud of variation by using CAT scan imaging. So if you go to ebbirth.com/birthjustice, you can find a link to download that handout, called Debunking Racist Myths about Pelvic Shapes. While we were publishing all this info for the public and also talking about on our podcast, we were featuring monthly trainings based on the research for our Pro members.
Some of you may have seen our free webinar on Failure to Progress or Failure to Wait. We did a private showing for our members, where they had a chance to get all of their questions answered, same with the evidence on Pitocin, but our research team also presented other topics. And I want to give a shout out to Ihotu Ali for creating two classes on the evidence on anti-racism, part one and part two, that were taught to our Pro members. And our programs team at Evidence basedBirth also had the idea to do a viewing of Bringin’ in da Spirit a documentary film. So we did that as a group together. So I would love to know what is your favorite podcast episode of 2022. Go ahead and let us know on social media or send us an email at email@example.com. I had a really hard time deciding what my favorite podcast episodes were.
I learned a lot from so many of our guests. I’m sure there is a recency bias where the ones that came out in the second half of the year are more recent in my memory and so I’m thinking about them more often. In terms of the research evidence, I loved our Protecting the Perineum series. It was really fun to debunk a lot of myths about that. I also really enjoyed talking about the top five most surprising findings from the abortion research guide, with doctoral candidate Tyler Jean Dukes. And publishing that project was a huge labor. I also love the education some of our guests did on issues related to reproductive justice, including episode 217, Disability Justice and Birth and Parenting with Stefanie Lyn Kaufman-Mthimkhulu. Episode 234, tackling Fat Phobia and Lactation with Kristin Cavuto. And episode 243, the Importance of Kit Counting for Fighting Disparities and Preventable Stillbirth, Stephaney Moody of Count the Kicks.
In terms of our most downloaded episodes of 2022, there’s lots of different ways to look at the statistics. We did surpass four million downloads this year, which was really exciting. It puts us in the top 5% of all podcasts. But to make it fair, because some podcasts have been out longer than others, so you can’t really go by the most downloaded this year. We looked at the most downloaded in the first seven days after publication. The fifth most popular podcast was 235, the Evidence on IV Fluids. The fourth most popular podcast was episode 222, Navigating Induction in Pregnancy at 35 Plus with Jennifer Anderson. The third most downloaded podcast was episode 224, Failure to Progress or Failure to Wait with the EBB Research Team. The second most popular podcast was Evidence on Birthing Positions and Tried and True Midwifery Techniques for Protecting the Perineum. And the number one most downloaded episode in the first week after publication was episode 241, the Updated Evidence on Birthing Positions.
I have to give a shout out to Jen Anderson who joined our program team this fall. She was featured in that episode 222, which was really popular. And another fun milestone. Haley Grachico joined us on the podcast a little over a year ago in episode 202 about her fast first time birth experience, after taking the EBB childbirth class. And I’m proud to let you all know that Haley Grachico has been our podcast coordinator since this fall and she’s working on a really amazing project for you all. In the beginning of 2023, we hope to release a free download that is a podcast listening guide to the Evidence Based Birth® podcast. Our research team was also busy with a brand new pocket guide that we released this year. Physical and digital copies went on sale November of 2022, for our pocket Guide to Comfort Measures, labor induction and our brand new Pocket Guide to interventions.
And they sold out really fast and we did a second printing run. This year, our research team was continuing our research on racism and maternal health. We have a brand new signature article, the Evidence on Anti-Racism and Healthcare and Birth Work coming in 2023, is getting really close to being finalized. You can go to ebbirth.com/birthjustice to see current resources and links related to reproductive justice, including the Research Resource Guide to Abortion. We also were able to feature several amazing advocates in the field of racism and maternal health and reproductive justice, including Kimberly Seal’s hours, where she talked about fighting bias in the birth room with the Irth app, that was episode 220. Episode 227, Amplifying the Need for Intersectional Birth Support for QTBIPOC Birthing People with Xian Brooks of the Dandy Doula. Episode 238 on Black Fatherhood and Fighting Anti-Black Racism with Brandon Diggs Williams, Licensed Clinical Social Worker. Episode 228, Uplifting Radicalized Birth Work with Anna, The Pocket Doula.
And we also looked at the research on doulas and the community based model and reimbursement for doula care with our EBB research team in episode 229. So we’ll have all these linked to in the show notes. You can also go to evidencebasedbirth.com/podcast and that will give you a list of all of our different episodes, from the very beginning of the EBB podcast up to today. I know that can be helpful because sometimes the podcasts start to disappear from some of the apps, once you reach more than a hundred podcast episode. And again, Haley’s working on that download for you all about the EBB podcast listening guide, which we’re really excited to unveil. There will be pathways for birth workers and for expecting parents so that they know where they can start. Because now we have so many episodes, it can be a little bit overwhelming.
So what are our plans for 2023? We have one, possibly two new signature articles in the works. The first brand new signature article is the Evidence on Anti-Racism in Healthcare and Birth Work that’s being led by Ihotu Ali. And then we have signature article updates that are going to be coming out in 2023. We’re going to be first tackling the updated evidence on Group B strep and antibiotics for Group B strep. We’re also hoping to tackle the updated evidence all about gestational diabetes, both induction for gestational diabetes and diagnosing gestational diabetes. And then another article that is slated for an update is the evidence on water birth, which is a fun topic as well. Inside our Pro membership, we’re already planning our trainings for the first half of the year. We’re going to be starting off January by having Dan, Mr. EBB, teach about profit first for birth workers who are running their own small businesses.
And Dr. Shannon Voogt is going to be coming in February to talk about action steps for when there is an emergency postpartum hemorrhage. And our spring public webinar that will be freely available to the public, we have a really exciting topic in mind. You all are going to love it, but I’m not going to share it just yet. And then in May of 2023, we will be opening applications for the EBB Instructor program. In terms of the podcast, we’re taking a break next week and then we’re going to come right back with an exciting guest on January 11th. And in the first week of February, we are hoping to release the newest evidence on Group B strep. One final reminder, before we go, that we are offering a special year in sale on the annual subscription to the Evidence Based Birth® Pro Membership.
If you join between now and December 31, you not only get a large discount on the membership, but you also receive a physical copy of our newest intervention pocket guide that retails at $50 and is sold out in the store. And this is for US based customers only. This is a fantastic way, also if you own your own birth business to get a tax deduction in before the end of the year. To learn more and join before the due date of December 31, visit ebbirth.com/membership. Finally, I just wanted to wish you all a happy New Year, happy holidays, here from the team at Evidence Based Birth®. We are so thankful that you listen to our podcasts, that you support our work through sharing word of mouth or being part of our programs or just reading our materials, we appreciate you. As is our tradition. At the end of every year, we publish a Spotify music playlist of different songs that have inspired us while we are all working for you during the past year. So you can check out the show notes to get the link to our Evidence Based Birth® music playlist for the past year. Thanks everyone, and we’ll see you in a couple weeks. Bye.
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