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Nursing Positions

by Dr. Sarah Winward, ND IBCLC

If you’re exclusively breastfeeding, you’re doing it a lot. Like a lot, a lot. But so often I notice that parents are getting into weird and uncomfortable positions while latching, and then they have to stay there and hold that for the whole of the feeding. You’ve probably heard me say that breastfeeding should never hurt. That also means that it should never hurt in your neck or your shoulders either. So, I wanted to share with you my top two most comfortable positions for nursing. The best part about both of these positions is that they require no equipment – no nursing pillows, no blanket rolls, nothing. Just you and your baby.

The Cradle Hold

Dr. Sarah Winward and Dr. Olivia Chubey, ND

This position involves holding your baby with the same arm as the breast you’re feeding on. I love this position because it leaves your other arm free and because you’re supporting your baby’s weight with your biceps instead of with your wrist (as you would be in football or cross cradle). You can also lean back to put some of their weight on your belly and this is often even more comfortable. 

I’ve recently seen floating around the internet that this position is meant for older babies with more head control. I disagree. I frequently recommend this position to parents with newborns and have them report that they are much more comfortable. Babies are born with good instincts, it’s often easier to latch them in this position because they are able to guide themselves. 

Check out our video for exactly how to get baby latched in the cradle hold.

Side Lying

Dr. Sarah Winward and Dr. Olivia Chubey

Exclusive bodyfeeding means that you’re also feeding your baby overnight. It is exhausting enough doing night feedings, but add in the extra steps of having to get up and move to the couch or arrange all your pillows ‘just so every 2 hours’ and it’s too much. It’s normal for babies to continue to nurse overnight in the first year (plus) of life, having to do this for that long would be literally impossible. 

Enter side lying nursing. I love this position because all you have to do is put baby beside you, nurse, and then pop them back in the bassinet. You don’t even have to sit up. Even better, you can have a partner bring baby to you and put them back down so all you have to do is roll over and nurse and you can stay half asleep for the whole process. 

This position is what makes exclusive bodyfeeding possible. 

Plus, it’s super relaxing for both parent and baby. If baby is clusterfeeding or if you’re having trouble with milk flow, this position is a game changer.

Check out the video on how to latch in this position.

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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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Two Tips to Avoid Nipple Pain when Breastfeeding!

Dr. Sarah Winward, ND IBCLC

Concerned about nipple pain?

Pain with breastfeeding is one of the most common concerns for new parents, and with good reason! How can we be expected to do something for 20-40 minutes, 8-10 times per day if it hurts every time!?

I hate seeing parents in pain, it’s especially hard because to make a full assessment as I have to see baby latching, which means I’m asking them to be in more pain so we can make things better.


Pain in breastfeeding is never normal.

Let me repeat that. 

Pain in breastfeeding is never normal.

Not in the first few weeks, not when your baby is teething, never.

Especially not when there’s damage to your nipples or you’re curling your toes every time you latch your baby. Pain is a sign that something is wrong. 

Pain in chestfeeding is not normal.

If you’re experiencing pain I highly recommend reaching out to a lactation consultant for hands on support. The most important thing is to figure out why you’re having pain so you can fix it.

Here are some of the two most common reasons for having pain with nursing:

A good latch can help you avoid pain.
  1. Latch mechanics– basically this is how you’re holding your baby. We have an article here on how to get a good latch, I recommend taking a look and reviewing it. One of the things I see commonly is that if you’ve had pain, you’re expecting pain and so you hesitate when you go to latch your baby. The hesitation means that baby’s latch ends up being more shallow – which will hurt. So, when you do go to latch them, make sure you’re latching with intention by putting pressure through their shoulder blades. 
What’s going on with baby?
  1. Oral mechanics- this is something that’s going on with baby. This could be a tongue or lip tie, it could be tension in their body or it could be something else getting in the way of their having proper oral function. This is where an assessment from a lactation consultant really makes a difference, especially if the latching tips aren’t resolving the pain. 

A note for those having pain sometimes during the feed but not all the time. This is very common, and usually can be fixed with just a few tweeks:

If you’re having pain at the beginning or end of a feed

Hangry babies can hurt!

Sometimes it takes a few seconds for the flow of milk to get going, if your baby is ravenous they can tense up before the milk gets going and this can hurt. Then, once the milk comes they relax. Catching baby on early feeding cues can help a lot so they aren’t “hangry” when you latch them. The other thing that can help is breast compressions, adding a bit of pressure at the chest wall to pick up the flow. If the pain picks up again once they’ve been on there awhile take this as an indication to switch sides. 

If you’re able to get things pain free but only if you hold your breast ‘just so’

Don’t force a latch.

You’re bringing your breast to your baby. A lot of times parents kind of pick up their breast and put it in their baby’s mouth. What happens is that if you move or change the latch they tense up their mouth because they’re trying to hold on to your nipple. Leaning back and bringing your baby to where your breast naturally lies will help a lot with this. 

If you’ve tried all the tips in this article and you’re still having pain, I highly recommend reaching out to a lactation consultant for a full assessment. For parents in Ontario, you can book a free 15 minute call with me here.

Sarah Winward
Dr. Sarah Winward, ND IBCLC
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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

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Things Your Care Provider Can’t Predict

by Dr. Ee Von Ling, ND

Care providers of pregnant people (OB, midwife, nurse and MD) seem to take pride in somehow being able to predict the future of your labour and childbirth. Do they have a special sense or skill set to be able to do this? 

No.  

They are regular humans just like you and me and they are NOT able to predict very much, if anything at all. But they will have you believe that they can. 

Here is a list of the most common things that your pregnancy care provider may try to predict but they cannot possibly know the absolute future: 

  1. When your labour will start. There is no way to know when your labour will start. Not by the size of your pregnant belly. Not if this is your first or second or 5th pregnancy. Not even if they check your cervix at 40 weeks (if you are still pregnant). And yet, we will hear of care providers telling clients that they will have their baby early or go past their due date purely on a personal hunch. 

Did you know that medicine and science don’t really understand how labour spontaneously starts? This always blows my mind because we certainly have many methods of artificially starting labour. We just don’t know the exact mechanism that causes your body to start its own labour. We do have some understanding that the baby influences the start of labour, and this makes sense. When your baby is mature enough to survive and thrive outside, their body secretes proteins from their lungs and brain that can eventually make their way into your blood circulatory system and to your brain. In the brain these signals received from the baby trigger the production of different hormones that prepare and perhaps trigger the body to start labour.  

Around your due date, your care provider may offer to check your cervix. This check is optional and only gives us a snapshot of what is going on with your pregnancy at that moment. Even if your cervix has changed and is showing signs of getting ready (getting soft, moving from posterior to anterior position, starting to dilate by 1 or 2 cm), we can’t tell when labour will start. Even if your baby is low in your pelvis, there is no way to predict when labour will start. 

There is no way to predict when labour will start if this is your first pregnancy or subsequent. Many people hear that first babies come late, and statistically this is somewhat true. According to the US childbirth data available, by 5 days after the due date, 50% of babies of first time parents will be born, and the other 50% are born after this time. What about subsequent babies? By 3 days after the due date, 50% of subsequent babies are born and the rest are born after this time. 

What does this mean? We are born procrastinators (you may groan now). 

There is no way to predict when labour will start according to family history or within the birthin history of the same person. Each pregnancy is different, and this includes when labour will start. That said, research has been able to find some factors that may increase the chance of preterm labour. Some of those factors are genetic and some of those factors are environmental (for example nutrient deficiencies, illnesses, smoking, drinking alcohol or doing drugs while pregnant). 

It may seem harmless to tell a pregnant person that their baby will come early or late. But for that person, such baseless comments can cause unnecessary stress or even cause that person to make pregnancy or childbirth-based decisions that may not be healthy and are certainly not warranted. 

  1. The size of your baby. The only way to get an accurate assessment of your baby’s weight is to weigh the baby after they are born. There is no accurate way to know the exact size of your baby before that. Not by the size of your belly. Not by the amount of weight you have gained. Not by ultrasound assessment.

It is pretty common, although not actually considered a standard part of prenatal care, to be told to get a 3rd trimester ultrasound. The main reasons are to assess the growth of the baby (read: size), amniotic fluid levels and general health of the placenta. Parents will be told, “Your baby is 1234 g”. The care provider might run with this info and say “based on this, your baby will be 4567g at birth. That will be a big baby! You will likely need a c-section”. Then they turn around and leave the room, leaving the pregnant person VERY DISTRAUGHT. 

There is a lot to undo here. First, ultrasound weight measurements are very inaccurate, with at least a 15% margin of error. The inaccuracy of ultrasound to measure weight WORSENS as you get closer to the due date, by at least 20% margin of error. There is no other professional industry that would accept such a high margin of error. Could you imagine if an engineer used tools with such a high margin of error? “I think this bridge will be 50 metres long, give or take 10 metres”. Or if your pharmacist said, “The dose of this medication is 100mg give or take 20 mg”.  Even with acknowledging the margin of error, it is very hard for parents to “unhear” that they may have a large baby. Thinking that a baby is going to be a certain size most definitely influences medical decisions around early induction and choosing c-section.I have had clients choose a c-section based on “big baby” predictions, only to find out the baby was a very average 7-8 pounds. 

Growth in pregnancy is not linear. This means that a snapshot of what is happening now cannot predict what will happen in the future. Weight gain often happens unevenly throughout pregnancy. You or the baby might gain most of your weight during 1 trimester and not as much the next trimester. As long as the placenta is healthy, some babies might be 80 or 90 percentile for weight during much of the pregnancy (according to ultrasounds) and then end up being 50% for their birth weight (real life weight).  

Let’s also not underestimate the amazingness that is your body. I have attended births where the parent vaginally birthed (and often without an epidural), 9, 10 and almost 11 pound babies. We just had no idea of the baby’s weight and just focused on her being able to birth her baby. 

Don’t get me wrong, ultrasounds can be a useful tool to track trends in a pregnancy. We can track over a series of ultrasounds that a baby is growing well, or not well, or is trending on the upper end of the weight charts. We cannot make such a guess based on just one ultrasound picture. Even so, there will still be surprises at birth. No technology that currently exists is perfect. 

Ultrasounds aside, any other comments on a person’s weight related to baby’s size should stop as there is no relationship between the two. In fact, let’s just stop comments on the size of people’s pregnant bodies altogether.  

  1. How long labour will last or how it will progress. When labour starts, your miraculous body is working to eventually accomplish a few things: a) Softening and thinning out the cervix from the firmness of your nose to the stretchiness of a piece of very thin spandex material; b) Drawing open the cervix so that it is fully dilated and “gone; c) shifting the muscles towards the top of the uterus so that they can better move the baby down into the vagina; d) Moving the baby around the pubic born to e) emerge and be born out the opening of the vagina.

There is absolutely no way to accurately predict how long any of these stages will take. Checking the cervix and the station of the baby (how far down they are in relation to a specific point in the pelvis) are a couple of the ways to assess how the labour is progressing. The softening of the cervix (step a) is expressed as a percent with 100% being completely soft and stretchy like a piece of spandex. It takes a lot of work for this to happen and it needs to happen in order for the cervix to open fully. Sometimes the cervix effaces completely first and then the cervix starts to dilate. So if the cervix is only minimally dilated (say only 1 or 2 cm) but it is 100% effaced, that is still a very good sign because the cervix can easily and sometimes quickly dilate to 10cm. 

Other times, the cervix softens a little then dilates a little, then softens a little more and so on. So when checked, the cervix may be 4cm (yay!) dilated but 50% effaced (still good, but more work and time may be needed for the cervix to become completely effaced and dilated). 

There are also those times when me and the birthing team are completely surprised when all of a sudden the parent goes from 5 cm to fully dilated within an hour. 

And while the cervix is changing, the baby is moving downward. The system of assessing this movement is called “stations”. Zero stations means the baby’s head is aligned with a bony landmark within the pelvic called the ischial spines (or simply “spines”). If the baby is higher than this, a negative number is used, like -1 or -2. If the baby is lower than this, it means the baby is descending into the vagina and positive numbers are used + 1, +2 and so on to +5 being the baby’s head is about to be born. In a textbook labour, when the cervix is fully dilated, the baby is at zero station. In real life the cervix can be dilated and the baby is at -2 station (still high), or the cervix can be just 5 cm dilated and the baby is at zero station (quite low). 

All this information just illustrates that there are too many factors in play to be able to predict or dictate how fast a labour should progress. Unfortunately a long held “formula” (called Friedman’s curve) is often quoted: “We expect your cervix to dilate 1 cm every hour.” This rate was created by a Dr. Friedman based on his observation of 500 births in first time labouring women aged 20 – 30 years old in the 1950’s. He was the first to put a timeline on labour and his observed rate of dilation in his limited population of study has been used as a guideline ever since. As you can imagine things have greatly changed since the 1950’s and this very limited view of labour can no longer be applied. To read a full and thorough critique of using Friedman’s curve you can read this article by Evidence Based Birth.

The main point here is that there is a huge range of how long a labour may last. As long as the birthing parent and baby are doing OK and as long as there are signs of labour progressing (cervix is changing, baby is descending), then we just need to afford you the time to allow your body work and make childbirth happen. 

Dr. Ee Von Ling, ND
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Choosing the Best Bottle for Baby

Dr. Sarah Winward, ND

Choosing a bottle can be confusing, especially if you’re planning on primarily breastfeeding/ chestfeeding. You’ve probably heard about nipple confusion or bottle preference and, rightfully, you’re a bit worried about this happening to you! 

As an IBCLC, I regularly support families who use bottles some or all of the time. Here are my tips on what to look for when choosing a bottle for your baby:


  1. Is it comfortable for you to hold?

This has nothing to do with baby, but if you’re planning on using bottles regularly, it needs to be comfortable. Some of the bottles on the market that are designed to “mimic” breasts are not remotely ergonomic. I recommend holding a few of different sizes to see what feels best for you.


  1. The nipple should be long with a wide base, not “nubby”.

These are the 2 general shapes you’ll see for both bottle nipples and pacifiers. A “nubby” nipple often encourages babies to have a very shallow latch, because their mouths rest comfortably around the nub and their lips end up on the smallest part. You want your baby to have a wide open mouth to avoid pain with nursing, these types of bottles are not doing you any favours. Try to find a nipple that is longer with a wide base. When you’re bottle feeding make sure your baby’s mouth is fully down around the base of the nipple so their mouth is wide open.


  1. Look for a slow flow nipple.

Bottle preference generally happens because bottles have very fast flow. While bodyfeeding, you have to ask for the milk to flow in order to get it going. If you tip a bottle upside down milk will drip out the nipple. When a slower flow nipple, you get less of that dripping because the hole is smaller. That means it’s going to be less overwhelming for baby if you do tip it up and it means that baby has to work to get the milk moving. 


The biggest thing to remember is that HOW YOU FEED YOUR BABY MATTERS THE MOST. Paced bottle feeding is a bottle feeding technique that mimics the flow of milk from the breast. We have an article on how to pace a bottle, including a video here.

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Paced Bottle Feeding

What is paced bottle feeding and why should you care? 

As a breastfeeding advocate, I am very much in favor of babies breastfeeding anywhere and all the time. But, it would be naive of me to think that this is realistic for every breastfeeding dyad. Lots of families choose to bottle feed some of the time and breastfeed other times. How you breastfeed a bottle fed baby matters, though. It's all too common that I see families soon after they've introduced a bottle because their baby has started becoming fussy at the breast or is refusing to breastfeed altogether. This is where paced bottle feeding comes in.

Paced bottle feeding is a technique that allows the baby to have much more control over the flow of the feed, and also mimics the flow of milk from the breast alot better. Babies don't get nipple confusion- they get flow preference. If you tip a bottle upside down you'll notice that milk starts to drip out, bottles are fast and consistent. Milk flow from the breast ebbs and flows depending on whether you're having a letdown or not. In fact, for parts of a breastfeed babies are getting no milk at all. Babies are smart and often develop a preference for the easier and faster flowing bottle.

Benefits of Paced Bottle Feeding

  • Baby has contol over how much they eat, so you aren't at risk of over feeding or under feeding them
  • Less chance of overfeeding often leads to less fussy babies because they aren't uncomfortable from having a distended stomach
  • Easier time going back and forth from breast to bottle
  • Although this has not been studied, because baby is controlling their intake this should help preserve the mechanisms in breastfeeding that prevent obesity and type 2 diabetes later in life

Are you planning on breastfeeding? Get started out right with our Free Breastfeeding Basics Guide. Grab it here!

How to do it

Check out the video below for a how to guide on paced bottle feeding.

Key points

  • Start the feeding with baby sucking on an empty nipple for a few seconds, this is expecially important if you've noticed your baby starting to get fussy at the breast
  • Keep the nipple 50% full of milk so that they baby can access it by sucking but it doesn't just pour into their mouths
  • Give your baby periodic breaks when you tip the bottle down so there is no milk available
  • You'll know it's going well if you see your baby taking pauses where they aren't sucking at all
  • Let your baby tell you when they are done and don't force them to finish what is in the bottle