Labour & Delivery Archives - Your Downtown Doula

Posted on September 6, 2023September 6, 2023 by Racheal Onah — Leave a comment

A Birth Partner’s Guide

Pregnancy, labor, and delivery can be an exciting time for the pregnant person, as they gear up to meet their new bundle of joy. However, there is also another key person involved in the journey of birthing a newborn baby – the supporting birth partner.

The birth partner could be a doula, romantic partner, parent, sibling, or friend of the pregnant person. A support person plays an integral role in the whole birth experience. Partners help set the tone during labor and delivery, by allowing the expecting person to feel happier and less stressed during labour and in the postpartum period.

What can a birthing partner do to prepare?

There are several things a support person can do to prepare for labor and delivery:

Attend birth classes & read books on pregnancy, labor, and delivery – This gives the birthing partner an opportunity to learn and understand the process of labor and delivery before the day. This includes knowledge about the stages of labor and delivery, as well as relaxation techniques they can offer to their partner.
Go to prenatal checkups with the pregnant person – It is important to keep up to date on the health of the pregnant person and baby.
Go over the birth plan – Being informed about the birth plan will allow you to advocate for the pregnant person during labor and delivery. It is important to bear in mind that things do not always go to plan, so it is important to be flexible and prepared for changes to the birth plan.

Support role to the birthing person

As labor and birth progress, the support person can help by:

Have a copy of the birth plan – You can help inform the maternity team on how you and your partner have planned for the delivery, as this will allow you and your partner to feel more in control of the birthing process
Help keep track of contractions
Applying relaxation and comfort measures such as a massage or counterpressure techniques to relax the birthing person
Be on stand-by for ice, drinks, and snacks
Stay with the birthing person so they are not alone

How to feel closer to the baby

Ways a birthing partner can feel closer to the newborn include:

Help cut the cord
Cuddles and skin-to-skin time with the baby
Perform baby massages as babies respond well to touch
Learn how to feed and bath the baby
Help settle the baby when they are crying or are fussy
Sing and talk to the baby
Go for walks with the baby
Be a key part of the bedtime routine

How to take care of yourself as the birth support partner

As a supporting partner, it is also imperative that you look after yourself as well. Some tips to stay well and healthy during and after labor is:

Find relaxation techniques for yourself as the process may feel overwhelming to you
Make sure to take adequate rest breaks when it works for your partner
Bring snacks and drinks for yourself

Hi, I’m Racheal! I’m a 4th-year Naturopathic Intern at the Canadian College of Naturopathic Medicine. I attended York University and obtained a Bachelor of Science degree with Honors in Biology. While working in healthcare, I discovered naturopathic medicine, and I learnt how NDs focus on the root cause of diseases and use natural interventions to treat ailments. From there, I joined CCNM, to study Naturopathic Medicine. As a part of my clinical rotation, I have a one-weekly pediatrics focus shift, where I see mothers-to-be, mothers, and baby’s during that shift. I have always had a keen interest in pediatric and family health, which is why I became an executive member of the CCNM pediatrics club. I went on to explore my interest in womxn’s health and pediatrics by publishing two papers that were related to the role naturopathic doctors can have in supporting pregnancy and outdoor education for children. I am working towards becoming a Naturopathic Doula because I believe there are several ways Naturopathic Doctors can support pregnancy, labour, and post-delivery.

Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.

What tests and screenings will be offered and when
When to sign up for prenatal education and what types to consider
Things you should think about that your care provider may not mention
Links to helpful resources

Posted on July 10, 2023July 10, 2023 by Dr. Alisa Murli, ND — Leave a comment

Informed Consent

by Dr. Alisa Murli, ND

Congrats, you’re pregnant!

Pregnancy is such an exciting time as you’re preparing for your newborn to arrive, but it can also be confusing or overwhelming. Whether this is your first pregnancy or subsequent, there is often so much to learn. In this article, we focus on informed consent and will go through all of the choices you may be faced with during pregnancy (and perhaps didn’t know you had?). By the end of this article, you should feel educated and empowered to seek out more information about your pregnancy and labour options.

What is informed consent?

Informed consent is when a healthcare provider presents you with all of the pertinent information necessary to make an informed decision. This means that they educate you about the benefits, risks and alternatives to any intervention or procedure. For informed consent to be valid, the patient must also be in a fully competent state and able to make a voluntary decision about said intervention (1).

Think back to a time you went to a medical provider; do you recall being given all of this information? You have the right to have all of the information clearly explained to you in a manner that you can understand, and you have a right to be given ample opportunity to ask questions and consider your options before making a decision (time may be limited in the event of an emergency).

Although this is something that all healthcare providers are aware of, in reality, informed consent is really lacking. This is particularly true of the interventions and procedures used for pregnancy and birth. This can be for many reasons, and more often than not healthcare providers are acting in your best interest and believe they are offering choice. What the lack of informed consent truly results in is the birthing person having a limited role in decision making of not only
their health but their baby’s as well. What this really means is the birthing person is void of basic human rights and bodily autonomy (2).

Informed consent is when a healthcare provider presents you with all of the pertinent
information necessary to make an informed decision.

Choices during pregnancy

Every choice during your pregnancy is ultimately up to you. Healthcare providers, whether it be your OB, family doctor, midwife, naturopathic doctor or doula, are there to guide you to make the best decisions for your health and safety. It is important to take their recommendations into consideration, however it is equally as important to understand that you have a choice and are provided with the benefits, risks and alternatives to each medical decision.

Let’s dive a little deeper into the choices you may be faced with during pregnancy and labour.

Birthing environment

Choosing your birthing environment is dependent on how you view your labour and birth and your choice of practitioner. If you would like a home birth or to give birth at a birthing centre near you, a midwife would be your best choice (TIP: apply for a midwife as soon as you know you are pregnant). If you’d prefer a hospital birth, you’re often able to choose between your family doctor, an OB or a midwife.

Did you know you have the right to manipulate your birthing environment to suit your comfort? For example, you are able to ask them to lower the lights, use essential oils and music, bring your own blankets/pillows from home.

Physical examinations

Consent for physical exams might look something like this, “I would like to perform a cervical check for you right now in order to assess the progress of your labour. I will be checking for the effacement (how thin your cervix is), the dilation (how wide it has opened) and the position of baby. This will help us to determine the best next steps for moving forward. The risks of a cervical check would include bleeding, discomfort, vaginal infections and premature rupture of membranes. If you do not wish to do a cervical check, we can proceed without one. Here are the alternatives…”

Interventions

Interventions during labour are used to start, support or assist with the progression of labour. Interventions can be anything from pain management to induction/augmentation methods to episiotomy to assisted birth techniques (ie. vacuum or forceps) and caesarean section. Believe it or not, you have a choice as to whether any of these interventions are used on you. For more information on alternatives to pain medications, visit https://yourdowntowndoula.com/alternative-options-to-pain-medications/

Labour positions/pushing

During labour, we often recommend various positions that can help with comfort and progression of labour. Here are some positions that are recommended for the various stages of labour.

People usually believe that the only way to birth is by laying on your back. While this may be the preferred option for some, it’s not necessary. There are several options for pushing positions and you may even use multiple positions. Some positions are better suited for your perineum and may lessen the effort needed to push (thank gravity). These are positions that tilt your pelvis in such a way that the birth canal is perpendicular to the ground rather than parallel.

Keep in mind that getting an epidural will limit the positions available to you, but that is okay! You can still use the peanut ball, sit up, turn from side to side and even try a supported squatting position for pushing.

Eating and drinking throughout labour

Contrary to popular belief, you are allowed to eat and drink through labour, even with an epidural. In fact, eating and staying hydrated through labour is necessary for increasing endurance. Imagine running a marathon without snacks and hydration! Of course it is not recommended to eat heavy meals, as this can increase risk of nausea, vomiting and increase your needs for digestion (and thereby shutting blood flow to your intestines).

The hospital might offer you jello and clear fruit juices for nutrition during labour, but here some great options you can bring yourself:

● Smoothies
● Bone broth
● Fresh fruit juices
● Natural electrolytes in water
● Coconut water
● Fruit
● Cheese
● Nuts
● Dark chocolate
● Protein bar
● Honey

Placenta delivery

Delivery of your placenta is often a passive experience that happens after your baby is born. Your doctor or midwife will be monitoring your placenta delivery and their job is to ensure it is completely removed.

Active vs expectant management of placental delivery:

In active management, the doctor or midwife may give you an extra push of pitocin to promote more contractions to help separate and push the placenta. The doctor or midwife may ask for a little push or may push on your uterus to help expel the placenta (and ask your consent first!). Active management was introduced to reduce the risk of postpartum hemorrhage, as the added contractions help to close off the footprint left by the placenta (3)

In expectant management, the practitioner will wait for the placenta to detach and deliver on its own, without the use of any added drugs.

Newborn management

After you give birth, there are several choices in which you may be faced with.

Cord clamping

The umbilical cord is meant to provide nutrients for baby in utero. Immediately after birth, the umbilical cord actually continues to provide nutrients until it stops pulsing (usually takes a couple of minutes). It used to be routine to clamp and cut the cord immediately. You now have the option of delaying cord clamping, which can be beneficial for the reasons stated above. The World Health Organization recommends delayed cord clamping in all normal birth outcomes (4). Keep in mind that you cannot do delayed cord clamping if you plan to donate or bank the cord.

Skin-to-skin

The World Health Organization recommends 90 minutes of uninterrupted skin-to-skin contact with mom after birth. This maximizes positive breastfeeding outcomes, fosters bonding and increases oxytocin levels in both baby and the pregnant person(5).

Vitamin K administration

Babies are born with very little vitamin K. Vitamin K is necessary for blood clotting and is not available in significant amounts in breastmilk. It is a regular procedure for babies to receive a vitamin K shot after birth to decrease the risk of a spontaneous bleed in the first 6 months of life. You do have options and alternatives for this, such as a preservative-free shot or an oral option.

Erythromycin eye ointment

This antibiotic eye ointment is given to every baby in the event that baby gets conjunctivitis (ie. pink eye). Most commonly pink eye can occur when the birthing person has an untreated infection with a sexually transmitted infection (chlamydia, herpes or gonorrhea), however other bacteria can cause this infection and can be picked up during birth or from exposures in the hospital or home (6).

Bathing of baby

The World Health Organization suggests wiping the newborn clean and delaying the first bath for 24 hours (7). This is because when babies pass through the birth canal, their skin is populated with beneficial bacteria that are needed for optimal health, including immune function, gut health and dermatological health. However, the decision is still yours!

Evidence Based Birth is a great resource for learning more in depth information about these management practices. I encourage you to read through the evidence surrounding thesepractices before making your decision. It is recommended that you review all of these choices and have them made as a part of your
birth plan before labour.

Informed consent and doula care

A lack of informed consent is one of the reasons that pregnant people seek out doula care. As naturopathic doctors and doulas, we truly understand the need for informed consent and see the negative effects of lack of informed consent in everyday life. Uncertainty can cause a lot of anxiety around pregnancy and birth. There is a universal lack of knowledge and education around pregnancy and labour. We are firm believers in evidence-based maternity care, and we strive to educate and empower our patients to remove this uncertainty and fear and make the best decisions for themselves and their babies.

Tips for prompting informed consent from your healthcare provider

Here are some ways you can ask for informed consent or more information from your healthcare providers (including your doulas!). Understandably, some patients are afraid to speak up because they are afraid of affecting the relationship. Don’t worry! There are respectful ways of asking for more information, and most often practitioners are happy to answer your questions.

● Can you please explain the benefits and risks of this intervention?
● Are there any alternatives to this?
● What happens if we do not do this intervention?
● How long do I have until I have to make a decision?
● Are you able to send me resources where I can find more information about this?
● Can you please ask my permission before doing physical exams?
● Are you able to explain the process of this procedure?
● I am feeling a bit nervous about this, can you please help me understand why it is
necessary for me/my baby?

Overall, the main takeaway from this article is that the choice is always yours! Advocate for yourself and never be afraid to ask questions about your body, your health, and your baby.

This article is meant to provide information only, it does not substitute for personalized medical care.

DR. ALISA MURLI, ND
Hi, I’m Alisa! I am a Naturopathic doctor, birth doula and pelvic floor therapist. Pregnant womxn are my favourite population to work with, both as an ND and a doula. Being a doula is exciting and meaningful to me. I love being able to share such a memorable time in your life with you. I pride myself in providing personalized care and supporting you in the ways that you need. Education about the birthing process is key, and providing parents-to-be with informed healthcare is an integral part of what I do. I have experience with various types of births and birthing practitioners (OB, midwives) and am there to advocate for you.
Background and experience: I am a licensed Naturopathic Doctor, who graduated from the Canadian College of Naturopathic Medicine. Prior to this, I achieved an Honours Bachelor of Science in Life Sciences (minor in psychology) at McMaster University. I completed my naturopathic internship with a focus in pediatric health, where I gained experience treating infants and children. I have additional training and certifications as a birth doula, in prenatal acupuncture, and in pelvic floor therapy. This allows me to help you with preconception to postpartum and beyond. Pregnancy and birth is beautiful and meaningful and it brings me joy to be a part of your journey!

REFERENCES

1.https://www.ncbi.nlm.nih.gov/books/NBK430827/#:~:text=Informed%20consent%20is%2
0the%20process,undergo%20the%20procedure%20or%20intervention.
2. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03023-6
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372362/

4. chrome://external-file/WHO-MCA-17.07-eng.pdf
5. https://www.who.int/westernpacific/news-room/feature-stories/item/skin-to-skin-contact-
helps-newborns-breastfeed
6. https://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-
newborns/
7. https://www.who.int/tools/your-life-your-health/life-phase/newborns-and-children-under-
5-years/caring-for-newborns

Posted on June 10, 2023June 10, 2023 by Laura Hill — Leave a comment

5 Comfort Measures (you might want to try during labour)

by Laura Hill (YDD Back Up Team Member)

Labour can be a daunting experience, but with the right planning, aids, and support, it can be a more comfortable one. Comfort measures during labour can help alleviate pain, reduce anxiety, and promote relaxation, making for a more positive birth experience. These measures are non-pharmacological techniques that aim to enhance the birthing person’s sense of control and well-being during labour. It is also important to have a support system in place, such as a partner or doula, to help with relaxation techniques and provide emotional support.

These measures are non-pharmacological techniques that aim to enhance the birthing person’s sense of control and well-being during labour

1. Baths and Showers

Hydrotherapy is a safe and effective method of relaxation and pain relief that has been used
for centuries. The warmth and buoyancy of the water in a deep bath causes a decrease in
stress hormones and increase in production of oxytocin.

2. Touch and Massage

Find out what kind of touch you find comforting and use that during labour. Light touch,
counter-pressure techniques, acupressure points and massage can help to release tension in
muscles and promote relaxation. Massaging with oils containing scents like lavender or
peppermint can also be helpful in promoting relaxation and reducing anxiety.

3. Peanut Ball

A peanut ball is an exercise ball used to help open the pelvis and increase the progress of
labour. It is especially helpful for positioning and pushing with an epidural.

4. Heat and Cold

Both heat and cold can provide comfort during labour and afterwards. Heat or cold (or an
alternation of the two) applied to the low back may help relieve pain. And a warm compress
on the perineum can be used to relieve pain and soothe the area.

5. TENS Unit

A TENS (Transcutaneous Electrical Nerve Stimulation) unit is a battery-operated device that
delivers electrical impulses through electrodes to your skin. These impulses are thought to
stimulate the release of endorphins, which when used during early labour, can build up to
reduce the sensation of pain.

What tests and screenings will be offered and when
When to sign up for prenatal education and what types to consider
Things you should think about that your care provider may not mention
Links to helpful resources

Posted on May 28, 2023May 26, 2023 by Dr. Sarah Winward, ND IBCLC — Leave a comment

Let’s get real about Postpartum Bodies

by Dr. Sarah Winward, ND IBCLC

What’s the biggest mistake to make after giving birth?

Rushing to lose weight.

It is my biggest pet peeve, as a women, that so many of us feel such intense pressure to look model ready 24/7.

If you don’t like the way you look after spending 9 months growing your baby, I get it. Your body has been completely taken over by the process. It’s not just yours anymore. And if you believe what you see in the media, you’d think that you should have your old body back immediately after your baby is born. That plus the lack of sleep of new motherhood can leave anyone feeling like they aren’t adequate.

But what you see in the media is not reality.

Let me break it down:

Your weight gain during pregnancy consists of this:

Baby ~7lbs
Uterus 2 1/2 lb gain
Placenta 1 lb
Mother’s breasts 3 lb gain
Mother’s blood 4 lb increase
Mother’s fat 5 + lb increase

So, most of this weight isn’t even fat! It will come away on its own. You just need to give it time.

Remember too that your core has undergone significant changes. Even if you don’t have a vaginal birth, your pelvic floor and abdominal muscles have a lot of stress just from carrying baby for so long. These muscles and ligaments need time to heal.

Basically, your body needs rest and rehab. I truly believe that every pregnant person should see a pelvic floor physiotherapist.

Rushing into exercise can lead to injury, including pelvic floor complications like incontinence. No physique is worth peeing yourself.

Coming from a kinesiology background and a competitive athlete background I always tell people there is no such thing as over-training its actually under-resting.

Cutting back on calories or “dieting” can be a big problem too. Breast milk production may also be affected, but more often we see exhausted women exhausting themselves even more. Your baby needs you as nourished as possible, that means eating nourishing foods. In nourishing amounts.

Growing your baby took you 9 months, assume it will take at least that long for your body to adjust afterwards.

So, give your body the rest and nourishment it truly needs.

Your body, mind and soul will thank you in the long run.

Posted on May 8, 2023May 8, 2023 by Dr. Ailya Patel, ND — Leave a comment

Postpartum Chills

by Dr. Ailya Patel, ND

Giving birth is one of a person’s most transformative and profound experiences. However, it is also an intense and physically demanding process that can lead to various postpartum symptoms, including postpartum “chills.” While it is a common and expected side effect of childbirth, many women are surprised and confused when they experience it.

What are postpartum chills?

Postpartum chills, also known as postpartum tremors, are a common and temporary side effect of giving birth. It typically occurs in the hours following delivery and is characterized by uncontrollable shivering or trembling. Some women may experience mild shivering, while others may have more severe symptoms.

Why do they happen?

Several factors contribute to postpartum chills. One of the leading causes is the rapid drop in hormones that occurs after delivery. During pregnancy, the body produces high levels of hormones, such as estrogen and progesterone, which help regulate body temperature. After delivery, these hormone levels drop rapidly, which can cause a drop in body temperature and trigger the body’s natural response to generate heat through shivering. Additionally, the physical exertion of labour and delivery can cause fatigue and dehydration, contributing to shivering. Women who receive epidural anesthesia during delivery may also be more likely to experience it as a side effect of the medication.

Are these chills typical?

Yes, postpartum chills are a common and temporary side effect of giving birth. It typically lasts for a few hours or days after delivery and does not usually require treatment. However, if you are experiencing severe or prolonged shivering, it is always best to consult with your healthcare provider.

How can you manage it?

While postpartum chills are not usually a cause for concern, they can be uncomfortable and sometimes alarming. So here are a few tips to help manage them:

Dress in warm, comfortable clothing and use blankets to keep yourself warm.
Drink plenty of fluids, such as water, coconut water, electrolytes or warm tea, to help prevent dehydration.
Rest as much as possible and avoid overexerting yourself.
If you experience severe or prolonged shivering or have other symptoms such as fever or chills, it’s essential to consult your healthcare provider.

Postpartum chills are usually a common and temporary side effect of giving birth. While it can be uncomfortable, it is usually not a cause for concern. Always consult your healthcare provider if you have concerns about your postpartum symptoms. Remember to take care of yourself, rest as much as possible, and seek help and support when needed.

Posted on April 21, 2023April 28, 2023 by Dr. Olivia Chubey, ND — Leave a comment

A Meet and Greet with Your Downtown Doula

Common questions we get and our answers….

by Dr. Olivia Chubey, ND

How long have you been practicing? How many births have you attended?

Our team is a mix of varied experience from those practicing since 2002 to newer graduates. Our collective prides itself on our collaboration and mentorship focus. Which means that even if you work with a newer graduate, they are under the direct mentorship of a more experienced naturopathic doctor and doula, with access to them during your birth. So no matter who you work with, you will get the benefit of the experience of our whole team.

What techniques do you use to help me through labor and birth?

Through our team’s experience we have created CONFIDENT BIRTH prenatal class. This class focuses on the techniques we have found work wonders for clients.

Additionally, as we are all naturopathic doctors we may use tools specifically under our regulated scope of practice including but not limited to: acupuncture, botanical medicine, homeopathics.

How do you involve/include my partner during labor and birth?

It depends on their comfort level of desire in participation. We have intake processes for both parents to see how we can best serve families in creating inclusive and family first births. Our role is not to replace your partner, but to assist them in helping you and filling in the gaps of care.

Have you attended births at my birth location and what were your experiences there?

Currently we cover the following cities: Toronto, Etobicoke, Mississauga, Oakville, Brampton, Vaughn, Aurora, Newmarket, North York, Markham, Scarborough, Ajax, Whitby, Oshawa.

Do you have any other clients that have due dates near mine? Do you have a backup doula? If so, may I meet her? How often is your backup doula used?

Sometimes we do! It depends on our caseload that month. Although it is unlikely that you will go into labour at exactly the same time as our other clients, we do have a backup team dedicated to ensuring smooth coverage in the case where your primary doula can not be present. During your on-call period you will receive information regarding who are your backup doulas, their contact information and an opportunity to meet with them. The backup team is SO great we wish they could attend more births, but the reality is that your primary doula is highly likely to be at your birth.

At what point in labor would we meet up? How should I contact you during labor and at what point? Is it okay if it’s in the middle of the night? Are you always on call?

We are on-call for you 24/7 starting at 38 weeks gestation. So yes – please do call us at 3am if your labour has started! We will go over the specifics of how best to mutually communicate and reach us during your appointments. While each client’s care is specific to them and their labour, generally, we will provide virtual support in early labour and meet with you when you are in active labour.

Do you stay for the entire labor and childbirth, or do you have a time limit for long births? How long do you stay after the birth?

While each client’s care is specific to them and their doula, if we are able to connect in active labour we are there until 1-2 hours after your baby is born. We will not leave you high and dry, but we try to aim for 24 hours (without sleep…can be longer if the doula has an opportunity to rest) maximum for safety purposes.

How do you feel about epidurals or any pain medication?

What matters is how you feel about them. Our role is not to choose for you, but to learn about your needs and desires and to assist in creating a positive experience through education, emotional and physical support and advocation.

Do you help with breastfeeding? What’s your experience and training with breastfeeding?

We do! Your birth doula will be able to support you getting started in immediate postpartum, however we also have a dedicated lactation team, including IBCLCs that do home visits. Our lactation team are also available for prenatal lactation education. Let your doula know if you’re interested in more support from a lactation consultant.

Do you have MORE questions? Bring them to your free Meet & Greet – book here!

Posted on April 3, 2023April 4, 2023 by Dr. EeVon Ling, ND — Leave a comment

Considering a VBAC*? You Need to Read This!

Dr. Ee Von Ling, ND

*There is a shift towards using the term TOLAC (Trial of labour after C-section) instead of VBAC (Vaginal Birth after C-section). In many ways this term is preferred, less emotionally loaded and less cumbersome than using VBAC. Thus, I will be using both VBAC and TOLAC interchangeably in this post.

One of the very first births I attended as a new doula was a home VBAC. The parents had taken my HypnoBirthing classes and requested me to be their doula. At the time I was just so excited to be going to a home birth that I didn’t even think about the significance of this being a TOLAC.

The mother told me her birth history and the events that had led up to her c-section – “failure to progress at 9cm”. I took all her info and simply reassured her, “every pregnancy is different and so this will be a different experience than your first one”. And it was different. Amazingly different. The labour and birth progressed just like any other normal labour and birth and the mother had her successful home VBAC!

This VBAC homebirth imprinted on me that VBACs were no big deal and they were just like any other birth.

It wasn’t until I started having more conversations with pregnant clients and doctors and reading comments in mommy forums and news articles that I would realize that VBAC’s were seen as A. BIG. DEAL. Words like “highly risky”, “uterine rupture”, “endangering baby”, “dangerous for mom”, “irresponsible” almost always accompanied the VBAC discussion. It was bad enough that women had fear of normal labour and birth itself, but having a past c-section somehow put a whole other layer of fear and worry on top of that.

So I double checked the evidence and the statistics around VBAC and risks and benefits. Contrary to the conversations, the numbers showed that a vaginal birth after a previous c-section was a reasonably safe and healthy choice for most women. The absolute risks were very low and the success rates for attempted VBACs were actually quite high. In fact, the risks for a planned repeat c-section were worse. If you’d like to learn more about the pros, cons and risks around attempting a VBAC, you can read this very excellent handout created by the Ontario Association of Midwives here.

✎ Edit

Over the last several decades VBAC rates have gone up and down. According to US statistics, In the 1990’s about 30% of those who had a previous C-section attempted a VBAC. Today that number is about 13%. These numbers have fluctuated because of changes in the practice guidelines of obstetricians. VBAC births themselves did not become more dangerous, but practice guideline updates recommended more medical requirements in order to offer them. These changes influenced the perception and accessibility of attempting VBACs – OB’s became less supportive of them and the public developed a bigger fear of them. Understand that the risks and outcomes for those who attempt VBACs did not change in the last 40 years.

Being able to go through a trial of labour after C-section might be a very significant and impactful choice. For some, being able to vaginally birth helps them to heal a previous birth trauma and reclaim the birth experience for themselves. As a medical industry, we should not take the personal decision to try for a VBAC lightly and we should provide unbiased information and support for that person.

If you had a previous C-section and are now considering a VBAC for your next childbirth, here are 6 things you can do to help improve your chances of birthing your baby vaginally:

Choose a supportive provider: This might be the most important factor of all. Having a midwife improves your chances of giving birth vaginally and with fewer restrictions around VBAC. If you are not able to get a midwife, make sure your OB is VBAC supportive. How will you know if they are VBAC supportive, ask them outright:

Are you supportive of VBAC?
What is this hospital’s TOLAC rate? How many of your own patients chose TOLAC and how many of those result in VBAC?
What would be your advice around increasing my chances of achieving a VBAC?

You will get a sense of their own attitudes and biases based on how they respond to these questions.

Learn techniques so you can labour at home for as long as possible: Choose a program that includes learning and practicing breathing exercises, visualizing, releasing past fears. Our clients who have been able to VBAC took HypnoBirthing classes, listened to positive birth podcasts, read books about empowered birth by Ina May Gaskin and Penny Simkin. From our own collective experience supporting our own VBAC clients, we teach a special condensed version of our Confident Birth Prenatal Program that focuses just on the relaxation exercises and techniques to help you be calm and confident during labour.

Ensure the baby is in a good position: Head down is not enough! Baby’s position with their back on the left side so you feel kicks or the big movements on the right (referred to as LOT) or baby’s back is in the front so you don’t feel a lot of kicks or movement elsewhere (referred to as OA) are the ideal starting positions for baby. A baby in the posterior position (or OP or “sunny side up”) may have a harder time being born vaginally. Perhaps during your previous birthing the baby was in this posterior position, which can lead to slow or arrested labour.

There are ways to help encourage a baby to get into the ideal starting position for birth. Daily positional awareness, acupuncture, massage, chiropractic, osteopath and physiotherapy treatments may help.

Get your labour to start naturally: If you labour starts naturally, this will help you avoid further interventions that might increase the risks of a TOLAC. Speak with your midwife or doula about ways to start labour that are safe for those who’ve had a previous c-section.

Try to avoid an epidural: An epidural can limit movement and slow down labour (if started early in labour). If labour slows down, then artificial oxytocin will be needed to help progress the labour. But using artificial oxytocin in someone who had a C-section increases the risk of having a VBAC (ie. scar separation). This is why learning good coping techniques and having a doula can be very helpful. That said, if you need an epidural to help you have a positive birth experience, then by all means, choose that for yourself!

If you have an epidural, use a peanut ball: Even if someone has an epidural, there are tips and tricks to help increase your chance of a vaginal birth. A peanut-ball is a peanut shaped exercise ball that can be used in a variety of positions to help open up the pelvis and positively influence the positioning of the baby as it’s being born.

Beware the “VBAC calculator”! Recently, I have been hearing about care providers using a “VBAC calculator”. Different factors about the pregnant person are inputted into an algorithm that is supposed to predict the percent chance of having a vaginal birth. The use of this is a HUGE RED FLAG to me, and if this becomes part of routine OB and midwifery practice I fear that VBAC rates will decrease even further.

What is wrong with these calculators?

First, the database of information that these calculators use is from observational data of a specific patient population. The one that care providers in Toronto have been known to use is from a patient population in the United States. American birthing patients and American birth management practices are very different from the birthing patients and birth management practices in Canada. VBAC rates in the US are much lower than VBAC rates in Canada. A hospital with low VBAC rates will produce patients with low VBAC rates and vice versa. So you can already see a discrepancy in applying such a calculator on a random patient.

These calculators are not evidence based, meaning no study has been done to test the impact of using these calculators to accurately predict actual VBAC success, we also need to study how these calculators impact decision making in both the OB and the patient.

We are well aware that there is bias in the practice of obstetric medicine, meaning, if a care provider is personally biased in the management of a particular patient, it greatly influences the outcome for that patient. For example, if this VBAC calculator happens to calculate a low success rate, then that can influence the OB to assume that the patient’s attempted VBAC will end up in a c-section.

Here is a link to an article that explains the research that critiques the use of VBAC calculators.

In any case, the American College of Obstetricians and Gynecologists had this to say about VBAC calculators: “… population-based statistics cannot accurately predict an individual’s VBAC success odds….It is ill-advised to use statistics as a primary indicator when making VBAC decisions.”

The role of a doula in your plan to have a TOLAC: The good news is, a doula can navigate at least 5 out of 6 of the positive factors listed. Having the presence of continuous and on-going support from a doula is supported by research to help you avoid a c-section (whether it’s your first childbirth or an attempt at a VBAC). If you are interested in learning more about how a doula could be an integral part of your VBAC team, book a free meet and greet with us today!

What tests and screenings will be offered and when
When to sign up for prenatal education and what types to consider
Things you should think about that your care provider may not mention
Links to helpful resources

Posted on March 25, 2023March 26, 2023 by Dr. Sarah Winward, ND IBCLC — Leave a comment

Birth without fear

Think about the last movie you saw that featured someone giving birth. I’m guessing there was a woman screaming, a man freaking out, and a doctor yelling “Push, push push!”

Now tell me how many of your friends are terrified by the thought of giving birth? Maybe you’re included in that group!

Popular culture does a really good job propagating the culture of fear around birth.

And that translates into our everyday lives.

You hear negativity about birth all the time. Even friends who haven’t had kids say things like “oh, you’ll be screaming for the meds” or “are you ready for your body to be destroyed”. Seriously, Sarah heard both of those things while she was pregnant.

I remember in my first maternal and newborn care class, so many of my friends whispered to each other during lecture about how scared they were.

I was scared too - how could I block out all that negativity?

But those lectures taught us about physiology. About how pregnancy is not a medical condition, it’s normal.

This drove me to look further, to learn more.

So, I dove head first into the birth world. Reading books, articles, watching videos. This lead me to a doula training. Everything confirmed what I learned in those first lectures.

Birth doesn’t have to be scary. It doesn’t even have to be painful!

My education and understanding of physiology took away my fear.

It also got me incredibly excited! I NEEDED to learn how to help parents achieve empowering birth experiences.

Get our Top 5 Tips for LOVING Your Birth!

This lead me to HypnoBirthing. This training taught me techniques that help parents remain calm and relaxed. Techniques that work WITH our physiology, to facilitate empowering birth regardless of circumstances.

How we view things matters.

So, that crazy pop culture birth scenario doesn’t have to be my experience. It doesn’t have to be anyone’s experience.

The more I go to births, the more I see how beautiful these moments could be. Labour can be a sacred space. Parents can connect with each other and welcome their babies into warm, nurturing environments.

All of these experiences have completely change my outlook about birth. Now, I look forward to becoming a mother and naturally birthing my baby. There is no more fear.

Posted on March 19, 2023March 19, 2023 by Dr. Kim Abog, ND — Leave a comment

Reasons why you SHOULD have a doula!

What is a doula anyway?

Doulas are companions who provide non-clinical support and care to a person during their pregnancy, childbirth and the postpartum period. Doulas work with people in labor, their families, and their health care team to ensure effective communication and understanding of their bodies and the many different elements of the pregnancy and birthing process. Doulas have a collective motivation to ensure that families have a secure, comfortable, positive birth experience.

Why should you consider having a doula?

Your doula’s main priority is YOU.

You may already have a few people in mind to support you on your upcoming labor and birth and the weeks and months leading up to it. Your partner, your family members, your midwife, your doctors, your nurses; they all have a role to play on your big day. However, they may not always be with you to ensure you are comforted throughout your labor and birth. A doula’s job is to provide you with physical, emotional, and informational support. Doulas make sure that expecting parents (1) feel safe and comfortable, (2) they are aware of their choices, (3) and that they are making fully informed decisions when it comes to their birthing experience.

The same can be said for a full-spectrum doula or a postpartum doula. A full-spectrum doula offers support to people during the full spectrum of pregnancy – from preconception, to birth, to abortion, to miscarriage, to adoption, to postpartum. A postpartum doula can help people feel comfortable and confident in caring for their newborn and make sure they get enough sleep, be nourished, and take enough time for themselves to fully recover. Doulas help parents transition smoothly into parenthood.

Your doula can be a personal resource guide.

You will likely be in touch with your doula well before labor even begins. Doulas can help expectant parents process conflicting pregnancy, labor and birthing, postpartum advice and figure out what is best for them and their family.

Doulas are educators. While it can be easy to simply go online and find answers quickly, doulas are more hands-on and offer non-clinical advice that is thoughtful, non-judgmental, and specific to their clients’ pregnancy experience.

You deserve to feel confident and have constant support

Having doulas in birth and in postpartum is associated with many benefits such as (1) reduction in the incidence of C-sections, operative vaginal deliveries, and likelihood of birth complications involving mothers or children; (2) reduction in the number of low-birth weight babies; (3) reduction in the duration of labor; (4) reduction in the need for pain-relief medications; (5) increase success of breastfeeding; (6) increase parents’ satisfaction of the birth experience; (7) reduction in the incidence of postpartum mood disorders; and (8) increase new parents confidence in the care of their newborn.

While no one can possibly predict how birth unfolds (no matter how much planning and preparation are done), having continuous advocacy provides a whole other level of comfort and confidence in a person’s ability to cope and thrive. Everyone is deserving of a chance to get the support they need.

If you have worked with doulas before, do share with us and help spread the word. If you have questions and/or are curious about how doulas and naturopathic medicine can help you have a positive birthing experience, don’t hesitate to reach out!

Posted on November 1, 2022November 1, 2022 by Dr. Arlene Dubier, ND — Leave a comment

Three Pain-Relieving Tools that Aren’t an Epidural

by Dr. Arlene Dubier, ND, Birth Doula and Lactation Expert

When we think “pain relief” and birth, our minds typically go straight to an epidural. After all, it’s one of the most commonly used pharmaceutical pain techniques. However, it isn’t the only option for pain-relieving techniques or comfort measures. We will review three techniques that you can use either yourself or with the help of an expert

Hands-On Techniques

This is referring to massage, acupressure or counter pressure that is done by a birth partner or doula. In the early stages of labour when surges are not as intense, light-touch massage can be a wonderful tool to stimulate superficial nerve endings on the skin. This touch releases tons of endorphins, otherwise known as “feel-good” hormones.

As labour intensifies, either acupressure, counterpressure or both can be used to apply a firm hold to certain body parts in order to take the pressure off the discomfort of the surge. These are tools which can be taught to you by your doula or knowledgeable healthcare provider. The key is to hold this firm pressure for the duration of the contraction so that the pregnant person feels relief and can focus on breathing through each surge.

Water!

Water can be such a wonderful tool during early and active labour. Water is used in a multitude of ways. For example, using the warm and running water from a removable shower head can relieve back pain from back labour. For our clients who have had a slow early labour, taking baths was one of the only tools that really helped to take the edge off the more uncomfortable surges. This should ideally be done with lukewarm water, and should not exceed an hour of being submerged. The reason for this is that being in the bath confers benefits up to a certain point of time. In practice, we have seen that feeling relaxed in the bath and having the water support the belly can help pregnant people progress a little more in active labour. However, after a certain point it may almost be too relaxing where labour does not progress. In this situation if water is helpful, we suggested staying in the bath for 50-60 minutes, getting out
for some time to try different positions and then getting back into the water.

Another stage of labour in which water can be helpful is during the second stage of labour; the pushing stage. During this stage, there is a lot of natural stretching that happens to the tissues of the perineum (the area between the vagina and anus) as the baby rocks down and around the pubic bone. Having the warmth and movement from the water can again take the edge off this pressure from these stretching sensations. Yet another way water comes to the rescue!

Nitrous Oxide (Laughing Gas)

Here is a type of pain relief you may have never heard of. Nitrous oxide, or laughing gas is only used in certain environments such as certain hospitals or at the Toronto Birth Center. Nitrous oxide is a colourless, odourless gas, mixed with oxygen and is inhaled via a hand-held face mask. The benefits of this is that it can be useful to relieve anxiety as well as dull the pain sensation. Most people use nitrous during the transition phase of labour which can
be to most intense (but shortest) part as the cervix is doing its last couple centimetres of dilation. Realistically you can use nitrous during any part of labour, including postpartum if you have a perineal injury which needs to be repaired.
The benefits of this is that using nitrous allows for people to be mobile because it does not affect muscular strength. It can also be started and stopped at any time, as it works very quickly and leaves the body just as quickly. Some potential side effects of using nitrous is that people can notice dizziness, nausea or claustrophobia from having to breathe deeply and using the mask. Click here to learn more about the use of nitrous oxide in labour.

There are so many pain management alternatives, I couldn’t mention them all in this post. Speak with your OB or midwife about the alternatives that are available to you. If you are looking for even more support, specifically with hands-on techniques, you may consider including a doula in your birth experience. If this is the case, please reach out to our team and inquire about our offerings.

Wishing you all the best on your pregnancy and postpartum journey!