In this episode, Dr. Rebecca Dekker dives into the evidence-practice gap, the disconnect between what research tells us is best during childbirth and what is actually happening in labor and delivery units around the world. She walks through the latest statistics on Cesarean rates, VBAC access, and the widespread use of non–evidence-based interventions, as well as the persistent underuse of practices proven to improve outcomes, like doulas, midwifery care, and birthing positions that support physiologic labor. Dr. Dekker also unpacks the systemic forces driving these gaps, including the role of paternalism, hierarchical power structures in healthcare, legal pressures, and the phenomenon of horizontal violence among healthcare workers. She explores how overlapping forms of oppression shape the experiences of both patients and providers. (02:40) Why research takes so long to become routine care (03:42) A look at U.S. cesarean rates and what's driving them (05:38) The rise and fall of VBAC access and why families struggle to get support (08:01) The "bait and switch" problem in maternity care (09:34) Interventions that are overused vs. underused during labor (11:47) How paternalism and medical hierarchy fuel the evidence gap (16:39) Horizontal violence among nurses, midwives, and doulas (19:11) Trauma and burnout across the maternity care workforce (23:04) Real signs of progress and positive change in birth settings Resources EBB 1 - Intro to Evidence Based Birth EBB 2 – What is Evidence Based Care? Listening to Mothers in California (Sakala et al., 2018) Basile Ibrahim et al. (2020) study on VBAC access and barriers Register for the EBB Course: How to Help Families Get Evidence-Based Care: evidencebasedbirthacademy.com/register/course-how-to-help-families-get-evidence-based-care/ 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.