The Birth Mag connected with Rebecca Dekker, PhD, RN of Evidence Based Birth regarding her new book, Babies Are Not Pizzas, in which she shares her own birth experiences. We got the chance to ask her a bit about her journey in writing the book, experiences with birth before having children of her own, and thoughts about how the birth community can do better. Babies Are Not Pizzas is available now here!
After years of sharing research through Evidence Based Birth, what inspired you to write about your own story?
Rebecca Dekker: So, I’ve shared little snippets here and there. Most people know that I had a first traumatic birth where I was separated from my baby for hours, followed by an empowering birth several years later with a midwife who provided evidence based care.
But for the most part, I kept my personal experiences to myself. For example, I did not talk publicly about how my traumatic birth occurred at the academic medical center associated with my own university, where I worked as an assistant professor. I didn’t talk about how I hired an underground midwife, how I had two home births, how I was afraid to go to the hospital for an induction at “42+4” weeks because I knew some of the nurses didn’t like me or my blog, how so many women were experiencing racism and obstetric violence in my home town. The nightmarish stories from doulas and parents in my town just seemed never ending. I poured out all my frustration into the Evidence Based Birth® blog—spending all my spare time reading research, analyzing research, and writing about it for the public.
Then there came a tipping point, about 4 years into my blogging journey, when I had to decide—was I going to leave the security of a paycheck and do EBB full-time? Or was I going to continue working for an institution that had indicated they would censor me if I tried to speak up, and that was using pressure, coercion, and force to make women give birth on their backs, in stirrups?
I ended up leaving my faculty job, and it was one of the hardest decisions of my life. It was also one of the best decisions of my life.
Two years later, after leaving my job, I had begun writing a book. It was meant to be a “Guide to Childbirth,” all about evidence based care. I sent it to some of my friends and family, and also to Aza Nedhari, a black doula and midwife whom I’d hired as a consultant to help me figure out how to address racism in the birth world and maternity care.
My friends and family told me they loved the draft, but Aza gave me her honest opinion, and that was that she did not like the book as a reader!
I asked Aza asked her what she did like, and she told me she liked the parts about my story. She said she kept turning the pages, wondering what would happen to me next. She advised me to tell my story, and to weave the evidence and data around that.
I took a leap of faith, and deleted most of my book draft. Then I started over to write my story, like Aza had told me to do. That’s how Babies Are Not Pizzas came to be simultaneously both a memoir, and a book about evidence based care in childbirth.
How did it feel to open up about something so personal?
Rebecca Dekker: It was really, really hard! I am a big-time introvert. For example, I hate going out at night to meet up with people. I’d just rather hang out at home in my pajamas, watching Netflix!
I’m also really averse to people learning details about my personal life—about my children, or my medical and birth decisions, or about my marriage. I’m not one of “those bloggers” who is 100% transparent about their life. I value my privacy a great deal. It’s really important to me to keep my private life, well… private. There are only a few people in my life whom I truly confide in: my husband Dan, Cristen Pascucci, my mom, my sister Shannon, and my childhood best friend Sarah. Outside of those five people, I don’t really share much about my life with other people. It’s just how I operate!
So, when Aza told me to tell my story, my first question was, “Isn’t that being self-centered?” She told me that no, it’s not being self-centered to tell your story. That some people just have interesting lives.
Over the next few months, as I developed the next iteration of the book, which would be a memoir, I told a few people my story. Once when I was having dinner with a group of birth workers in Canada, and another time when I had dinner with a group in Hawaii. Both times I said, “Can I tell you a story, and can you let me know if you think it’s worthy of being in a book?” Both times, they were on the edge of their seats the whole time I told the story. And they said… definitely, yes. It needs to be a book. One of them in particular, a birth worker in Hawaii, told me that I had this platform for a reason—that I had a microphone. And I should use my microphone to tell my story, because it could impact so many people. These birth workers gave me the courage to move on with finishing the draft.
In addition to fears of exposing my personal life, I also had fears about being retaliated against, or punished, for speaking up about the unethical practices happening at the institution where I was formerly employed. I was terrified that the book could be used against me in a lawsuit. So, I asked my business lawyer to look it over. I actually paid him hourly to read the whole book! Not only did he love the book and find it fascinating, but he told me he didn’t see anything in there that could be a target for a lawsuit. He reminded me that the truth is an absolute defense against claims of defamation. So, after I got the green light from him, I knew it was time to finally publish.
If there was one thing, above all others, that you wish you had known before giving birth for the first time, what would that be?
Rebecca Dekker: The one thing I wish I’d known was that I absolutely should’ve had a doula with me in that particular hospital. I wish I would’ve known to push back against Dan’s fears of “a stranger being in the room”—which was his reason for being reluctant to hiring a doula. It’s a pretty common fear of partners, I hear. In retrospect, I’m sure he would have been okay with a doula if I’d explained the importance to him. But at the time, I didn’t know why having a doula was so important.
If I can go ahead and name a second thing I wish I’d known—that is, I wish I’d known to take an independent childbirth class. Our hospital-run birthing class taught us how to be compliant patients, and that was it. I had no idea that I could, and should, advocate for myself. They didn’t even teach us how to stay comfortable during labor! They said we could use an epidural, or we could use “breathing techniques,” which we practiced the really old-fashioned way, hee-ing and hoo-ing and everything. And that was it! Looking back, it was so ridiculous. There were zero other pain management strategies offered or taught!!
I know now that there’s an entire toolkit of pain management techniques that you can use during labor, ranging from continuous doula support and upright positioning, to hydrotherapy, acupressure and music. None of this was offered or taught or encouraged. They didn’t know about these options, and I don’t think they cared.
It seemed like all they wanted was for you to have an epidural, and if you didn’t want an epidural, you were going to be forced to endure a painful natural labor on your back, in bed, hooked up to monitors. Who wants to do that? So, of course I chose an epidural! I had no idea there were so many options that I could have brought with me to the hospital, or trained myself how to use!
As a nurse, what was your experience with birth before having your own children?
Rebecca Dekker: Mainly, it was what I experienced in nursing school, because after I graduated I did not want to go into labor and delivery—I went into med-surg and telemetry (cardiovascular) nursing instead.
The week before my very first nursing school experience in L&D, we were required to complete an interactive virtual experience, where we “cared for” a recorded pregnant woman in labor, using the computer screen. As our virtual patient’s labor got more intense, and she started vocalizing more—shouting and crying in pain—I found myself feeling lightheaded and weak. My vision started to go black on the edges. I felt like I was feeling her pain in my own body. I stumbled off of my computer chair, sat on the ground, and put my head between my legs.
I called my mom that night, panicking about my ability to make it through my labor and delivery rotation, and the fact that I would have to be present at a real birth. She said, “Rebecca, I know your compassion makes it hard for you. Just keep saying to yourself over and over, ‘I’m helping, not hurting. I’m helping, not hurting.’”
Using my mom’s mantra, along with some granola bars hidden in my scrub pockets that I would sneak every so often to keep my blood sugar up, I successfully watched my first birth during my junior year of college—without fainting. A twenty-two year old mom was laboring in her hospital bed, hooked up to all kinds of monitors, and not allowed out of bed. She told the nurse she didn’t want pain medication.
The laboring woman rode her way through the contractions, lying flat on her back, her boyfriend slumped in the chair next to her, clearly out of his comfort zone, hands covering his eyes and ears. In the end, my patient got the unmedicated vaginal birth that she wanted, and her boyfriend brightened up a bit after the baby was finally born. My patient asked me—her nursing student—to be in some of the pictures afterwards, holding her baby. I imagine I’m still in their family photo album and baby book!
I felt privileged to be there at the start of her baby’s life, but still not entirely comfortable with the experience.
I believe I was present at a few other births during nursing school, including a Cesarean, but I don’t remember the details. I do know that I got the privilege of making a home visit to a couple I had previously cared for in the postpartum unit. It was so much fun going to their home after they were discharged, assessing the mom and baby, and doing some health teaching. And they were so excited to have me visit. My nursing program was really unique in that we were required to do a home visit each semester. It really gave me a perspective in the “real life” situations of the clients I cared for in the hospital.
Birth trauma is mentioned multiple times in your story. What would you say to care providers hoping to lower the chance of birth trauma happening on their watch?
Rebecca Dekker: In my mind, whenever there’s a health care decision to be made, the ideal care provider would provide full and accurate information about all of the risks and benefits regarding ALL the client’s options, including the option of doing nothing. And then the care provider would step back and let the client decide. And honor that client’s decision.
Also, when you mentally keep the client at the center of care, and respect the client as being the owner of their own body, and also respect them as the decision maker for their baby (even in utero!), then everything else falls into place.
Care providers should also be trained in providing universal trauma-informed care. One-fifth of all American women have been raped, and even more have been abused or assaulted in some way. Care providers need to understand the triggers that can be present in childbirth, and work to avoid aggravating those triggers for everyone. That’s because you never know when someone is a survivor of assault, especially because many people don’t feel safe disclosing their history of abuse or assault. You’d be amazed how many nurses and doctors and midwives have no idea of how to provide trauma-informed care.
Finally, I would say that care providers need to treat their own secondary trauma. One thing that I’ve seen, is that a lot of cases of birth trauma are related to the providers pre-existing secondary trauma. Previously witnessing traumatic births can cause providers to act in ways that violate the autonomy of subsequent birthing people they care for. So, seeking counseling and therapy for secondary birth trauma and PTSD are really important for anyone working in labor and delivery.
Who do you feel will benefit most from reading “Babies Are Not Pizzas”?
Rebecca Dekker: I had such a hard time choosing who my ideal reader would be! For months, I debated who the book should be written for—should it be for people who’ve had a traumatic birth? First time parents? Midwives? Doulas? Nurses? Nursing students? Medical students? I asked a bunch of people, and none of them could help me decide.
Finally, I decided the book would benefit anyone who found birth or babies interesting. I pictured myself having coffee with someone, and telling them my story. I think any of those folks that I listed above would benefit most.
But I definitely would love to catch some people at the beginning of their career in the health field, because those are some of the most formative years of your life. If we can teach our future doctors, nurses, and midwives about true evidence based care and human rights in childbirth before they’re exposed to lesser quality care, that will make all the difference in the world.