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