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: EBB 206 - Evidence on Perineal Tears and the Importance of Avoiding Episiotomy with EBB Founder, Dr. Rebecca Dekker EBB 210 - Evidence on Warm Compresses and Hands-on vs. Hands-off for Protecting the Perineum EBB 216 - The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker EBB 218 - The Evidence on Perineal Massage during Labor with Dr. Rebecca Dekker 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.