Rebecca Dekker has a PhD in Nursing and uses her research knowledge and skills to summarize the medical evidence about birth related topics through her company Evidence Based Birth, which is helpful for both the consumer and the perinatal professional. “Babies Are Not Pizzas” is Dr. Dekker’s first book, and it details her journey to realizing that there is a lack of evidence based medical policies and procedures specifically surrounding pregnancy and birth in American hospitals. Interwoven with her personal story, she exposes the sometimes stark contrasts between the medical evidence and actual hospital practice. Dr. Dekker also highlights her professional accomplishments and critical issues such as obstetric violence and racism within the system, which are illustrated with several consolidated stories that have been shared with her. According to Dr. Dekker, this book was written for “anyone who cares about birth.” I sincerely appreciate Dr. Dekker’s efforts efforts to spread this important information so that more people will know about the often surprising realities of institutionalized American maternity care, but as a childbirth professional what I found the most surprising about this book was what may have been missing. 

For childbirth professionals, reading this book is extremely validating. Reading it reminded me of my own realization that evidence does not always dictate policy or actions, especially when it comes to maternity care. Dr. Dekker chooses her words carefully and is very open about her epiphanies in learning the hard truths about maternity care in the United States. She raises important, pressing, and prescient topics such as racism, patriarchy, and power differentials in the medical setting. She rightly advocates for the return and growth of midwifery in the United States, and for people to think about why we birth the way that we do. Dr. Dekker asks readers  to question the norms of childbirth that are currently being presented. That is a valuable story for birthing families. She braids the evidence from the medical literature that contradicts so many of these norms within her personal story, and that is certainly an attractive writing style for readers. The book takes us on a journey through Dr. Dekker’s awakening and the process of how she turned her passions combined with her research skills into a force for change, allowing her to shift gears substantially and build a successful business. 

Dr. Dekker has a clear command of the medical evidence, and her contributions to the childbirth community have been significant and very welcomed. Her materials, generously available at no cost on the Evidence Based Birth website, are shared all over the world. I use some of her handouts with students in my Lamaze childbirth education courses. Dr. Dekker joins a long line of dedicated individuals and diverse organizations who have been committed to improving birth outcomes and the state of maternal infant outcomes for many decades.

Perhaps it is beyond the scope of this book, but I think it is also worth mentioning that Dr. Dekker’s lens for writing this book is firmly grounded in medical research, and understandably so given her background. Sometimes, this filter can be problematic, as it excludes entire disciplines that have been integral for understanding childbirth practices around the world and here in the United States such as bioethics, medical sociology, medical anthropology, history, linguistics, education, and psychology. While Dr. Dekker references single sources for several of these topics, I would have appreciated a deeper dive into these influential disciplines. 

Dr. Dekker’s solutions for fixing our oppressive and hierarchical American maternity care system are to address our own personal internalized oppression, to help change institutions by building bridges with powerful people, and by changing culture. I completely agree that these are important steps, but I feel like the book left me searching for practical steps to effect positive change. To be clear, entire academic and professional careers have been built on studying power dynamics, culture change, institutionalized oppression, and the consequences (both individual and institutional) of internalized hate. While these topics are not the focus of this book, one can not ignore the contributions that these fields of study have had on our current maternity care system. 

I sincerely appreciate what Dr. Dekker is doing to raise awareness that the institutionalized system of maternity care in the United States is not entirely evidence based in practice and needs serious fixing. Dr. Dekker has created a platform for her message and is using her privilege as a very educated and successful disruptive entrepreneur who openly acknowledges her position to not be financially threatened for telling the truth about our broken American maternity care system.  We know that change will be achieved when many like-minded people and organizations from across the spectrum work together and collaborate to fix this broken system. 

Dr. Dekker’s personal experiences during the process of growing her family have helped create and shape a vision and a business designed with the goal of improving maternal outcomes, and helping more families demand evidence based care.  Rebecca Dekker is a force for change and through her book “Babies Are Not Pizzas,” she is furthering the conversation about evidence based maternity care in the United States. Professionals like myself can appreciate Dr. Dekker’s message and consumer-friendly style when considering resources to share with our students and clients.  

About Hillary Melchiors

Hillary Melchiors, Ph.D., MPH, LCCE, CD(DONA) holds a Ph.D. in Medical Anthropology and a Masters in Public Health from Case Western Reserve University. Since 2014, she has worked as a DONA birth doula and Lamaze childbirth educator in Evansville, Indiana and is the owner of the Doula Group of Evansville. She is also a co-founder of The Birth Geeks.

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