REPLAY: EBB 221 - Evidence on Birthing Positions and Tried-and-True Midwifery Practices for Protecting the Perineum

Evidence Based Birth®

Rebecca Dekker

Pregnancy, Health & Fitness, Childbirth, Parenting, Birth, Medicine, Kids & Family, Doula, Obstetrician, Midwife

4.6 • 978 Ratings

🗓️ 3 December 2025

⏱️ 48 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In this episode, Dr. Rebecca Dekker explores the research on birthing positions and tried-and-true midwifery practices for protecting the perineum during childbirth. She explains why the flat-on-your-back position we often see on television isn't ideal and walks through the key differences between upright, sacrum-flexible positions, and common hospital practices like lithotomy and routine episiotomies.

Dr. Dekker reviews data from global research as well as real-world wisdom from midwives, including the extraordinary outcomes of hands-off, undisturbed birth approaches in the Philippines. She uncovers how hospital system pressures, caregiver convenience, and even obstetric violence drive the overwhelming use of recumbent positions and invasive interventions while sidelining evidence-based, patient-centered care. You'll hear firsthand strategies for minimizing severe tears, promoting intact perineums, and advocating for birth plans that prioritize the autonomy and comfort of birthing people.

Content Warning: Discussion of tears of the vagina, severe tears from the vagina to the rectum, obstetric violence related to episiotomies, and being forced giving birth on your back.

Resources

For a full list of resources, visit: ebbirth.com/221
Watch the video version here on our YouTube channel which includes study breakdowns and PowerPoint slides.
Protecting the Perineum Series:

For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Transcript

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0:00.0	Hi, everyone. On today's podcast, we're going to talk about the evidence on birthing positions
0:04.4	and time-tested midwifery practices for preventing tears in childbirth.
0:12.9	Welcome to the evidence-based birth podcast. My name is Rebecca Decker, and I'm a nurse with my PhD
0:18.5	and the founder of evidence-based birth. Join me each week as we
0:22.9	work together to get evidence-based information into the hands of families and professionals around
0:28.3	the world. As a reminder, this information is not medical advice. See eBbirth.com slash disclaimer
0:35.5	for more details.
0:43.4	Hi everyone and welcome to today's episode of the evidence-based birth podcast.
0:49.1	My name is Dr. Rebecca Decker, pronouns she-her, and I'll be your teacher for today's episode.
0:54.5	Today I'm so excited to bring some evidence-based information to you about perennial tears and research on preventing tears with birthing positions and time-tested midwifery practices.
1:01.1	Before we get started, I want to let you know that we will mention topics including
1:04.8	tears of the vagina, severe tears from the vagina to the rectum, and obstetric violence
1:10.6	related to episiotomies
1:12.2	and being forced to give on your back.
1:14.3	So today's episode is the fifth in a series we're doing this year called Protecting the
1:18.8	Perineum.
1:20.1	In the first episode, number 206, I talked with you about perineal tears, what are the factors
1:26.1	that increase the risk, the health consequences
1:28.8	of tears, and why it's so important to avoid an episiotomy. In the second episode 210,
1:35.2	I talked about warm compresses and compared the hands-on versus hands-off technique. In the third
1:41.5	episode, which was episode 216, I talked about the practice of
1:45.2	perineal massage during pregnancy and I revealed how some of the research on that
	...

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