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Are Prenatal Classes Really Necessary?

-Dr. Olivia Chubey, ND

Yes! Yes! A resounding YES! 

In case we were being too subtle

You are setting yourself up for failure if you don’t take a prenatal class.  

(I know that sounds harsh, but this is too important of a topic to tiptoe around.)

I know what you’re thinking: “Well of course you would say that, you teach prenatal classes!”  True! But, why do I teach them? 

Because I truly believe that a GOOD prenatal class is the #1, (yes, NUMBER 1) factor that leads to improved satisfaction surrounding birth. And I’d argue satisfaction with your birth experience is pretty important. 

Here’s why this really matters:

About 1 in 4 people who have given birth in the UK, and 1 in 3 in the US, describe their birth as traumatic. (Unfortunately, we don’t have stats in Canada). Not just hard, not just tiring, long or painful, but TRAUMATIC.  The birth of your baby should not be a traumatic experience! Even if there are unexpected circumstances, you should not come away from your birth feeling traumatized. It has always been my goal to reduce this statistic. 

Knowing this, It honestly shocked me to learn that only 50% of pregnant families in the GTA take prenatal classes.  But, I understand why this happens. 


  1.  You’ve been told childbirth is unpredictable and the doctor will “tell you what to do”.


Yes, birth is unpredictable. And yes, your doctor can tell you what to do, but is this how you want to experience birth?  In an effective prenatal class you learn techniques that help you cope with the marathon that labour can be.  Being prepared means you have the tools and skills to cope, even when unexpected things arise.  Each birth is indeed a unique and individual experience, and yet, there is a benefit to knowing what to generally expect and what to do.  Even explorers had a compass to navigate unknown lands.  

Your OB is definitely an important resource but they don’t arrive until the baby is literally ready to be born. Unless there are complications. (I like to say a birth is going well when you barely see the OB). You will have some assistance from the nurse but their primary role is to perform regular medical checks of you and the baby. Your birth is likely to progress normally, which means you and your partner are largely on your own: first labouring at home, then making your way to the hospital, then waiting in triage to be assessed, and then continuing in the labour and delivery room. 

It is very possible that some of the recommendations from your nurses and even your OB will not be evidence based. Many things are simply hospital policy or individual bias of the care provider. Did you know that on average it takes about 20 years (yup) for policy to catch up to current evidence. The unfortunate reality is that the onus is on you to come armed with knowledge, questions and the ability to advocate for yourself and your baby. 


  1. “I’m going to get an epidural, so I don’t need to prepare or learn coping skills”

In the movies: Water breaks. Rush to hospital. Get an epidural. Aaah, relief.

In reality: Early labour may last days. You get to the hospital triage and wait for a long time before getting assessed. Hopefully you didn’t arrive too early (or you’ll be waiting some more). Eventually you get to your labouring room and you request an epidural. If it’s a busy time (labour and delivery is the busiest place in the hospital), you may be waiting up to a couple hours more. Very occasionally, the epidural doesn’t work.  Or, your labour is progressing so quickly that there is no time to get an epidural. 

No one seems to tell you that you may be in labour for a long time before you get an epidural. So if getting an epidural is your only “coping” mechanism, you’ll be in for a rough ride. 

Learning comfort measures and relaxation exercises for labour and birth is not just for those wanting a natural birth. Learning these things gives you tools you can use in any birth situation which increases your chance for a positive birth experience. 

Read more here → Quick Tips on Having a more Comfortable Labour 


  1. “I’ve heard that hospital classes are not very useful.” 

“I can’t find one that works with my schedule”. 

“I’d rather have just the information that applies to me and my birthing situation and preferences”  


I get it, you have access to all the information you could ever dream of on the internet. However, it takes time to filter through all of it and do you even know what to look for? If you’ve never given birth before, how will you know what “method” to learn? What if someone who has supported many families in a range of birth situations was able to teach you the inside tips and tricks to help you feel calm and confident during labour and birth. Yes, being calm and confident during childbirth is entirely possible! In fact I believe that every pregnant person DESERVES to be calm and confident during this very important life changing event! 

If group classes and their schedules don’t work for you – consider a private prenatal program. I’ve noticed that clients seem to get more out of private classes because I’m able to individualize information. Clients also love that the classes are scheduled around their convenience. 


  1. Birth has basically been a terrifying mystery your whole life.

    I remember the initial joy I had when learning about birth in medical school.  I finally understood what goes on, from implantation, pregnancy and birth.  It resonated with me, my intuition, it was normal – I didn’t have to be afraid of it.  My education empowered me. However,  the joy was quickly followed by frustration.  Why did it take a medical degree to learn this, why didn’t I know in my prime “child bearing age” anything about birth outside of the dramatized ER births on television. 

Most people are very afraid of giving birth, and don’t really want to think about it. But knowledge truly is power. If you understand what you body is doing during labour, how the muscles work, how your baby is working with you then you can learn how to work with your body and not against it.   

Read more here → How Can My Partner Prepare for My Birth? 


Ok, so prenatal classes are essential for a positive birth experience. But how do you figure out which class to take? Not all classes are equal – do your research. For your convenience I’ve created the following checklist:

Will your prenatal class include ALL of the following? 

  • -Ends when you are 37 weeks pregnant or earlier
  • -Teaches and practices in-class practical relaxation exercises that you can use
  • during labour (helpful for after birth too!)
  • -Teaches your partner how to be a GREAT birthing partner
  • -Covers stages of labour and birth from a non-fear based approach
  • -Covers the birth plan in an evidence-based approach so you feel educated and empowered about what to expect and how to manage labour and childbirth
  • -Includes a workbook with exercises to help you prepare mentally and emotionally
  • -Includes additional resources such as audio recordings, videos and props
  • -Allows you to contact the instructor directly in case you have any questions or concerns
  • -Treats birth as a physical and emotional experience and not simply a textbook reading assignment. 
  • -Celebrates the miracle and power of pregnancy and childbirth!

If you’re on a budget, the City of Toronto has a free online prenatal class here “Welcome to Parenting”

Yes, that’s right, I’d rather you take ANY prenatal class, even if it’s not mine. 

However, I and another birth-loving ND’s and doula colleagues, have created our Confident Birth Prenatal Program specifically from our experiences as mothers who have given birth, and as doulas who have supported birthing families. From our many years working in this area, we observed and listened. The result?  A prenatal program that meets all the criteria above. And as the name implies, you WILL feel more confident and prepared for childbirth. 

Learn more about the Confident Birth Prenatal Program

I want families to feel empowered, calm and confident. Getting educated and having resources helps.  I teach and work with families because I LOVE sharing all the wonderful, interesting, mind-blowing things that your body does in labour and how you can help it do its job easier.  

We’re so passionate about helping families get a positive start to parenthood through positive birth we offer not just one but two different prenatal programs! 

Confident Birth Prenatal Program

HypnoBirthing – The Mongan Method Program

Would you like to learn more about how a doula and naturopathic doctor can support you in pregnancy, childbirth and postpartum? Click here to book a free 15 min Meet and Greet today! 

** Your prenatal class with a naturopathic doctor may be eligible for coverage by your work benefits/ health insurance plan. Inquire with us today! 

Dr. Olivia Chubey, ND
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Top 3 Pregnancy Reads

by Dr. Sarah Winward, ND IBCLC

Given the MILLIONS of books out there on pregnancy and childbirth, it can be hard to decide where to invest your time as you prepare for this new adventure!

Here is a list of my top 3 favourite pregnancy reads that I recommend to my clients.

The list is short & sweet but packed with great information to help you feel prepared!


1) MAGICAL BEGINNINGS, ENCHANTED LIVES: A HOLISTIC GUIDE TO PREGNANCY AND CHILDBIRTH

By: Deepak Chopra M.D.

Available on Amazon for about $21

Why I love it: This book combines the latest in evidence based medicine and the ancient wisdom of Ayurvedic medicine in a way that only Deepak Chopra can. Providing a holistic and spiritual approach to pregnancy and childbirth, including simple exercises you can do in your home to help you feel more connected and aware during all stages of your pregnancy and 4th trimester.

2) INA MAY’S GUIDE TO CHILDBIRTH

By: Ina May Gaskin

Available on Amazon for about $20

Why I love it: Ina May Gaskin is single-handedly responsible for reviving the midwifery movement in North America, with more than 30 years of experience she is a veritable guru. This book starts with a fantastic collection of birth stories written by women from every walk of life that really help to normalize the whole process of birth and inspire incredible confidence in what a woman’s body can do. The second half of the book is full of information from Ina May on everything from inducing labour to pain management to orgasmic birth, all with an emphasis on restoring woman’s faith in their ability to navigate natural childbirth

3) THE NATURAL PREGNANCY BOOK:YOUR COMPLETE GUIDE TO A SAFE, ORGANIC PREGNANCYAND CHILDBIRTH WITH HERBS, NUTRITION AND OTHERHOLISITIC CHOICES 

By: Aviva Romm M.D.

Available on Amazon for about $20

Why I love it: As an MD with many years of experience in alternative medicine, Aviva Romm is staple in the field of holistic women’s health. This book provides a knowledgeable introduction to the world of natural remedies during pregnancy.


BONUS: MY FAVOURITE BOOK FOR BIRTH PARTNERS

THE BIRTH PARTNER: A COMPLETE GUIDE TO CHILDBIRTHFOR DADS, DOULAS, AND ALL OTHER LABOR COMPANIONS

By: Penny Simkin

Available on Amazon for about $25

Why I love it: I consider this book to be an essential read for anyone who is attending your birth. It covers every topic from how to prepare for labour right up to newborn care, in a wonderfully inclusive way. It provides invaluable information on every possible birth path including medical interventions so that you and your partner are in the know before you need to make decisions. The also has pages marked for quick reference, so it’s great to have on hand during that birth itself.

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How Can My Partner Prepare for My Birth?

by Dr. Sarah Winward, ND IBCLC


Is my partner truly prepared to help me in childbirth?

Do a quick google or amazon search on “childbirth preparation” you will get a list of results that are overwhelmingly geared towards you, the pregnant person. You might notice that there are very few books written that would help prepare your partner for childbirth.

Why is this a problem for me?

How you are cared for and supported during childbirth affects how you give birth and how you feel about it. How you feel about your birth experience can also influence how you feel about your own ability in being a mother as well as affect your chance of developing postpartum depression and anxiety. Knowing this, it’s pretty clear that ongoing emotional and physical support during the very transformative experience of birth is of the utmost importance.

What about a doula?

A doula is a person who provides continuous and on-going emotional, physical and informational support for the labouring person. It has been shown that doulas help to reduce the rates of interventions, including epidural use and c-sections and help to increase reported satisfaction in birth experience. In other words, having a doula increases the chance of having HEALTHY AND HAPPY parent and baby.

But what if I can’t have a doula?

Not everyone can access a doula. Even though having doulas would actually reduce health costs, increase positive outcomes and would be a good basic addition to any healthcare system, hiring a doula is not possible for everyone.

At the time of this writing, COVID-19 virus (simply referred to as coronavirus) is emerging as a global and local public health concern that is resulting in changes in hospital policies. Hospitals are restricting the number of people who can attend births, in some cases reducing it to only one person, usually just your partner. As a doula, when I attend births, the more support the birther can receive, the better their experience. Sometimes, in addition to their partner and me (their doula), their own mother and/ or a friend will be there too. So this change in policy can greatly impact your birth experience and well-being.

How should my partner best prepare to support me? 

Here are some tips to help your partner be your “doula”:

Communication! Be honest about your fears around childbirth and be honest about your partner’s strengths and weaknesses in handling high stress situations. Play up those strengths and how they can be best used to help you during labour and childbirth

Take a high quality prenatal class that focuses on teaching techniques and skills that your partner can use to help you during labour and childbirth. We at Your Downtown Doula offer the Confident Birth Prenatal Class for a comprehensive approach to help you feel relaxed and confident during childbirth and labour.

Labour at home for as long as possible. If the concerns around infection still exist at the time of your childbirth, then reducing your hospital stay is a good idea. Your partner can help you with relaxation, help distract you, do massage and attend to your basic needs. Doing most of your labouring at home can also reduce unnecessary interventions.

A great book for partners is Penny Simkin’s The Birth Partner. It is specific to doulas and partners and contains very comprehensive information.


Want to learn more about our Confident Birth Prenatal Program?

Click here to sign up for a complimentary virtual Meet & Greet with one of our instructors (by the way, did we mention that they’re all Naturopathic Doctors!)

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Finding Comfort During Labour

by Dr. Sarah Winward, ND IBCLC

Labour is intense, to say the least. But does it have to be painful? It can be helpful to reframe the sensations you are feeling. In the words of Ina May Gaskin “labour is an interesting sensation that requires all of your attention”. Many people prefer to refer to surges or rushes as opposed to contraction, HypnoBirthing follows this tenant as well.

Labour is an interesting sensation that requires all of your attention.

Ina May Gaskin

The Pain-Tension-Fear Cycle

It’s very common to have fears surrounding birth. When we experience fear it releases adrenaline which in turn can cause ineffective muscle contractions around the uterus. As a result the production of oxytocin and endorphins decrease and the muscles in the uterus start working against each other. All of this restricts blood flow to your uterus and is a trigger for pain. It also lowers your pain threshold. In dangerous situations, this fear-pain-tension cycle allows for response and survival, in birth it can become a complication. Often, as the pain increases the fear increases and then the tension increases resulting in a repeating, and counter-productive, cycle. So, reducing pain really comes down to reducing tension in your body.

Breaking the Cycle

In her book “The Birth Partner” Patty Simkin discusses the 3 R’s of labour. These are Relaxation, Rhythm and Ritual. Engaging in all 3 of these brings you into the present moment and allows you to move through each contraction without being overwhelmed by them. Often rituals will arise spontaneously during the course or your labour and they can change as your labour progresses. The best rituals involve rhythm and repetition, which lead to relaxation. Things to incorporate in your rituals include: focusing on the breath, staring into someone’s eyes, “slow dancing” with your birth partner, dancing to music, or anything else that feels good to you in the moment.

Helpful hints for your birth partner

Penny Simkin’s book The Birth Partner also outlines a great tool for partners. It is called the Take-Charge routine and is outlined in detail in her book. It is great to use when the birthing person is having difficulty maintaining their ritual or is appearing to be overwhelmed or distressed.

1) Remain calm, others pick up on your energy

2) Stay close, bring your face close to theirs

3) Anchor them by calmly holding their shoulders or hands

4) Get them to look at you, eye contact itself can help to bring them back to the moment

5) Talk to them in between contractions, make suggestions of rituals to try, such as concentrating on the breath

6) Help them regain their rhythm, move your body with theirs

It may also help to remind birthing persons that they are about to meet their baby!

Tips to use in the moment

Any of the following can be helpful during labour, but remember that the right thing for you to do is whatever makes you fell calm, safe and relaxed:

  • Discuss any fears that you are experiencing with your doula, partner or care provider
  • Progressive relaxation, guided meditation or visualizations
  • Make noise and breath with sound
  • Change positions: hands and knees, on a birth ball, walking around, slow dancing
  • Acupressure
  • Use water such as a shower or birthing pool
  • Ask for assistance and allow your partner and doula to support you with hip squeezes, low back pressure, massage, etc
  • Hot or cold applications to your face, back or neck
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Herbal Medicines during Pregnancy

by Dr. Sarah Winward, ND IBCLC

There is a lot of wisdom in traditional herbal medicine, but with health food store selling more products than most people know what to do with, it’s hard to know what to take. This is why, if you are using herbal products, it’s important to have a practitioner, like a Naturopathic Doctor, who is knowledgeable and who is familiar with what is safe during pregnancy. Here, we’ve provided you with some good information and a place to start!

(This doesn’t replace individualized medical advice!)


Herbs that you may want to keep on hand during your pregnancy

Red Raspberry leaf

Why? Nutritive- nutrient dense, high in vitamins and minerals, including iron, calcium and magnesium; uterine tonic- helps prepare the uterus for labour

How? Drink as a tea, 2-3 cups/day

When? Last trimester of pregnancy to help get your body ready for labour

Research: Shortens labour and leads to fewer interventions

Traditional wisdom: Speeds childbirth


Stinging Nettle Leaf

Why? Nutritive tonic, also high in vitamins and minerals, including chlorophyll, vitamin A, C, D and K, and iron; contains protein, helps to bring in mother’s milk, anti-inflammatory

How? Combine with red raspberry leaf to drink as a tea

When? Can be consumed safely throughout pregnancy and breastfeeding

Research: No clinical trials, but experiential and observational evidence show benefit in anemia, preventing postpartum hemorrhage and preeclampsia

Traditional wisdom: Pregnancy tonic, improves kidney function, prevents postpartum hemorrhage, reduces hemorrhoids, increases milk supply


Cranberry

Why? Urinary antiseptic, anti-inflammatory, preventing and treating urinary tract infections by blocking the ability of E. coli to stick to the lining of the bladder

How? As an extract in capsules form or as juice (not cranberry cocktail), 1-2 cups/day for preventing UTI, consider capsules for an active UTI

When? Good to have on hand for the first signs of a UTI/bladder infection, combine with increased fluid intake to help flush the urinary tract. **If symptoms don’t resolve in 1-2 days, or if you develop severe symptoms (fever, low back ache, visible blood in urine) contact your health care provider immediately.

Research: Preventing and treating UTI, safe for use in pregnancy

Traditional wisdom: Preventing and treating UTI


Ginger

Why? Antiemetic, helps with morning sickness, anti-inflammatory, carminative- soothes pain from gas/bloating

How? Fresh or dried root steeped in hot water, drink as a tea 1-2 cups/day

When? If you are experiencing nausea or vomiting in pregnancy. Caution with doses higher than 2 g/day as this is traditionally considered an emmenagogue (brings on your period).**If you are having very severe or frequent vomiting, contact your health care provider

Research: very strong evidence in favor of use in nausea and vomiting in pregnancy

Traditional wisdom: warming tonic, useful in nausea and vomiting in pregnancy


Chamomile

Why? Promotes relaxation, relaxes the nervous system, relaxes the smooth muscles of the digestive system, soothes pain from gas/bloating, anti-inflammator

How? Drink 1-2 cups as a tea, especially soothing in the evening

When? Can be consumed throughout pregnancy, at any time but especially if you are feeling nervous or anxious**Caution with this herb if you have a ragweed allergy, they belong to the same family of plants

Research: Sedating, sleep inducing, some evidence in treating mild anxiety, decreases gas and soothes digestive spasms

Traditional wisdom: nervousness, muscle spasms, gas and colic


What to Take & what to Avoid

Safe Herbs

  • Garlic (Allium sativum)
  • Senna (Cassia senna)
  • Turmeric (Curcuma longa)
  • Echinacea (Echinacea spp.)
  • Licorice (Glycyrrhiza glabra)
  • Chamomile (Matricaria recutita)
  • Ginseng (Korean) (Panax ginseng)
  • Raspberry Leaf (Rubus ideaus)
  • Cranberry (Vaccinium macrocarpon)
  • Bilberry Fruit (Vaccinium myrtillus)
  • Ginger (Zingiber officinale)

*Despite these herbs being listed as safe, it is important that you advise your medical practitioners regarding any supplements that you are taking. These herbs can have other adverse effects such as raising blood pressure that may be important in your individual case. This list may change based on ongoing research and safety studies.


Unsafe Herbs

  • Dong quai (Angelica sinesis)
  • Bearberry (Arctostaphylos uva-ursi)
  • Arnica (Arnica montana)
  • Wormwood (Artemisia absinthium)
  • Barberry (Berberis vulgaris)
  • Blue cohosh (Caulophyllum thalictroides)
  • Greater Celandine (Chelidonium majus)
  • Guggul (Commiphora mukul)
  • Goldenseal (Hydrastis Canadensis)
  • Chaparral (Larrea tridentate)
  • Gypsywort (Lycopus europaeus)
  • Bugleweed (Lycopus virginicus)
  • Oregon grape (Mahonia aquifolium)
  • Pennyroyal (Mentha pulegium)
  • Boldo (Penmus boldus)
  • Poke root (phytolacca Americana or Phytolacca decandra)
  • Jamaica dogwood (Piscidia erythrina)
  • Pasque flower (Pulsatilla spp)
  • Sage (Salvia officinalis)
  • Pau d’arco (Tebebuia avellanedae)
  • Tansy (Tanacetum vulgare)
  • Thuja (Thuja accidentalis)
  • Tylophora (Tylophora indica or Tylophora asthmatica)
  • Cat’s claw (Uncaria tomentosa)

*Please do not take any of these herbs unless prescribed by a licensed practitioner that will carefully monitor your health and the health of your baby. This list may change based on ongoing research and safety studies.

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

Are you preparing for your best possible birth? 

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Nitrous Oxide – the “other” pain relief option

by Dr. EeVon Ling, ND

** At the time of this writing, COVID-19 policies have restricted the use of nitrous oxide in some birth settings. Inquire with your birth location if this option is available to you. 

What is it? 

Laughing Gas for pain relief?

Nitrous oxide (N2O). Aka “Laughing Gas”, “Gas”, “Nitrous”, “Entonox” (Brand name). 

It is a colourless and nearly odourless gas that is a chemical compound and mixture of nitrogen and oxygen. It has both analgesic and anesthetic properties – meaning it can reduce or alter pain sensation and pain perception.  You may know about nitrous oxide because of its wide use in dentistry. It is the same gas, but the concentration used during labour is much less. 

I haven’t heard much about Nitrous Oxide. Is it common in labour? 

You may be surprised to learn that N2O is the most commonly used form of analgesia in childbirth around the world. 

Historically, N2O has been in use for more than a hundred years! It was widely used in US hospitals for childbirth in the 1930’s – 1950’s. By the 1960’s, epidural use sharply overtook as the primary choice for pain relief and N20 use would pretty much disappear from labour and delivery in the US. But more recently in Canada, its popularity has increased as a pain relief option.  A survey in 2006 found that about 1 in 5, or 20%, of women who gave birth in Ontario used N2O for pain relief. In comparison, the rate of epidural use is about 50-60%. 

Is it as good as using an epidural for pain relief?  

The short answer is “no”. 

It does not replace getting an epidural in terms of pain relief. An epidural is meant to completely take away pain to the point where you usually don’t even know when you are having a contraction or not. Because N2O doesn’t take away pain like an epidural, I have noticed that OB’s and nurses don’t mention it as an option to clients, even to clients that express that they want to labour without an epidural. They don’t consider the value it may offer and in fact, I’ve heard OB’s tell my clients that nitrous oxide “does nothing”. This thinking is a result of comparing N2O with an epidural, but it is a great disservice to completely dismiss it as a useful coping tool.

The more thoughtful answer is that nitrous oxide is a “good enough pain relief”. The following are quotes from my own clients who used nitrous oxide as their main pain relief: 

“It helped take the edge off”

“It helped take the edge off” 

“It made me care less about the pain”

“Breathing through the tube helped distract me” 

“It helped me relax more and focus” 

“It helped me birth without an epidural”

“Without it, I would not have been able to have my homebirth”

“I think it made me a little giddy”**

In some cases, clients have used N2O while waiting to get an epidural or when they are receiving stitches on their perineum post birth. 

What can I expect if I use N2O? 

Begin use at the beginning of a contraction

Where available, it is used in a hospital or birth centre setting, and occasionally some midwife groups have it available for home births (check with your midwife or birth location for availability). It is administered through a tube with a face mask attached. When you are in labour, you hold the mask to your face and deeply breathe in the N2O at the very beginning of or in anticipation of a contraction. The maximum concentration is reached within 60 seconds so you continue to breathe the N2O gas until the contraction ends. Once the contraction is over you take the mask off of your face. Repeat this for each contraction if you continue to use it. If you’ve learned breathing exercises for labour (which I highly recommend that you do, either through a comprehensive prenatal program, HypnoBirthing or through our own Confident Birth Prenatal program), the deep breathing that you’ve been practicing is perfect for using with N2O. 

It is quick acting with the effects felt almost immediately. As described above, N2O does have the ability to alter the way you perceive and feel pain. It doesn’t take away pain like an epidural, but it can help increase your ability to cope with it. 

At the biochemical level, N2O alters levels of certain brain chemicals. It reduces those neurochemicals that activate pain (N-methyl-D-aspartate, NMDA for short) and increases neurochemicals that increase endorphins and make us feel good (dopamine, norepinephrine, endogenous opioids). It has the ability to produce a sense of euphoria and occasionally psychedelic effects. (**Yes, I’ve observed a couple clients get a little “high” while using N2O, all to their benefit)

You are able to remain alert and have full control of your body (no numbing effects). You don’t need an IV or continuous fetal monitoring, you can move freely and use the washroom, and you can eat and drink as normal. 

If you don’t think the N2O is helpful, or if you start to feel drowsy or dizzy, you simply stop using it and it leaves the body within 30 seconds.  Being able to fully control how and when you use N2O is seen as a big benefit to using this option. 

Studies of thousands of people who used N2O during labour (compared to placebo) report 

N2O helps by increasing endorphins
  • Decrease in pain perception
  • Decreased anxiety
  • Increased sense of control
  • Increased satisfaction

That said, when compared to epidural use, women were much less likely to rate N2O as effective pain management compared to those who used an epidural. But when compared with no pain relief or placebo, there was better pain relief reported with N2O use. Reported levels of satisfaction were about the same among epidural users and N2O users. And most N2O users said they would have used it again. Again, highlighting that N2O doesn’t replace using an epidural, but it may still be a very useful measure for those who want to birth without an epidural. 

Is it safe for my baby? What are the side effects? 

Some nitrous oxide does cross the placenta, however, it is safe for both you and baby when used in labour in a full-term pregnancy. It is not recommended in preterm labour as there is increased risk of brain hemorrhage for the preemie baby. Care providers may recommend using N2O only when you are in active labour (cervix is dilated 6cm or more) to reduce excess exposure to the gas. 

N2O is safe for baby when used in active labour

Otherwise, the use of N2O has not been found to affect APGAR scores in babies (the initial assessment of well-being for the newborn) and does not slow down labour or increase risks (such as interventions or c-sections) for the pregnant parent. That said, no long term studies of nitrous oxide on both the parent or baby have been conducted (in fact, no long term studies of many interventions in birth exist). From a biochemical point of view, N2O exposure can decrease levels of vitamin B12. Vitamin B12 is an essential nutrient for blood, nervous system and metabolic functions. It is found in animal-based foods such as meat, eggs and usually included in prenatal vitamins. If levels of vitamin B12 is a concern, this is something that can be addressed post birth with your naturopathic doctor. 

Potential side effects (from most common): 

  • Nausea 
  • Vomiting
  • Dizziness
  • Drowsy
  • Reduced sense of awareness
  • Reduce feelings of being present; Increases feeling detached from situation 
  • “Mask phobia” from using the mask on their face

Bottom-line: 

Nitrous oxide, if available, can be helpful during labour. It can be used as your main coping strategy (along with massage, relaxation exercises and breathing techniques) or be a helpful tool as you wait for an epidural or even be used immediately post birth if you need to receive stitches for your perineum. 

We at Your Downtown Doula are fully supportive of your choices in birth. We act as your source of information so that you are fully aware of the options so that you can make good decisions for yourself and your baby in labour. We have attended births where parents chose N2O, epidurals or other means to cope and in the end, positive births can happen no matter how you decide to journey towards parenthood. 

Want to learn more about how a doula can be a valuable support to you during pregnancy, labour, childbirth and beyond? Book a free 15 min meet and greet with one of our Naturopathic doctors and doulas today! 

Dr. EeVon Ling, ND

Resources: 

https://www.contemporaryobgyn.net/view/nitrous-oxides-revival-childbirth

https://evidencebasedbirth.com/nitrous-oxide-during-labor/

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Do I *Really* Need a Birth Doula?

Dr. Olivia Chubey, ND

Yes!

And no. And Maybe.

It depends. On a lot of factors. Let’s break this down in an easy way. Take a few minutes and ask yourself the following questions:


  1. What is important to you in your birth experience?
  2. Do you have a birth companion?
  3. What kind of support do you expect from your birth companion?
  4. Are they capable of giving your that support?
  5. Do they have the tools and knowledge to support you?

If you answered YES to #2 but NO to #4 and #5.  

You *might* be able to get away without a doula if you take a prenatal class that focuses on educating you and your birth companion on coping techniques, how to use them in labour, and common interventions – for example our Confident Birth Program.  You may find that your birth companion may be enough, armed with the information they have learned to help you with your answer in #1. 

If you answered YES to #2, #4, #5 you may decide to still work with a doula for one of the following reasons: 

  • I understand that my labour may be longer, and I value the idea of my partner being able to rest so that they may help me more after baby is born. 
  • My partner feels anxiety regarding whether they can be whatever I need them to be/remember it all etc, so it would be good to have knowledgeable and comforting help in addition. 

(*Research has shown that the most positive birth experiences for fathers were ones where they had continuous support by a doula or a midwife.)

  • I know that statistics show that moms have better birth experiences and less medical interventions when a doula is present

(*Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons.)

  • I desire a low-intervention and/or no-intervention labour and understand the skill set and assistance a birth doula provides can support those goals even further then I can alone, or solely with my birth companion. 
  • I experience anxiety with hospitals, medical equipment, etc.
  • I understand a birth doula may have other areas of help and support that they can share with me to smooth my transition into parenthood. (For example, Lactation Support)
  • I feel birth is more than just a biological event, and would like to work with someone who treats it more holistically. 

If you answered NO to #2, I would highly recommend a doula. 

If this has piqued your interest or you’d like some more questions answered, you can book a complimentary Meet & Greet with a doula from our collective today! We’ll spend about 15 minutes with you in a video chat to answer you personal questions and help you decide if we’re the right match to support you in your birth!

Dr. Olivia Chubey, ND

*Evidence Based Birth, “Evidence on: Doulas”, May 4, 2010, Rebecca Dekker, PhD, RN.

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Alternative Options to Pain Medications

To epidural or not to epidural… is that even the important question? 

Dr. Olivia Chubey, ND

Do you want an epidural?

Great!

Do you want to labour and birth without an epidural?

Great!

Do you want to wait as long as possible before getting one?  Or, get it as soon as possible?  

Regardless of your personal preferences or medical necessities, in every circumstance – the real question is ‘can I cope with this’? 

Cope with discomfort, with pain, with the pressure of being a parent, doing the right thing for me – for baby…and the list of things goes on and on….   

The birth of your baby and the labour process, is a complex, enigmatic, beautiful collision of science, faith, luck, love and transformation.  But when discussed in modern science – it is usually reduced to pain. (If I were to extrapolate further, the entire birth experience often is reduced to: whether you will tear, what gender you are having/do you have a name, and whether you will breastfeed)

And I get that.  Pain is scary.  We are also wired to want to avoid pain, just like birth – it’s human nature, so it’s no wonder it’s become such a focus of our energy.

So whether or not you want, or need, the epidural, there are so many techniques/ways of being that can help get you more comfortable and able to cope – so that birth can be more than just about the pain.

Here is a quick breakdown of some of them

  1. Breathing Techniques
  2. Visualization techniques 
  3. Relaxation techniques
  4. Using hand on manual therapies
  5. Positions
  6. Water
  7. Music 
  8. Affirmations 
  9. Education – understanding your body and also the hospital interventions
  10. An active birth companion [partner doula or otherwise] and supportive healthcare team

I want you to know these and how to use them. 

I am deeply passionate about sharing the education, training and experience that I have with you. I want to support you through one of your most vulnerable experiences. 

My hope, by doing so, is to further reduce the statistic of you calling your birth a ‘traumatic experience.’ 

Connect with me, or anyone on our team – we are all just as passionate about this!

We can talk about what your needs are and suggest what course of action we recommend based on your unique needs. 

Or, if you just want to learn these techniques – click here to learn more about our Confident Birth Program or email info@yourdowntowndoula.com!

Dr. Olivia Chubey, ND

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You *just know* how to parent!

Dr. Kim Abog, ND

Have you ever had a strong hunch about something and it turned out to be true? Have you ever defied that little voice in your head (much to their dismay) and felt regret about it? 

As a parent, you may have already had several introductions, friendly or rude, with your parental gut instinct

“How to Trust Your Intuition”

Planning for parenthood can feel overwhelming.

When people become parents, they may naturally become open to learning about different aspects of parenthood and childcare to brace themselves for raising children. Many seek counsel from books, families and friends, classes, websites, and doctors and specialists. 

While the above traditional methods can help to sharpen child-rearing acuity, they may not be enough to prepare you for the imperfect mess of parenthood. Yes, that part of parenthood where everything you’ve read, seen, heard, or learned gets thrown out the window and seems to contradict what your child needs. That is because there is simply no way (yet!) to pass on instinctual information and intuition.

“Something feels wrong.” You’re probably right.

Your gut instinct, also known as gut feelings or intuition, is your natural ability that helps you decide what to do or how to act without thinking. Gut feelings are thought to be signals communicated between your brain to and from your digestive tract. Some experts also postulate that emotions play a key role in decision-making (naming gut instincts as somatic markers). 

There is still a lot to learn about the engrossing overlaps between the worlds of psychology, neurobiology, and gastroenterology. One thing experts generally agree on is how parents (research-wise, mothers in particular) can be more sensitive or susceptible to particular cues and signals from their children. 

Science has not fully caught on with Nature’s Human Parent Design yet but we are seeing some fascinating evidence of intuition in action. 

The Pregnancy Brain 

Mom, your brain will adapt!

A 2017 study has shown that pregnancy causes substantial changes in brain structure, primarily reductions in gray matter volume. Gray matter loss is not necessarily a bad thing in pregnancy, because the volume reductions occurred in regions that enable us to read social cues (ie. reading baby’s behavior intuitively). These same regions had the strongest response when mothers looked at photos of their infants. Gray matter loss was only seen in (new) mothers but not in fathers. It’s not clear why women lose gray matter during pregnancy but this may be evidence that brain remodeling may play a role in helping women transition into motherhood and respond to the needs of their babies. These reductions lasted for at least 2 years postpartum.

New Parent: trust your gut!

The Sixth? Seventh? Eighth? Sense

There are also some studies that have noted the significant value of using solely the parent’s recognition of baby’s cries, touch, and/or concern in proceeding with the management of fevers and ear infections. Generally speaking, parental concerns may be more useful to exclude the possibility of health issues than “rule in”. These global findings also amplify the need for care practitioners and advocates to promote and prioritize parental well-being in health practice in order to strengthen parental intuition

You just know.

Parents: You’ve got this!

Parenthood is a steep learning curve, and one that you’ll be on for an indefinite amount of time. You will always be a parent. You just become more comfortable with the uncertainty. Getting comfortable means trusting and believing in yourself enough to know that you are capable of taking care of and advocating for your family. It is also in knowing that there is no one right way to do so. You got this; you always have. 


Dr. Kim Abog, ND

 

Sources

https://pubmed.ncbi.nlm.nih.gov/23591865/

https://www.ncbi.nlm.nih.gov/books/NBK75333/

https://www.racgp.org.au/afp/2012/september/a-is-for-aphorism

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

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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.

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: 

  1. 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. 

  1. 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.  

  1. 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. 

  1. 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.

  1. 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! 

  1. 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!   

Dr. Ee Von Ling, ND

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