Babies Are Not Pizzas: They're Born, Not Delivered

by Rebecca Dekker

One in three births is traumatic.

It doesn’t have to be that way.

Rebecca planned to give birth at the hospital affiliated with her university, where she was an award-winning nurse researcher finishing her doctoral degree. But hospital practices and policies that were more than twenty years out of date left her with complications that seemed preventable. Worst for Rebecca, her healthy baby was whisked off to a nursery right away. She spent the first few hours after birth begging to see her own baby!

A few years later and pregnant again, Rebecca put her research skills to work and examined the hard evidence on what went wrong with her first childbirth experience.

She discovered shocking truths that not only impact millions of families every year, but would change the entire course of her life.

Embark on a journey with Rebecca as she exposes the stark realities of institutional care during childbirth and reveals inspirational solutions for parents and professionals alike.

Genres: Parenting, Nonfiction, Health, Medical, Memoir, Audiobook, Education

258 pages, Kindle Edition

First published August 20, 2019

Reviews

[Katherine · Rating 4 out of 5]

All medical professionals should read this, in the hopes of not perpetuating a culture of disrespect towards pregnant women.

I had thought at first that this would be a bit like The Science of Mom: A Research-Based Guide to Your Baby's First Year but for pregnancy/labor, and I had hopes it could replace Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong - and What You Really Need to Know with more credible analysis. However, this is more the story of how the website EvidenceBasedBirth.com came to be. If you just want the information on different pregnancy/labor conditions and interventions, just read about it on the website directly instead.

As for parents, this could be either validating to your own experiences or it could be a little bit too frightening, especially if you are a first-time mom planning to deliver in a hospital. I'm not sure how I would have reacted if I'd read it then, but it certainly would have provided a very strong answer to "why do people not want to see OBs/give birth in a hospital?" which I understand now through personal experience.

[Kimmy · Rating 2 out of 5]

I so badly wanted to like this book because there is sooooo much I agree with the author on. However, she leaves so much of the evidence out. Towards the end, she admits that it sounds like she wrote the book I would've preferred but a single friend told her some criticism on it and told her to include more of her story and to "weave the evidence" in with that. However, I think she really missed the mark on doing that. While there may have been some evidence nuggets hidden in there, they were grossly overshadowed with horror stories. While yes, there are issues in the maternal healthcare system that need to be addressed and changed, it was a portrayed in a way that was mortifying even to me, someone who is pregnant with baby #3 and considers themselves to be rather educated in childbirth.

I was so excited to start. The title of the book really grabbed me, and the first few chapters excited me. I have friends who are pregnant with their first baby and I suggested they read it with me when I was only a few chapters in because I wanted them to be hopeful. I wanted them to feel like they could learn what choices they could make and how to feel really empowered and involved in their delivery...but the further I got in the book, I had to tell them to stop! First time mom's already have a fear of the unknown and I can't see how any first time mom could read this and not have that fear insanely amplified by knowing what hospitals could do to them.

Besides the hospital horror stories though, a lot of the authors personal story didn't resonate in a manner that felt like it fit with the book. Had I wanted a book about starting a business or entrepreneurship or something, the story would've fit. But in this context, it did feel rather out of place hearing about her inner personal conflict with her place of employment getting in the way of her passion. And then especially as a mom who is still in a place where she needs to work to help provide for her family, it just felt awful. Like even with talking about how her husband was the one who stayed home at first and how it made their lives soooo much better and was so great. It was like "yeah, I get it! Wouldn't it be soooo nice". And typically I'm not bitter hearing that kind of thing, but here I am, an expectant mother wanting some encouragement and tips as I'm trying for the 3rd time for my ideal birth, and then I didn't get that at all but instead got the sting of the reality I face knowing I'll have to work.

I do suppose maybe that this book was just written for a different audience...people actually in healthcare maybe? With me, i was just left hugely overwhelmed and discouraged. Though I will admit, I did enjoy the first few chapters and a few morsels after here and there. I would only recommend this book to a very specific person. Maybe a burned out L&D nurse? Don't know any of those though. I never in a million years would recommend this to an expecting friend unfortunately. Which is really too bad, because it just seems like such a missed opportunity to get out there. There are so many books on childbirth, but they seem to be such opposite ends of the spectrum. A book with the evidence and thoughtful ways to feel empowered to get an evidence based birth in any setting would've been so great for the countless women who don't have the opportunity for home birth or to drive to Tennessee to birth on a farming community brimming with midwives.

Maybe next the next one.

[Lacey · Rating 4 out of 5]

Not exactly what I expected. But I enjoyed it. I thought it would be a nonfiction piece of work (which it kind of is). It turned out to be more of a memoir. The author tells her story of childbirth and the practices in our hospitals that are not evidence based but traditional, "cover your butt" practices, and many are harmful. She empowers her readers to speak up and help change our birthing practice in hospitals to be more patient focused and evidence based. I learned a lot and was shocked and enlightened by the stories shared of women and their birth experience.

[Lindsey Hendricks · Rating 4 out of 5]

Slapped, mostly

[Amy Hansen · Rating 3 out of 5]

A good book with some very good information. I wish the focus had been more on data and less on her personal story. I think the thing I disliked most about the book was that it somewhat encouraged fear as a motivation for driving change. I would have liked more data and fewer stories about all the abuses that can and do happen during birth.

That being said, I did find her chapter on hospital hierarchy informative and helpful, though not really surprising. As a physicist, through and after grad school myself and other physicists would talk to each other about our TA/tutoring experiences. It was largely agreed that the pre-med students were the worst to deal with. Not because they got bad grades (though many did) but because as a group they had such little true interest in understanding concepts or developing independent thought and problem solving skills. They just wanted to memorize stuff and work the system to get a good grade. They weren’t all like that, but as a group a lot of them were. Our conclusion was “Physics saves lives. It keeps some people out of med school.” It does seem, however, that this kind of personality would be particularly good at propagating the bad system that Dekker describes.

[Sarah T. · Rating 1 out of 5]

You'd think this book would give practical evidence based information that would help guide a pregnant woman to birth. You'd be wrong. It's a biography of why the author started her website and how she left academia to pursue that goal. It's honestly hard to get through, because at a certain point you keep asking "how is this supposed to be helping me?" This would be better as lifetime movie than a book she is trying to sell to pregnant women. If you are a non-pregnant healthcare professional or a businessperson interested in why she started her company, then you will like this book. If you are pregnant, avoid it until after birth because it has nothing that can help you for before birth. Spend your time on more clear and helpful resources for now, you look only have nine months to prepare and you don't want to waste a chunk on this!

[Emily Trettel · Rating 3 out of 5]

I’m just not persuaded a website needs a memoir.

[Mary · Rating 5 out of 5]

When Rebecca Dekker had her first baby, it was a difficult, slow labor which led to the use of several interventions like Pitocin to speed up labor and an epidural to manage the pain. She avoided a c-section, but even after successfully delivering her baby, she endured several hours of being separated from her newborn daughter for unclear reasons. It would be a long time before she could properly process her birth, and when she did, she realized she was one of the 1 in 3 women who will experience a traumatic birth. Her experience lead her to study the interventions that the medical staff used on her to see if they could be supported by research. She discovered that many of the interventions were not based on recent research findings and seemed to come out of tradition and long-held practices. This eventually lead her to create the website, Evidence Based Birth, where she would use her academic experience to publish articles examining different birth practices.

Babies are Not Pizzas is not primarily a book meant to educated and inform you about best birth practices, but rather, it's Dekker's personal story--how she came to create her website, and why she fights for birth practices based on evidence. As a nurse herself, she has strong compassion for those working in the healthcare industry. She offers an inside look at why nurses and doctors will often choose to enforce out-dated practices when there are other options better supported by research. She also doesn't shy away from sharing the real stories of women who have been impacted by these practices.

While this isn't a research book, Dekker does talk about some of the topics that she has researched, and she also goes into the history of childbirth and how practices from 50 years ago are still influencing hospital policies today. I appreciated her story and her desire to put important information in the hands of women so they can be better informed when talking with their doctors and healthcare professionals. I also appreciated that she explained how women can be involved in changing their local hospital policies as they advocate for their rights in giving birth.

This is a must-read for anyone who has either witnessed or experienced the brokenness of the medical system when it comes to pregnancy and childbirth. I hope that this will continue to lead to change and reform in hospitals across the country as women are educated and informed about childbirth.

[Monica Johnson · Rating 4 out of 5]

Feeling grateful for women like Rebecca who’ve done this work so that 5 years later I have evidence based and empowering choices available to me during birth

[Leah Savas · Rating 3 out of 5]

I didn't realize going in that the entire book was a memoir of sorts. But the format worked well, especially at the beginning. In the early chapters, the author told the stories of her own three pregnancies and births. The retelling had very helpful information about what labor and delivery can look like in a hospital setting as compared to a home birth. I appreciated the information she shared about what practices are evidence-based and what hospital routines are simply medical tradition.

After about the first third of the book, though, the story took a slightly different direction, focusing on the author's advocacy work. I found this less helpful and often somewhat political in tone but still interesting. If I had been short on time, I probably would have put the book away after she finished telling the story about the birth of her last child.

[Tiff · Rating 3 out of 5]

The book was mostly the story of how she created her website, interspersed with birth stories and interesting parts about how modern childbirth culture came to be. Twilight sleep (horrifying) and the history of racism/white supremacy during birth (also horrifying) in particular were fascinating and I’d like to learn more about these.

Overall it made me very happy that we’ll have a doula who will look out for my preferences and rights as a patient.

[Danielle]

What I liked about this book:
1. Focus on making birth decisions based on research evidence.
2. Insights into how many hospital systems in the US consistently practice in ways that are not evidence-based, leading to poorer maternal-child health outcomes.
3. History as to why the system is the way it is today, and good information to challenge biases about midwives and natural childbirth.

What I did not like about this book:
1. After the first few chapters, which were extremely interesting and informative, the book devolved into pure advocacy (preaching, really) and frankly, a boring career memoir.
2. Home births are romanticized, and the downsides (which I believe are pretty significant!) aren’t discussed.
3. While some research is presented (again, mostly in the first few chapters), the rest of the book contains mostly a detailed memoir of the author’s career trajectory interspersed with some n=1 anecdotal birth stories.

For those foraying into the hospital-based birth system, I think it’s eye-opening and worth reading the first few chapters. After that - not so much value unless you plan to also make evidence-based childbirth your calling.

[Melanie Matson · Rating 4 out of 5]

I can tell you that when I put this on my TBR list I did not expect to read a book about obstetric violence and abuse, but that's what I got. This book was eye opening! I found myself in constant awe and horror as a learned about current practices in hospital labor and delivery wings and how most of them are at least 15 years out of date with current research! What the heck! Anyway, I'm here to review a book not give a summary. The book was organized in a simple enough way to understand and included many references to evidence-based knowledge about pregnancy and birth that, should I ever have children, I would refer to as well as doing some of my own research. It made me want to go straight hippy and read a book by Ina May Gaskin. Some of the knowledge was beyond me, just because I have never been pregnant and might never be. But it was simple enough to understand while simultaneously disheartening. But I did learn at the very end that if you don't want to read the book, like I did, you can go to the associated website for any questions you may have from vitamin K to racism to lithotomy.  It was certainly an interesting read, very emotional. I do not get anything from posting this link, but if you want an unopinionated version of this book I'd recommend reading the research articles posted on the Evidence Based Birth Blog @ evidencebasedbirth.com.

[Coco Smith · Rating 3 out of 5]

This book started out fine. Great even. Everyone likes hearing a good (or bad) birth story. I’ve had 4 babies of my own and have plenty of story to go along with them. A lot of them traumatic and scary. So I had true compassion and empathy for what she was sharing and wished I had advocated for myself and baby better. I wish I would have read this earlier so that I could have been more informed and done some research.
BUT, as a book, it went downhill quick after the woke chapter!! What a load. She’s really pushing agendas and making false assumptions to rile everyone up. Maybe the nurse in her story was racist. Or maybe she is a rude nurse who treats all of her patients that way. Ever think of that? Just because someone is mean, doesn’t make them racist. Why can’t I be oppressed if I’ve been treated the same way? (The answer is because I’m white.) People need to get their heads out of their butts and start caring about people instead of the color of their skin. I know a lot of strong, capable black women who are perfectly capable of advocating for themselves just like white women, or ANY woman.
I feel like this book got derailed and she just used it as a platform to draw people to her website in hopes of supporting her family.
I do like the content and idea of advocating for yourself and doing your research and having the best birth possible!!! That’s very important. But there’s also a lot of scenarios we don’t and can’t know about and a lot of women WANT to be told what’s going on and what to do next. Not every woman wants to give birth on her hands and knees, at home, in a pool. I couldn’t even if I wanted to. I had high risk pregnancies from the start.
But we DO have a long way to go in the medical field when it comes to compassion and treating the mother like a human being who loves her child and wants what’s best for it, even if that goes against what they advise.
Lots to think about, but I wish there would have been a better outcome at the end. Tell us the differences we are making and seeing out in the world! Don’t just promote your website. It was too personal. I didn’t want to know all about her family life. She talks about at the end what her book was originally about…that’s the book I would have preferred. But overall, an important look at the medical
System and how we can make it a better place for us when we need it.

[Jacqueline · Rating 4 out of 5]

As a CNM and new mother who has turned to EBB both professionally and personally this was a great, quick read. It’s an excellent resource for those of us in birth work who could use a little inspiration to keep striving for evidence-based, compassionate, family centered care. I really appreciated how Rebecca broke down how difficult it can be to elicit change in the healthcare system and how trauma impacts provider decision making and unit culture. For birthing people this is still a great resource though it’s not written as a pregnancy and birth guide. It goes beyond that and focuses more on patient rights (you would be surprised how many patients don’t know they can decline care, after all, they know their bodies best), how to be a good advocate for yourself in the healthcare system, highlights evidence surrounding common maternity care topics, and makes a case for the midwifery model of care. Overall a great read to learn about the origins of EBB and current challenges in US maternity care.

[Lenny · Rating 3 out of 5]

A doula I interviewed for my pregnancy recommended this book, and while it’s not a bad book per se, it’s the wrong book to read while pregnant. Let me be clear, I deeply admire Dekker for her approach and leaving academia to bring evidence-based birthing practices to hospitals, educators, midwives, doulas and most importantly, expecting parents.

However, this part is one-half memoir and the other half horror hospital birth stories, and neither were helpful to me. The latter half were deeply upsetting (and pregnancy hormones didn’t help), but this book is almost 20 years old and practices have changed. I would have appreciated data or more of a guide, but (perhaps ironically) Dekker skips the “evidence” in favor of her personal story and the founding of EBB. It’s a nice story, but not necessarily helpful for a reader preparing to become a parent.

[Hannah Polomcak · Rating 5 out of 5]

If you are a birth worker of any kind, I highly recommend this book. It gives so much insight to the hospitalization of birth in America and the heartbreaking truth of how midwifery model of care nearly died out (and has in a lot of areas). I loved hearing Rebecca’s personal story of how EBB came to be. It ignited a spark within me! Before reading please make sure you have a soft spot to land as it is intense at times. I don’t necessarily recommend reading while pregnant unless again, you have the best support to process with during and after.

[Whitney · Rating 4 out of 5]

I’ve always known I wanted a “different” birth experience than those I saw on TV, but only recently have I really figured out why those births didn’t sit well with me: the person giving birth never seems in control.

I am so grateful for people like Rebecca Dekker who are fighting the good fight, and for people like my SIL who share amazing resources with me ❤️

[Jamie · Rating 5 out of 5]

I have already enjoyed reading many of the articles on Evidence Based Birth as well as listening to some of the podcast episodes, so I was very pleased to find out this was written by the founder of that organization. I thought this book was excellent and brings a lot of awareness to what has gotten better, and what still needs more work.

[Elizabeth]

One I would not recommend while pregnant. It was a memoir about her starting her website (which I find to be great and very informative!) but there wasn’t helpful information in the book for me to gather for pregnancy and birth.

[Katri-Helena Allas · Rating 5 out of 5]

Lugesin eestikeelset versiooni, ent seda pole Goodreadsis. Lugu, mis läks üsna ootamatusse suunda (eestikeelse pealkiri on "Positiivne sünnituskogemus on võimalik") - nimelt autori enda sünnitusloost ja kõigest sellest, mis on süsteemis valesti jõudis ta välja hoopis oma eraettevõtluseni ja oma missioonini. Aga see oli ka huvitav. Üht asja illustreerib see kindlalt - kui sa ei lähe ise sünnitama teadlikuna, siis tehakse sinu eest palju otsuseid, millega sa ehk hiljem nõus ei ole.

[Hannah · Rating 3 out of 5]

I really wanted to like this book. I appreciate so much of what she shares. As a L&D nurse, I know firsthand how many routine birth practices we implement that are not evidence based! I wish she included more evidence and less of horror stories.

[Mandy Gloyeske · Rating 5 out of 5]

Anyone who is pregnant, might be pregnant in the future, or works in the birth field needs to read this book! It is very eye-opening to problems in the obstetric world but also what steps are being made to help remedy it. Every parent needs to be informed about their choices in birth and this book can help tremendously.

[Enjoli Mallet · Rating 5 out of 5]

I absolutely recommend this book for all birthworkers. The stories in this book will spark a fire 🔥. It is crazy how horrible of health system is.

[Gracewellworn · Rating 5 out of 5]

Excellent.

[Shivani Kailesh Patel · Rating 3 out of 5]

I like the author’s podcasts as an introduction to evidence based birthing information. This book is about her story of starting EBB and not the evidence itself. Listen to the podcasts and read the articles on her site if you’re looking for the evidence.

This is more a review of the whole brand of EBB: I really do appreciate EBB as a resource, but I feel it does bias towards the unmedicated approach for the most part and I don’t think her interpretation of the studies is free of her own bias/judgement/interpretation. Like the Emily Oster book, EBB is an excellent jumping off point for reading papers yourself if you’re into that kind of thing.

[Buhtichka · Rating 5 out of 5]

Great read, I like how she was looking for the reason behind one's actions and trying to understand it all and make sense. And the blog is a great resource for everyone who's expecting.

[Jess · Rating 5 out of 5]

This book is one of the best pregnancy/birthing resource I’ve reviewed.

The book centers around the birth experiences and career journey of the author, Rebecca, a nurse and founder of Evidence-Based Birth (EBB).

The story begins with the traumatic birth of Rebecca’s first child. During birth, Rebecca didn’t advocate for herself because she wanted to be seen as “good patient.” As a result, she experienced a painful birth experience. She was left to lie down for a long period of time, not permitted to walk around, and given painful procedures in active labor that could have been prevented. Perhaps the worse part is that she and her baby were unnecessarily separated for the first few hours after birth.

Throughout the book, Rebecca weaves evidence about birth into her story. She talks about the things she was made to do during her first traumatic labor, and why recent scientific evidence shows those things are not beneficial to the mother or baby.

She dives deep into the history of birth. I appreciate that she addresses the historically-rooted misogyny and racism that still plagues the birth industry today.

I feel empowered after reading this book to learn as much as I can about the birth process. Her story helped me understand how important it is to educate myself before going into birth.

I also feel equipped to advocate for what I want, rather than caving into real or perceived pressure that I have to do everything the doctor and nurses tell me to do.

I’m also grateful I hired a doula for this reason. The doula will provide me with options during birth and help me advocate for what I want.

I’ve already had a phone conversation with my doula based on what I’ve read in this book. The book helped me form stronger ideas and preferences for my upcoming birth and discuss those with my doula.

Sadly, I can’t take the EBB Childbirth Class because you’re required to attend classes on-site. The locations and dates of the classes don’t work for my schedule. They don’t have an online class available yet, as of this writing. Instead, I signed up for an online class with another service (though I wish I were taking one of EBB’s childbirth classes!).

I highly recommend this book if you are preparing for birth. Rebecca’s story is powerful, and she weaves informative evidence into the story to help you understand your options during birth. In addition to the book, the Evidence-Based Birth podcast is great. I’ve been listening to that regularly for a few months now.

[Kristen · Rating 5 out of 5]

I really enjoyed this book. As a pregnant person, I think if I were giving birth in a different part of the country, it would scare me a lot, so I wouldn't recommend it to all expecting parents. However, I finished this book feeling empowered and lucky to be giving birth in a hospital that is much more aligned with evidence based care. I'm also so glad that I've made the decision to hire a doula to help me advocate for a hospital-based birth experience that I can feel good about.

For me, it was really eye-opening to read about some of the injustices that can happen in hospitals when birthing parents are unaware of harmful policies and unable to advocate for themselves. Rebecca's story of her first birth is a warning that if you just let the doctors do whatever they want to you without researching and considering your own preferences, you may end up with a terrible experience. Even if you do research your preferences, your choice of birth location (which may be unfortunately dictated by your insurance company) can make a lot of your choices unavailable.

If you know anything about me and my passion for social justice, you better believe that I really appreciated Rebecca's focus on systemic racism and sexism, because these are factors that absolutely affect the birth experience, and we need to keep learning about them, raising awareness, and working towards solutions.

I'm glad I went into this book knowing it was a memoir and not expecting it to be a guide to evidence-based birth practices. The EBB website is a great source for more information, and it was really helpful to read Rebecca's story and learn about how she processed her own birth trauma and found ways to have an empowering birth for her second and third children, as well as advocate for others to heal from their trauma and/or have empowering and evidence-based births.

[Jacqueline · Rating 5 out of 5]

I enjoyed this book going in and knowing that it wasn't intended as a resource for labor and delivery, but also a memoir and brief history into the business of childbirth in the United States. I didn't know that midwives used to be the main source of support for birthing mothers until medical associations pretty much realized they can get a ton of money from deliveries in the hospital and pushed out the midwives. Personally, I didn't find the anecdotes about traumatizing birth experiences in the hospital all that horrifying--I still plan to give birth in a hospital, but I feel more empowered now knowing that I have access to resources on how to design my birth plan and will be having a doula to advocate for me. The first or second chapter recounting the author's first birth was really fascinating, as she dived into the evidence surrounding her hospital's decisions. There's so much I hadn't thought of before and just took for granted that it must be the "right" thing to do--continuous fetal monitoring, no food or drink during labor, birthing positions, etc. Not to say that one decision is worse than the other, but I do think it's important to be informed of the evidence behind birth practices and the pros and cons of the alternatives.
Overall, pretty fascinating read into how Evidence Based Birth was created, and I like how she recognized intersectionality in relation to birth trauma.