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Doula Digest

By Naomi Starsiak

Know the Terms, Pt 1

The question that seems to be foremost on the minds of moms-to-be that I speak with, is, “How do I avoid a C-Section?” It’s a good question to ask since C-Sections are the most common OR surgery in the United States. The World Health Organization recommends a 10%-15% C-Section rate as being optimal, yet New York State has a 37% rate and here in the Mohawk Valley that rate can climb up to 42% depending on the hospital where you deliver.

The first bit of advice I give to moms is: know the medical terms. If you understand the point doctors and hospital protocols are coming from, it becomes much easier to navigate a path to the birth outcome you want.

“Latent” vs “Active” labor – at the very start of labor, contractions are short and sporadic, most often they’re referred to as Braxton-Hicks or practice contractions; this is the latent phase. The latent phase can last for days and there is no need to go to the hospital at this point. As contractions settle into a regular pattern and increase in length, labor shifts into the active phase, where everything in the body kicks into “the baby is coming” mode.

The problem for moms is knowing when to go to the hospital. If you show up while clearly in the latent phase, you’ll be sent home. If you come in crying, “I can feel hair and have to push now” you’ll be given top priority. It’s the in-between where things get fuzzy. In 2014 the American Congress of Obstetricians and Gynecologists, the national body that governs OB’s, reviewed their guidelines and set 6 cm of cervical dilation as the point at which labor switches from latent to active.  It should be only after this point that women who come in to a hospital should be admitted, yet a lot of hospitals still follow the old guidelines of 4 cm.

What hospital admittance means for a woman in labor is the starting of a clock. Every hospital has policies on what is or is not “progress” so the sooner you are admitted to the hospital the more time you spend being held up to their standard for an average length of labor. That’s not to say that you should wait until you feel hair, but ask questions of your care providers, especially the nurses, since they are generally the ones who know the most about hospital policies. Ask what the hospital’s guidelines for active labor are and if they match A.C.O.G.’s and the newest evidence.

Naomi Starsiak is a birth and postpartum doula, a placenta encapsulator, a natural birth consultant, and co-owner of A Peaceful Birth doula & childbirth service. You can find her on Facebook at



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