Tag: confident birth

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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:

  1. 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.
  2. 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.
  3. 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:

  1. 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
  2. Help keep track of contractions
  3. Applying relaxation and comfort measures such as a massage or counterpressure techniques to relax the birthing person
  4. Be on stand-by for ice, drinks, and snacks
  5. 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:

  1. Help cut the cord
  2. Cuddles and skin-to-skin time with the baby
  3. Perform baby massages as babies respond well to touch
  4. Learn how to feed and bath the baby
  5. Help settle the baby when they are crying or are fussy
  6. Sing and talk to the baby
  7. Go for walks with the baby
  8. 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:

  1. Find relaxation techniques for yourself as the process may feel overwhelming to you
  2. Make sure to take adequate rest breaks when it works for your partner
  3. 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
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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

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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.

 

 

 

 

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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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!

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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.

✎ 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: 

  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. EeVon 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
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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.

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Getting a Handle on Prenatal Health

by Dr. Yasmin Amini, ND

Pregnancy is a time of anticipation, preparation and excitement about many things to come! Nine months worth of questions and answers is what we, at Your Downtown Doula, are here for.

The prenatal period is unique for every family!


As Naturopathic Doctors and doulas, not only do we provide education and information, we also provide therapies and treatments. The prenatal period is unique for every family, and the challenges and milestones are experienced differently. Some common areas of service during the prenatal period include and are not limited to:

  • Proper supplements: doses and brands
  • Nutritional guidance: what to eat and what to avoid
  • Exercise: beneficial positions for mom and baby, healthy movement
  • Symptom management of all things pregnancy
  • Physical therapies with acupuncture, cupping, massage

As pregnancy progresses, you may be confronted with an overwhelming amount of decision making, from labour and delivery, to baby products, physician referrals, and the list goes on! At Your Downtown Doula, we are here to help you sift through the noise of decision making and give you the information you need to feel prepared and confident heading into the next steps of your journey.

We can help you prepare with the following individualized prenatal services offered at Your Downtown Doula:

(Click the links above to get connected with support today!)

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
Dr. Yasmin Amini ND
Dr. Yasmin offers naturopathic and doula care in English, French, Farsi and Spanish. She also has a focus in postpartum care.
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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!)