EBB 341 – 2024 Year-in-Review and Sneak Peek of 2025!

Dr. Rebecca Dekker – 00:00:00:

Hi everyone, on today’s podcast, we’re going to do a review of all the research we published at Evidence Based Birth® in 2024 and give you a sneak peek of what’s in store for 2025. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Decker, 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 https://ebbirth.com slash disclaimer for more details. Hi everyone, and happy new year. My name is Dr. Rebecca Decker, pronouns she/her, and I’ll be your co-host for today’s episode. Today I have two co-hosts with me. We have Morgan Richardson Cayama and Sara Ailshire, who are both research fellows at Evidence Based Birth®. Today, we are so excited to talk with you about the research that we published in 2024. We’ll give you an overview of some of the most important research findings that we found as we were diving into the research. And we’ll also talk about what’s in store for you at Evidence Based Birth® in this new year of 2025. So you’ll have some sneak peeks of some projects that are coming out, as well as some research and ways you can get involved. So Morgan and Sara, welcome back as co-hosts.

Morgan Richardson Cayama – 00:01:25:

Yeah, it’s great to be back.

Sara Ailshire – 00:01:26:

Yeah, happy to be back again.

Dr. Rebecca Dekker – 00:01:28:

Awesome. Okay, so what we’re going to do, if it’s okay with you all and with our listeners, is we’re going to talk about the three Signature Article updates, as well as one of them was a new Signature Article, actually. And then we’ll go into some of the other research we published at Evidence Based Birth® before we move on to what’s new for 2025. Does that sound good to you all?

Morgan Richardson Cayama – 00:01:48:

Sounds great.

Dr. Rebecca Dekker – 00:01:49:

Let’s get started. So I will start first with the evidence on water birth. So this article was originally published a little more than 10 years ago. In 2014. And we most recently updated it on Valentine’s Day, February 14, 2024. So we updated the Signature Article. We updated the handout. We came out with a podcast episode, number 300, which I think water birth was just a fun, you know, topic to have for that nice round number of Evidence Based Birth® 300. And just as a reminder for you all, with water immersion in labor, that’s when you get into a tub or pool of warm water during the first stage of labor. And that’s when you get into a tub or pool of warm water during the first stage of labor. And that’s not really that controversial. Most people are accepting of that as an intervention for pain management and for coping with labor. But what’s a little bit more controversial is water birth. That’s when you remain in the water during the pushing phase and the actual birth of the baby. And then the baby is brought to the surface of the water after birth. With a water birth, the third stage of labor when the placenta is born may take place in or out of the water. So when we updated the Signature Article in 2024, there were three major studies that we included in this update. So I just want to kind of give you a review really quickly of what the new research was that we added to the water birth article. First of all, we added a new systematic review published by Burns et al.. In 2022. 2022. This is the largest, highest quality, and most important review on water birth that’s ever been published. They included 36 studies on water, using water to cope during labor, and 25 of those 36 studies were focusing on water birth, not just getting in the tub in the first stage, but actually having the baby in the water. And they were looking at both hospital and home births and freestanding birth center births from the year 2000 all the way up to the year 2000. 2021. It had more than 157,000 participants in this study. And the researchers found that either laboring and or giving birth in the water was associated with quite a few positive health results compared to not getting in the water. These health results included less use of Pitocin to speed up labor, less use of injectable opioids for pain management, less use of epidurals. Less use of drugs. Lower pain levels. Lower rates of episiotomy. Lower rates of postpartum hemorrhage. Lower rates of maternal infection. And higher rates of maternal satisfaction.

They also found higher rates of an intact perineum. That means giving birth without a severe tear or without a tear that requires stitches. However, this was only seen in hospital obstetric settings. In midwifery settings, they found no differences in rates of intact perineum between water immersion and no water immersion. That’s possibly because midwives in general tend to have much higher rates of your perineum being intact after the birth. Whereas OBs tend to have higher rates of severe tears for a variety of reasons, sometimes including the fact that they have higher risk populations. But this was, you know, the first big review to really look at. Such a large number of participants giving birth in water, and they found a lot of positive outcomes from water birth. They found no differences between the water group versus the standard care group with rates of artificial breaking of the waters, AROM or amniotomy. They found no differences in Cesarean rates, although the Cesarean rates were really low overall, only about 3.6% on average. No differences in rates of shoulder dystocia, severe perineal tears, needing manual removal of the placenta, having low five-minute Apgar scores for the baby. There were no differences as well in the babies needing resuscitation, having temporary breathing problems or respiratory distress. There were no differences in newborn death or breastfeeding initiation. There was only one negative result in the APGAR score for the baby. The baby was not able to breathe. There was no negative association they found with water birth. And that was a higher risk of something called cord avulsion, also known as snapping of the umbilical cord after birth, which I’ll talk just a little bit more about that in a minute. So that was the largest, most highest quality review ever published on water birth. We also, in this update, were able to talk about the largest single study ever published on water birth. In this study, they had 17,530 water births. In 17,530, they had 17,530 water births. In 17,530, they had 17,530 matched land births, all taking place in freestanding birth centers. This study was published by Bovbjerg et al.. In 2021. So one of the problems in the past with observational studies where there’s not a randomized trial is that unlike a randomized trial, in a randomized trial, people are randomly assigned to groups. You kind of have two equal or equivalent groups at baseline. In observational studies, you can’t guarantee that the two groups are similar in the same time. So you can’t guarantee that the two groups are similar in the same time.

For example, it’s expected that people with complications will be asked to get out of the tub or they won’t be allowed to have a water birth by the provider, or they might not be offered to get in the tub by the provider if they’re having complications. As a result, you tend to see better outcomes in the water birth group compared to the group that gives birth on dry land, partly because the people who do complete their birth experience, water, had smoother, less complicated childbirth experiences. So in this study by Bovbjerg et al.., they really wanted to kind of deal with this problem. And so how they did it is they matched participants in each group, the water birth group and the land birth group. They used a process called propensity scoring, which is an evidence-based way of making sure the two groups are as similar as possible at baseline. The only difference hopefully being that one group was extremely similar to the other. So they matched participants in each group, the water birth group, and the other was not. They were looking back in time at medical records, but the births that they examined came from a data set where everything was like followed forward in time, meaning they started collecting the data at each birth and collected all the way through. This means that they can’t handpick who ends up in the study because they’re following everybody who had a water birth. And this helps protect against a kind of bias known in research as selection bias. To help further protect against selection bias, they also excluded anyone who transferred to the hospital during labor. And this decision was made because when people transfer to the hospital when they’re planning a freestanding birth center birth, they typically have medical reasons or the labor is going longer or it’s more exhausting.

And so that would have tilted the results in favor of the water births at home. If they had included people who had transferred during labor, this would have tilted the results in favor of the water births at home. If they had included people who had transferred during labor, this would have tilted the results in favor of water births in the freestanding birth centers. Because they were having less complicated births. So this process of matching the two groups did work really well. Both the water birth group and the lamb birth groups were quite similar at baseline. Most of them, 73 to 74%, had given birth before, so this was not their first baby. And most of the people in this study came from high-resourced groups. Most of them were married or partnered, about half of them had a college degree or higher, and most of them had private insurance. Just like the systematic review I told you about earlier, this study also found a lot of positive outcomes associated with water birth. There were lower rates of postpartum hemorrhage, fewer postpartum transfers to the hospital, fewer postpartum hospitalizations for birthing people, a lower rate of severe perineal tears, fewer newborn transfers to the hospital, fewer cases of newborn respiratory distress, and fewer newborn hospitalizations. There was also a lower rate of newborn hospitalizations. There was also a lower rate of newborn hospitalizations. There was also a lower rate of newborn death in the water birth group. There were 0.28 deaths per 1,000 deliveries in the water birth group compared to 0.51 deaths per 1,000 deliveries in the land birth group. The only negative effects seen with water birth were higher rates of umbilical cord avulsion or tearing, sometimes called the cord snapping. That was 0.57% in the water birth group and 0.37% in the land birth group. And there were also higher rates of umbilical cord avulsion or tearing, sometimes called the cord snapping. That was 0.31% in the water birth group and 0.25% in the land birth group. But neither of these resulted in higher hospitalization rates for birthing people or babies, and none of the cases of umbilical cord snapping resulted in death or serious injury.

They also found no differences between the water birth and the land birth groups in the rate of NICU admissions in the first six weeks or in rates of postpartum uterine infections of newborn infection. The last new study I want to talk about was published in 2020 by Vanderlaan and Hall, and this was a review or systematic review of all of the case reports that have ever been published in English about poor newborn outcomes after water birth or after water immersion during labor. And the purpose of this review was to highlight patterns that can be addressed to make water birth safer. It was really nice to see that this article had come out because previously we had tried to personally summarize all of the case reports that had ever been published on this topic. So it’s nice now to be able to point to a systematic review where they’ve done all that hard work of digging through the literature to find these case reports. So they identified 35 published articles with a total of 48 reports of poor newborn outcomes. There were 43 events after a water birth, 11 of which were minor conditions that resolved quickly. Only 14 of these case reports were published in the previous 10 years. And so most of these cases were not reflecting current best practices for water birth. The authors kind of summarized their findings based on five patterns that they found. The first pattern was the importance of preventing exposure to waterborne pathogens, such as Legionella and Pseudomonas bacteria. These are specific bacteria that are waterborne and could be dangerous. And they don’t typically cause infection after land births, but there have been 12 cases of infection reported in the past after water births. And so this really underscores. The importance of water birth providers, ensuring a clean water supply and using strict cleaning protocols. The second pattern that they found is that water aspiration or accidental breathing in of water is not as common as the opponents of water birth claims.

This is often used by obstetricians or pediatricians as a way to prevent people from having water birth as an option. They’ll say, the baby will breathe in the water at the birth. And they found only a single confirmed case of water aspiration has ever been published in the research. There were 11 case reports that described what the researchers thought was water aspiration, but seven of these cases ended up being misdiagnoses and should have been labeled as temporary breathing difficulties in the newborn, which is common in all types of birth, including land births. So this is something called transient tachypnea of the newborn or TTN. It’s defined as a temporary delay in the clearing out of birth fluids from the lungs. And this occurs at about six out of every 1,000 babies born on land at term. So because this can happen in any newborn, it makes sense that it would sometimes be seen after a land birth. And out of the 48 case reports on water birth in general, only that one single confirmed case was ever reported of true water aspiration. And in this case, the newborn was dropped in the tub after the birth and remained in the tub for an unreported amount of time. So clearly not a safe situation. The third pattern that they found was that cord avulsion, which I mentioned several times already, or snapping or tearing of the umbilical cord, is a potential risk at any delivery. However, research shows it does occur more frequently in water birth than a land birth, possibly because people are pulling the baby too quickly out of the tub to get them to the birthing person’s chest. And possibly because in some of these cases there was a short umbilical cord. Because of these case reports that were published around the year 2000, protocols were developed and implemented around the world by water birth providers to prevent cord avulsion, and to identify it quickly if it happens, the treatment is clamping and cutting the umbilical cord, and then monitoring the baby.

The fourth pattern that they talked about was the importance of following water birth protocols. There were eight case reports that suggest the provider was not trained in safe water birth practices. Some examples of unsafe water birth practices included permitting a water birth, even though there were signs of complications such as thick meconium in the amniotic fluid, or the birthing person having a fever. Some other unsafe practices are using hot tubs or home bathtubs with jets, because this increases the risk of bacterial growth with water. And then another example would be keeping the tub filled with water for days or weeks, which can allow the growth of bacteria. And then the final pattern was that they found several case reports of newborn low blood sodium levels, and they proposed that it’s possible that if you stay in the tub too long, and you’re drinking a lot of water, This could increase the risk of the birthing person having low sodium levels in their blood, which could then affect the baby. And they said that this is an area that needs more research. So overall, what has changed since the last time we updated the Signature Article? Well, the research on water birth continues to grow, and we have consistent findings that water birth has maternal benefits. And the fact that there seems to be protection of the perineum with water birth is a relatively newer finding. Also, researchers are starting to see potential newborn benefits of newborns doing better after water births than in comparable groups that are giving birth in land. However, the main increased risk is cord avulsion or snapping, which can be prevented in most cases by following current prevention guidelines. However, despite all of this, the American Academy of Pediatrics is still discouraging water birth, and this has had a negative impact on the availability of water birth around the world. So if you want to learn more, again, I highly recommend our full podcast episode, EBB 300. You can also go to https://ebbirth.com slash water birth to get the free one-page handout on the evidence on water birth. And then we also had Dr. Elizabeth Nutter come on the podcast on episode 318 and talk about the difficulty of getting water birth in hospitals and what we can do to advocate for more families to have access to this option.

Sara Ailshire – 00:17:29:

Rebecca, was there anything that you learned while updating the article that surprised you or anything that you weren’t expecting to see as you’re going through all the new research?

Dr. Rebecca Dekker – 00:17:39:

Yeah, that’s a good question, Sara. I think in the past, some of the systematic reviews had conflicting findings about protecting the perineum. The previous time we updated the article, there was some research suggesting that there were maybe higher rates of minor tearing with water birth. But that seems to have been cleared up now that we have larger, higher quality studies. We’re kind of seeing the opposite. We’re definitely seeing a trend towards better outcomes in terms of lowering both the risk of episiotomy and tearing in some settings with water birth, which I think is really interesting.

Sara Ailshire – 00:18:15:

Yeah, absolutely.

Dr. Rebecca Dekker – 00:18:16:

So Sara, that brings us to you. What was your major project this year that you worked on and what do you want to tell us about it?

Sara Ailshire – 00:18:23:

Sure. So the Signature Article that I worked on updating this year was the doula article. I was originally published in 2013, and we were able to publish an update. On April 17th of 2024. I was one of the authors, as well as Rebecca and Ihotu Ali. In addition to the authors, we benefited tremendously from the guidance from our expert reviewers, and those people were Rhonda Fellows, Heather Christine Struwe, and Cristen Pascucci. So we updated the Signature Article and we also generated a new handout. We also had a number of podcasts about doulas in the last year. The updated podcast to go along with our updated Signature Article was EBB 309. And then in 2024, we had about four podcasts that focused specifically on the work of doulas from everywhere from culturally sensitive doula training in India, EBB 307, to the importance of bilingual doula care, EBB 328, and a few others as well. So in the article, we got to delve into what doulas are and all the different types of doulas that are out there. The doulas that we’re most familiar with probably in birth world would be the companions who support you during pregnancy, labor, and birth, who are trained to provide continuous one-on-one physical support, emotional support, and care during labor, birth, and sometimes after birth as well. They can provide information and support to families before or during birth and into the postpartum period. But as we get into in the article, there’s a lot of different types of doulas, a lot of different types of trainings, certifications, traditional practices, and perspectives on doula care. And it was really fun to kind of explore all the different types of doulas that are out there doing incredible work. Some things that we added to the article in this update was an investigation of the history of the term doula and a brief history of birthways, birth practices in the United States. And that was really interesting for me.

I’m a trained anthropologist. And the term doula that we use today actually derives from an anthropologist’s research in birth practices in Greece. And that word has since traveled far beyond her dissertation and her later book into common usage. We also talked a little bit about how people become doulas, how prospective doulas can identify the best trainings for their values or approaches to this work. And we also developed a short guide for families to help them with the process of choosing a doula, help them think through what is going to be important to them and what questions they might ask a prospective doula. In order to ensure the best fit. In our article, we also were able to update with some of the research on how doulas can benefit birthing people of color as well as LGBTQ2SI families. And something that I was really proud of being able to do personally with this update was to acknowledge the incredible work of doulas around the world, as well as the unique challenges that they face. And this is something that I think the research is still going to be catching up on. What are the different things that doulas do? What are the different things that doulas encounter, depending on where they’re working? But it was really, really cool to be able to do some of that. And there’s just a ton of new evidence. And I just pulled a few of the things that, you know, I was really excited about and that, you know, were big parts of our update on the research on doulas. So there’s a 2022 systemic review by Wynn and Helan Fancher. And they looked at. Nine studies of over 7,000 participants to, oh sorry, nearly 7,000 participants to explore the benefits of having a female relative serve as a lay doula. And they found that birthing people consistently reported positive birth experiences when they were served by these lay doulas. However, the lay doula’s impact on the rates of Cesarean and length of labor was inconsistent.

Some of the studies showed that there was a positive impact, while others found no difference. So this review concluded that the positive benefits of continuous labor support are most beneficial when provided by a formally trained doula who is not part of hospital staff, but that there can be some benefits in just having continuous labor support, even from somebody who is necessarily, you know, a doula in the sense of the word. So doulas provide a real added benefit. But the importance of… Support, care, you know, proves to be true across the board, right? Something else that we looked at was how important continuous labor support for medulla or other labor support professional can be, particularly for birthing people of color. In a 2022 analysis of the Listening to Mothers in California survey by Malik, Toma, and Shenassa, they looked at responses from nearly 2,000 self-identified women of color, as well as women who received Medi-Cal insurance or public insurance. And they all, they reported that having a doula present with them during birth was… More likely to result in them also reporting that they experienced respectful care during labor and birth compared to those who did not have a doula with them. Having a doula who’s present, who can relate to the experiences of a birthing person, who might speak their language, have a shared cultural or ethnic background, who comes from same communities is vitally important. And the research, and there’s much more in just this one study, really demonstrates that to be the case. So something that I think a lot of people know just through practice, through experience, research is sort of proving out. Another thing that we were able to add to this update was a focus on how doulas can support LGBTQ2SI birthing families. All health care providers and birth workers, including doulas, can and should educate themselves about how to best meet the needs of LGBTQ2SI, queer and gender diverse families during pregnancy and childbirth. And we’re able to highlight some of the organizations that provide specific trainings.

We’re also able to, you know, for our doula practitioners out there, identify what some of the research says about how to best provide the support, what it can look like, giving some real examples. Examples, because I think a lot of time people say, oh, you should just support. But what does that mean? One of the great things about the research in this area is that there’s some concrete ideas out there. So that was a really nice thing that we were able to do. These studies are small. Compared to some of our larger studies that we’re able to cite because LGBTQ2SI plus families, they’re not well represented in the research, but there’s still a lot of research out there and there’s a lot of researchers who are working to change that. So it’s cool to be able to include some of that new work. This update also included a review of professional recommendations from organizations like the American College of Obstetricians and Gynecologists in the U.S.., the American College of Nurse Midwives in the U.S.., the National Institute for Health Excellence in the U.K., and the The Royal Australian and New Zealand College of Obstetricians and Gynaecologists in Australia and New Zealand. All of these professional organizations recommended that birthing people have birth companions of their choice and ACOG the American College of Obstetricians and Gynecologists, the College of Nurse Midwives in the U.S.., as well as the National Institute for Health and Care Excellence in the U.K., specifically recognized doulas as… Particularly providing a benefit to birthing people. So it’s really interesting to see that the value of doulas is widely recognized. It’s recognized in professional organizations that guide how doctors and midwives and other health professionals practice. And it was just nice to see that the benefits of doulas bring are being recognized by these professional bodies.

Dr. Rebecca Dekker – 00:26:32:

Lots to cover.

Sara Ailshire – 00:26:34:

Lots. A big update, but it was really fun to work on. It was really interesting. I enjoyed, you know, getting into the research and yeah. It was a good time updating the doula article.

Dr. Rebecca Dekker – 00:26:44:

And that was a big update too. It was not easy. We wrestled with it because there was so much new research, but also so many more aspects and perspectives that we wanted to include, such as the terminology of doula, like where that comes from, why some people may find it problematic. The whole section that you and Ihotu helped add about global issues faced by doulas and barriers to having doulas with you in the hospital. Yeah, if you’re listening and you’re a doula, we want to give you a shout out. Thank you for everything that you do. And I think in the United States, I feel like that was like 10 years ago, right? When EBB was just kind of a fledgling organization. I used to ask high schoolers and college students, do you know what a doula is? And most of them had no idea. Or if they did, they were confused with it in a midwife. And now when I ask students and young people, they almost all know what a doula is. And that may have to do with social media and some other aspects. But I think in general, it’s interesting to see how about over a 10-year span, you can go from people not knowing what this profession is to everybody knowing what it is, which is really cool. Yeah. So thank you, Sara, for that update.

Morgan Richardson Cayama – 00:27:54:

Yeah, thanks so much, Sara. I love that that article, too, is a way that I can still kind of pass on information to my own friends and family who… Because I recently trained as a doula. I haven’t really been practicing as much since I am. In a PhD program and kind of stretched in for time, but. I still have friends and family that always ask me, like, what even is a doula? I had a cousin recently who was pregnant. So that was like a great article that I could give to her and share with her. To learn more about it. So that was a great piece of work. And so something else, a big thing we’ve taken on this year is talking more about The ARRIVE trial and elective inductions at 39 weeks. And this is a project that I worked on along with Rebecca, too. And we’ve put a lot of time and effort into it this year. And so we had originally released a podcast episode, podcast episode number 10, actually, in an original two-page handout on The ARRIVE trial way back in February of 2018, which was not long after The ARRIVE trial results came out. And it was sort of fresh on everyone’s minds. And so since it had been a few years, we decided it was time to dive back into that research, look and see what’s been published since then about elective inductions and compile all of that this year. So we did that and we presented a webinar on The ARRIVE trial for Pro Members back in April of this year. And then a few weeks later, we also did a public Q&A on that topic where we had compiled some of the questions from the community and a lot of just the recurring questions that we hear from birthing people and birth workers about. What even The ARRIVE trial is, and the impact of elective inductions at 39 weeks. We then dug even deeper into the research and compiled all of that to write our first full-length Signature Article on The ARRIVE trial and elective inductions at 39 weeks. And that was published recently in just this past October. And along with that, we updated our two-page handout. And we also have a Spanish translation coming soon. So stay tuned for that as well. And of course, with that, we also presented the evidence in a podcast episode. That was episode number 334, Evidence on The ARRIVE trial and elective inductions at 39 weeks.

And so I’ve kind of been talking about this, The ARRIVE trial, elective inductions, but what even is The ARRIVE trial and what has been its impact on birth and why is it even important to talk about? So just briefly, again, we dive a lot deeper into the Signature Article, but The ARRIVE trial is an acronym. It stands for a randomized trial of induction versus expectant management. And it was a study that was done to compare elective inductions at 39 weeks of pregnancy to expectant management. And when we say expectant management, we’re really talking about a wait and watch approach where you wait to see if labor will begin on its own, sometimes referred to as spontaneous labor. However, some folks in that expectant management group do go on to end up needing inductions, either for medical reasons or they approach, you know, a term, 42 weeks, and they end up with an induction as well. However, the purpose of that study was to see if elective inductions at 39 weeks could lead to improved health outcomes for babies. That was sort of the big thing they were looking at. But they also wanted to look at its impact on health for birthing people and also Cesarean rates. And so one important thing about this study that I’ll kind of reiterate a few times is that the study only included people who were giving birth for the first time to a single healthy head down baby. And so what did the researchers find? Well, they actually found no differences or no impact on death or serious complications for babies. So again, that big thing that they were looking at. However, they did see a difference in Cesarean rates between the two groups. So those who were electively induced at 39 weeks had a lower risk of Cesarean birth. It was 18.6% compared to 22.2% among those who received expected management. So that’s about a 3.6% difference in that absolute risk of Cesarean between those two groups. And then they also found a lower risk of pregnancy-related high blood pressure in the induction group. Even though there wasn’t a huge difference in those Cesarean rates, again, it was a 3.6% absolute difference. And you can do a math formula, and that ends up being about a 16% difference in the relative risk of Cesarean.

The ARRIVE trial has still really impacted practice, especially here in the U.S. And elective inductions at 39 weeks have kind of been touted as… This great way to reduce Cesarean risk. And even after The ARRIVE trial results were published, The American College of Obstetricians and Gynecologists, or ACOG, that we mentioned earlier, used findings from that ARRIVE trial to develop a recommendation around elective induction at 39 weeks, where they said, you know, it’s reasonable to offer an induction to, again, low-risk, first-time birthing people. They also, though, as part of that recommendation, encourage providers to take into account the values and preferences of the birthing person, whether an elective induction was something that they wanted for themselves. Also, you know, to consider. The staffing and the resources available at the place where the birth would take place, because inductions usually do require. More staff, more resources to accommodate sort of a longer labor than we see with inductions. And the other impact is that we’ve seen increases in rates of 39-week elective inductions, especially here in the U.S.. Since this study was published. And we’ve also heard from birthing people and birth workers that Findings from The ARRIVE trial have been used to you know, pressure and coerce people into having elective inductions at 39 weeks, which of course any pressure or coercion. During pregnancy and birth is, of course, a violation of patient rights and also respectful care. And we talk a little bit more about that in the Signature Article as well. And we really covered a lot in the Signature Article. It’s quite a long article. We go in depth. We cover everything from, you know, what is elective induction, different types of methods of induction. We present a lot more background information about The ARRIVE trial, how it was conducted in the protocols. And then we also talk about some of the key limitations and challenges with this study that are really important to keep in mind that gives a little bit of context about the study. We talk about how findings from that ARRIVE trial compare with other more recent studies on the health impacts of elective inductions at 39 weeks. We talk about benefits and risks of elective inductions at 39 weeks, alternative ways to lower that risk of Cesarean other than an induction.

We’re actually working on a podcast episode, a coming episode, for that as well. We took a big in-depth look at alternative ways to lower the risk of Cesarean other than induction, and that will be coming out in two weeks on January 15th. So look out for that. And we talked about the ways that elective inductions, again, impact respectful maternity care as well as patient autonomy, which I just talked a little bit about briefly. We look more at professional guidelines, not only in the U.S.. As well as Canada and the UK and what professional organizations say about elective inductions at 39 weeks. And we cover even more common, frequently asked questions that we hear a lot around elective inductions at 39 weeks. And so, again, just to kind of summarize. What does more recent research tell us about that impact of elective inductions at 39 weeks? Only one study that we ended up finding or reviewed found a reduced risk of death or serious complications for babies who were electively induced at 39 weeks. Compared to expectant management. So again, The ARRIVE trial didn’t find any difference. And out of the studies that we reviewed, only one did find a lower risk. The other studies we found either showed no changes between the two groups, elective induction or expectant management, or they actually saw an increase in the risk of shoulder dystocia for babies who were born in the induction group. The ARRIVE trial and most other studies that we found that looked at the risk of pregnancy-related high blood pressure did find lower rates of this among those who were electively induced at 39 weeks. And that makes some sense because we know that risk of pregnancy-related high blood pressure does increase the longer a pregnancy continues. But when we looked at the impact on Cesarean rates, that was also still really unclear.

So a few studies using medical records in individual hospitals found no decreases in Cesarean births after The ARRIVE trial came out. However, three very large studies that used data from U.S.. Birth certificates. Found slight decreases in rates. And we talk a little bit more in the Signature Article about some of the challenges with U.S.. Birth certificate data. But still, it was kind of a mixed bag. Half the studies found no impact, and the other half found slight decreases. So again, as an important note, And not to sound like a broken record, but nearly all of this research has been limited to healthy people giving birth for the first time. With a single healthy head down baby. This research generally does not apply to those who have pregnancy or obstetric complications. Or who have given birth before. And I say this because at least one study we reviewed found that rates of elective inductions were still increasing among those who had given birth before. Some people who have given birth before also still say that they’re receiving some pressure. To have an elective induction at 39 weeks, again, even though the research has not really been done with this population. And so ultimately, we concluded after looking at all these different studies and all of this research, that although elective inductions at 39 weeks have become increasingly common, especially here in the U.S.. Because of that ARRIVE trial, there still isn’t strong evidence that it lowers Cesarean rates or improves newborn health. However, it does probably lower that risk of developing pregnancy-related high blood pressure. So that is something to keep in mind. And yeah, that was a big lift for us. And it feels good to get it out there to the public because I know this is a very popular and also controversial topic in the birth world. So that was exciting.

Dr. Rebecca Dekker – 00:37:10:

Yeah. Thank you, Morgan. And also the handout, people have found that so helpful. So if you haven’t gotten that handout yet, go to https://ebbirth.com slash arrive. And there’s a free two-page handout all about The ARRIVE trial and some of the research on the benefits and risks of elective induction, which I still see. I think it has a daily impact, hourly. By the minute, people are being told to have elective inductions at 39 weeks. I just had somebody else tell me yesterday that they were recommended that. So it is becoming one of the biggest issues, especially for doulas and childbirth educators, but also for midwives who maybe they’re collaborating with obstetricians and the obstetricians are pressuring them into pressuring their clients to do elective inductions. And then you have the nurses who are seeing the impact of this increased number of inductions that they’re having to care for. Which are longer, more time-consuming, require more interventions. And then in 2024, we also had a shortage of IV fluids after Hurricane Helene destroyed the facility in North Carolina. And so all of a sudden, we had people being told they couldn’t have their elective induction. After they were told, you really need to have this. It’s important for your baby’s health. And then all of a sudden, well, nevermind. We don’t have enough IV fluids. We’re rationing them. So it’s not that important. So it’s just been an interesting year. Lots of interesting developments.

Morgan Richardson Cayama – 00:38:32:

Yeah, it’s very confusing, I think, for birthing people too.

Dr. Rebecca Dekker – 00:38:36:

And we have good questions in the Signature Article that you can ask your provider. Suggestions for how you can talk with your provider about this subject. So big thanks, Morgan, for your big first Signature Article project at EBB. Thanks. On top of these Signature Article updates and the new Signature Article on the ARRIVE study, we’ve been updating some of our research-based resources at EBB. Do you all want to talk about that?

Morgan Richardson Cayama – 00:39:01:

So one of the first things I did when I came on as a research fellow was to help update our pain management series with three updated YouTube videos and podcast episodes. So there was one on injectable opioids, and that was podcast episode number 312. We did one on epidurals for pain management during labor, and that was episode 317. And then last but not least, the impact of epidurals on the pushing phase of labor, and that was episode 320. And it’s really exciting because these epidural episodes have been some of the most popular podcast episodes this year. So it was great to be a part of that.

Sara Ailshire – 00:39:32:

This year, we also had a couple webinars that were available to the general public on the latest research on different topics. And I think, Morgan, you and Dr. Decker led the one in the spring focused on The ARRIVE trial that came out in advance of the Signature Article, right?

Dr. Rebecca Dekker – 00:39:49:

Mm-hmm. Yep.

Sara Ailshire – 00:39:50:

And then in October, Rebecca and I, we co-led the fall webinar, which was all about the evidence on cervical exams in pregnancy. So it was super interesting. We got to… Talk about, you know, different strategies that researchers are coming up with to find ways to practice giving cervical exams without always needing to practice on a person. You know, uses of Tupperware and tennis balls, but really important, particularly because it. Takes some of the pressure off of real people having to have cervical exams and demonstrates what you could do in even like a resource-limited setting to train providers on an important skill. Something else that we updated this year was a new handout, and this is for our professional members. This is all about Rh incompatibility, which is a topic that comes up quite a bit here at EBB. Rh incompatibility is a common issue, but there’s a really long way to go that we’ve found when it comes to educating not only birthing people, but birth workers as well, as to what it is, what it means, what causes it, and how it can be prevented. So our handout builds on what we covered during our conference this year, where we gave a presentation on this topic. And we also discussed some of the findings that we talk about in our handout in our podcast episode, EBB 329, which is all about blood types, Rh incompatibility, and the RhoGAM shot.

Dr. Rebecca Dekker – 00:41:18:

So glad that we recorded that podcast episode because it’s one of those questions we get emailed to us daily about Rh incompatibility and the RhoGAM shot or the anti-D shot. So that was a really fun project to work on. Also this year, Sara kind of alluded to our conference, but we hosted Signature Article’s first virtual conference in March of 2024. We had 12 sessions over two days and an additional two bonus Q&A sessions after the conference ended. And we had 14 panelists representing just a wide array of expertise in pregnancy and birth. I mean, more than 600 attendees and most of them attended live. So it was a really incredible experience. We also updated the Evidence Based Birth® Pocket Guides for 2024. That was a huge project. And in addition to updating the Pocket Guide to Interventions, Comfort Measures, and Labor Induction, we published a brand new Pocket Guide, All About. All About Reborn Procedures. And each one is my favorite when they’re born, each Pocket Guide. And this one, of course, was my favorite, again, when it was born. The physical Pocket Guides are all sold out currently, but you can still get the digital ones at https://ebbirth.com slash shop. If you do want a physical copy, they’re laminated and on a key ring. Make sure you’re subscribed to our email newsletter because we do plan to restock in February. Also, in terms of projects we completed at EBB, we had three team members have babies this year. Sara, you were among them.

Sara Ailshire – 00:42:53:

I was.

Dr. Rebecca Dekker – 00:42:54:

Yeah, it was hard to believe, but also just really an amazing and the best little baby boom at Evidence Based Birth® ever. Now we have all these new cute babies around. In addition to the other children who wander in and out of our meetings, we have little newborns too. So what is coming in 2025? Well, there have been a lot of exciting things happening behind the scenes at Evidence Based Birth®. And so now I’m excited to give you a sneak peek at what you can expect this year in 2025. So the first announcement that I want to make is we will be hosting another virtual conference in 2025. So stay tuned for details. Over the next two weeks, we’re going to be releasing a lot of information. Ticket sales will be opening in the next few weeks, and you can get on the waitlist now at https://ebbirth.com slash waitlist. So if you’re on the waitlist for early access to get conference tickets, you will get access to the lowest ticket prices and the best bonuses, as well as early access to a VIP ticket option that we’ve been having a lot of fun planning. And I’m pretty sure those will sell out really quickly. So only way to get one of those will probably be on the waitlist. We are also going to be updating some of our Signature Articles here at Evidence Space Birth. The first Signature Article that will probably be published in 2025 is the updated evidence on vitamin K, including info about the infamous black box warning that we get emailed literally every day about. So we’re going to cover that in this year’s update. And then we are also going to update the Signature Article on gestational diabetes, diabetes, particularly evidence on the glucola drink. Some of the new alternatives that we’ve seen become popular in the last few years. There’s a lot more like, quote unquote, natural options for the testing. And then we also want to update the evidence on fetal monitoring. So those are the three Signature Articles we’ve targeted for updates this year. And there may be others, but those are the three we’re planning on right now. We’re also going to update some of our natural induction podcasts.

Those are some of our most popular episodes on the podcast. And I want to look through and see which ones have some new research and add to that collection or update that collection of natural induction podcasts and YouTube videos. Also do a few more of our pain management podcasts. As we were updating the Pocket Guide to Comfort Measures, we saw some of that new research has come out. For our Pro Members, we have a lot of exciting trainings planned this year that Chanté will be dripping out to you all over the course of the next few months and letting you know as they’re coming out. We also have a brand new handout for our Pro Members all about the flu vaccine and pregnancy that will be available soon. That’s another question that we get emailed or messaged to us almost daily. And we’re also going to poll you. So those are some of the projects we’re planning on. But we want to know. So what you want from Evidence Based Birth® in 2025. So a survey is going to be coming out soon to everyone who receives our email newsletter. Again, if you’re not subscribed yet, go to https://ebbirth.com and sign up right there on the homepage. This is your chance to kind of put your topic in the hat for something we might study or publish about in 2025. We also have an incredible podcast lineup over the next few months with some iconic birth workers. And amazing topics we’ve already recorded. We’re recording this in December. We’ve already recorded almost through April because we like to get way ahead. And so it’s so hard to sit on these episodes and I see them on the calendar and I’m like, oh, they just have to wait a few more months. But there’s some really good ones. So three of the episodes I’m really pumped about. Morgan and I just recorded the top 10 evidence-based strategies for lowering your risk of Cesarean.

I also recorded, I recorded a really cool episode with a The New York Times journalist and that we’re calling this episode uncovering the facts about cord blood banking and Sara and I are going to be shortly in the next few weeks recording the vitamin K update for the podcast. And we have a special guest teacher who’s going to be teaching calming breathing techniques for pregnancy, but they’re also helpful for birth workers. And that’s a really practical episode. I’m really excited because we literally like do breathing together. So this is a really cool episode. There’s a lot of fun episodes coming out over the next few months. Another program that is coming in 2025 that we have just finished enrolling the pilot group for is a special new program called the Evidence Based Birth® doula trainer rewards program. So if you’re at the top of the doula field and you’re already engaged in training new doulas, we have been developing a program with these doula trainers and their trainees in mind. So this is an application. Only process and doula trainers who are accepted into the program receive special rewards and perks at EBB, including the ability to give special custom coupon codes to their doula trainees so that their trainees who are becoming brand new doulas can have immediate affordable access to the Evidence Based Birth® Pro Membership for their first year as a doula inside the Pro Membership.

They’ll be able to get all of our continuing education courses and certificates. Our comprehensive library of PDFs to use with clients, a supportive community where they can attend doula mentorship meetings and live trainings. And one of the courses in our course library is all about how to set up your birth business. I’m excited to announce that we have already enrolled and welcomed five doula trainers into the EBB doula trainer rewards program. So these are the very first doula trainers to be part of this program. There was a group of EBB Instructors. And a few Pro Members who were invited to apply. And these people had special early access to apply and their trainees that they’re training to become doulas in 2025 will already have these special Evidence Based Birth® rewards for training with them. So I’d like to welcome our five new doula trainer rewards program members. We have EBB Pro Member Naima Beckles from the organization for your birth. Naima specializes in community-based doula trainings in the New York City area. EBB Instructor Leiko Hidaka offers doula trainings in the Dominican Republic. EBB Instructor Ruth Kraft of honoringwomen.com is based in Florida and she trains doulas online and travels all around the U.S. We also have EBB Instructor, Ms. Charlotte Shilo-Goodreau of Community Birth Companion who trains community-based doulas in Louisiana and EBB Instructor Heather Christine Struwe of Community Aware Birth Worker Doula Training. And we have a couple of other active EBB Instructor members who are also active in the program. So congratulations and welcome to these five doula trainers who are kind of like the inaugural part of our program. If you train doulas and you’re interested in becoming part of this group, starting in 2025, all active EBB Instructors and active EBB Pro Members will be eligible to apply for this program. So if you’re in the Pro Membership or the instructor program, just stay tuned for our newsletters. When we announced the applications are open.

So speaking of becoming an EBB Pro Member, today and tomorrow are the last days of our end of the year slash beginning of the year sale on the EBB Pro Membership. So we are doing a special where you can get 28% off the annual membership rate. This allows you to get in at the original low price of the EBB Pro Membership and save hundreds of dollars. This is a deal we have not offered before, and it involves you pay for just six months and you get the full 12 months. So pay for six months and get the full 12 months. The EBB Pro Membership and our other programs and services, such as the conference and the instructor program, go to fund the research work that we do here at Evidence Based Birth®. So you may or may not be familiar with this. We talk about this on our About page, but here at Evidence Based Birth®, we do not take any funding from outside companies or investors so that we can stay free from conflicts of interest and stay true to our mission. So if you’re listening and you’re already a Pro Member or an instructor or a childbirth class graduate, or you’ve purchased one of our Pocket Guides or other products or services, we are so grateful to you. You are the reason that we are still able to continue doing what we’re doing and making the research on childbirth publicly accessible. If you haven’t been able to participate in those ways, there are other ways you can help Evidence Based Birth® stay sustainable. You can leave us a review on your favorite podcast. And you can forward our podcasts, handouts, and resources to a friend so that they can learn about Evidence Based Birth® and we can continue to get the word out there about the research on childbirth and our mission of making that research publicly accessible. That kind of concludes our sneak peek for next year. Morgan and Sara, is there anything you’re particularly excited about?

Morgan Richardson Cayama – 00:52:20:

Yeah, I’m really excited for that preventing or reducing your risk of Cesarean webinar. I think that was… A lot of research and time went into that as part of our Signature Article on The ARRIVE trial. And I think that’s going to be a really… Practical and exciting podcasts for people to listen to.

Dr. Rebecca Dekker – 00:52:36:

Yeah, and that episode is coming out on January 15. It’s going to be EBB 343. Again, the top 10 evidence-based strategies for lowering your risk of Cesarean. Sara, what are your thoughts?

Sara Ailshire – 00:52:49:

Oh, wow. I’m really excited about vitamin K. It’s been in the cooker for a while here getting ready, and I’ve sacrificed my algorithm investigating some of the misinformation around vitamin K. So I’m really excited to see what all of that work is going to look like when it’s made beautiful by our content designers and out there for everybody to take a look at themselves.

Dr. Rebecca Dekker – 00:53:14:

Yeah, that is definitely one of the most controversial topics, and I would have never guessed that 15 years ago if you told me, you’re going to write an article about vitamin K that will like, so much traffic will come to your website that it’ll crash and people will be… That’s the article where people used to call my old workplace and shout at the administrative assistants because of what I was publishing. I had no idea it was going to be so controversial. So yes, I understand, Sara. When you’re saying you sacrificed your algorithm, meaning you’re looking up the misinformation and now social media is feeding you more misinformation.

Sara Ailshire – 00:53:54:

Yeah, between that and RH aliens, it’s…

Dr. Rebecca Dekker – 00:53:58:

Yeah. You don’t know what we’re talking about with the aliens. You’ve got to go to the episode on RH. That is episode 329, Q&A about blood types, Rh incompatibility in pregnancy, and the RhoGAM shot. So yeah, that was definitely an interesting… Research finding. So if you’re curious, if that piqued your curiosity, go listen to episode 329 about aliens and the RhoGAM shot. For me, I’m really excited about the conference. So we have been, you know, we had our first in-person retreat in I think three years. This October, we didn’t really talk about it, but a bunch of team members from EBB got together in Las Vegas where we have a team member who lives there. And we were planning out the conference and the topics and the ideas. And our research team is going to have some interesting presentations to put together. So I’m not going to reveal the topics yet, but just know they’re going to be good. And they’re going to be things we haven’t really talked about before at EBB. So it’s going to be amazing. So thanks again, Morgan and Sara, for joining me today as we kind of like looked back into 2024 and looked forward into 2025.

Morgan Richardson Cayama – 00:55:12:

Thanks.

Sara Ailshire – 00:55:13:

Happy to be here. Thanks. It’s been fun to look back on everything.

Dr. Rebecca Dekker – 00:55:16:

Everybody that wraps up today’s podcast. Again, happy new year from our team to all of you who are listening. We just hope that, you know, you continue to benefit from the resources we put out here at EBB and that you have a wonderful year ahead of you. Thanks, everyone. Bye. Today’s podcast was brought to you by the Evidence Based Birth® Professional Membership. The free articles and podcasts we provide to the public are supported by our professional membership program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours. Live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories. We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit https://ebbirth.com membership.