How to cope during the transition phase of labour

“I couldn’t think. I couldn’t move. I was in survival mode. I was overwhelmed by rectal pressure, and touch was distracting. I wanted an epidural.” For Jennifer Parkinson, memories of the intensity of transition stay with her. She also remembers that it was over quickly (she never did get an epidural) and that soon she was pushing her baby out.

What is transition? Transition is the final phase of the first stage of labour, following early and active labour. At this point, a woman progresses from seven to 10 centimetres, often in less than an hour. The word transition means that her body is making the shift from opening the cervix to the beginning of the baby’s descent. Often during this phase, she starts to feel the pressure of the baby’s head coming down, sometimes accompanied by an urge to push.

But transition is best known for its emotional challenges. Nanaimo, BC, labour nurse Andrea Wing says Parkinson’s responses were typical. “A woman’s behaviour may change. She doesn’t know what to do. She may be panicked or scared, and nothing helps. At this point, some women say, “I can’t do this” or “I need something for the pain.”

Advance preparation Partners in Melissa Cowl’s Alliston, Ont., prenatal class express concerns that they won’t be able to handle seeing their wives crying or losing control. Cowl counters, “In 15 years of attending births as a doula, I have never seen women behave the way they do in movies, screaming and hitting their partners.”

Cowl reassures partners that they know the labouring woman best. They have supported her through other challenges and will rise to the occasion. She advises couples to think now, long before labour begins, about what might help.

So rehearse. At home, you could practise in the bath or shower, on your bed or on the toilet. Imagine some intense moments of transition. Ask your partner to encourage you with his reassuring voice and touch, and by breathing with you as you sigh or moan through the pretend contractions. Talk about what you think might help.

Then write those ideas into your birth plan. This practice will reassure you both that you are ready to work through the toughest part of labour together.

What can I do to help myself? Here are some strategies that have helped other women through transition:

Focus on your breath: It sounds simple but it takes enormous commitment to keep your attention on inhaling and exhaling. Sometimes by transition, a woman is so tired that she appreciates her partner reminding her to breathe with every contraction.

Make sounds during contractions: These may come quite naturally. Often women make low moaning sounds. Low sounds help relax the mouth, which corresponds to a more relaxed cervix and vagina. It may help to focus on particular sounds, such as ohh or ahh, as you exhale, or on a word like open to remind you of the work you’re doing. The sounds may be loud, strong and deep. Some women say their sounds match, or drown out, the intensity of the sensation. Horse lips — exhaling and vibrating your lips like a horse — can relax the tissue around the baby’s head and help resist pushing too early.

Change positions: Melissa St. John’s labour slowed at six centimetres during her second birth. Then a nurse suggested she move onto her knees, with her upper body leaning over the raised head of the bed. “I went from seven to 10 centimetres in 15 minutes!” she recalls.

Wing finds many women like a position on their side with the top knee bent and that leg supported at her ankle and knee or thigh. Then the partner gently rocks the knee from bent to straight. This provides a soothing rhythm during the contractions and helps relax the pelvis.

Let go: How your labour progresses, and how it feels, are beyond your control. Your job is to follow your body’s lead: Accept, and work with, the sensations that are bringing your baby to you. In transition, a new sensation is rectal pressure. Some women tense with this sensation, but your body needs to relax to it. Envision the final opening of your cervix. Soon the pressure will be constant and you will be ready to push.

“This part of labour demands complete surrender,” writes medical anthropologist and doula Cynthia Gabriel in her soon-to-be-released book, Natural Hospital Birth: The Best of Both Worlds. “During transition, the rational mind is wholly subsumed. Some women describe transition as an out-of-body experience.” Let your partner deal with the external world, while you focus inward.

Ask for help: Even if you don’t know what you want, you are letting your support people know that they need to do more.

Partners: How can I help? Most women say that they couldn’t have got through labour without their partner. They often say their partner kept them focused and gave them a sense of security.

Talk to her: “Hearing my husband say, ‘I love you’ was my private epidural,” Gabriel remembers. She refers to this as a connecting phrase, grounding and reassuring her when she was experiencing the big emotional shift of transition. Other phrases you might say:

• “Breathe in. Exhale down your body.” • “Breathe your cervix open.” • “I know it’s hard.” • “You’re doing it.” • “You’re safe.” • “You’re almost there.” • “You’re so close to having our baby.”

Stay close: Be by her upper body so she can feel your presence, hear your voice and even look into your eyes.

Keep her cool: During transition she may become very warm. You can give some relief by fanning her. Wipe her brow, neck and face with a cool washcloth. Leave it on her forehead, but remember to exchange it often for a cool, fresh one. Offer her drinks of juice, water or ice chips.

Try touch: Many women want less or no touch at this point, but some appreciate a firm hand on their arm or shoulder. Some women reach out to hold their partner’s hand. She may squeeze very hard so you might want to remove your rings or adjust her hold.

Help her move: In her second labour, Parkinson went through transition in the shower. She knew her baby was close, but couldn’t imagine leaving the shower, so her husband stepped in and helped her to the bed.

Can I manage without drugs? Cowl says that how you cope in early and active labour is how you will cope in transition. If you have made it to transition without pain medication, you can go the distance. A woman in one of Cowl’s doula- training workshops put it this way: Labour is progressive, like math. You need grade one, then grade two and all the way to grade seven math in order to do grade eight math. You work through it and find that if you can do grade seven math, then you can do grade eight.

What if I do want pain meds? Because transition occurs just before pushing and is usually short, if you ask for pain medication at this point, your options may be limited. There may not be time for the epidural procedure before you are ready to push. And because you’ve made it this far, you may, with encouragement, find the strength to go further. If you experience a longer transition, there are usually pain relief options, such as entonox (“laughing”) gas, to help you get through.

Is it always so intense? Like other aspects of labour, each woman’s experience of transition will be different. For some, it is an unnoticeable shift from active labour to pushing. In transition with her first baby, Parkinson sat on the toilet to cope with the rectal pressure she was feeling. She found herself moaning. Soon she felt the urge to push and moved to the bed. Parkinson says this transition was fairly easy.

And when Patty Hill’s labour got intense, she went to the hospital and into the tub. Hill, who prepared with HypnoBirthing, says, “I was able to stay relaxed and focus on my breathing techniques. I was in my own zone, very quiet. I did think, ‘I don’t know how much longer I can do this,’ but didn’t say it.” And very soon she was ready to push.

While you don’t know what your transition will be like, you can be ready for the challenges it may bring. With good preparation and support, you may well amaze yourself. Gabriel tells women that sometimes “labour demands that you reach your limits, and then you find that you can go further. At that moment, women do not feel strong — but when reflecting back on their birth, they will acknowledge their strength.”

Signs of transition You are likely in transition if you are:

• seven or more centimetres dilated • trembling and shaking • sweating, feeling hot or chilled • nauseous, vomiting or having dry heaves • feeling overwhelmed after coping well with active labour; announcing you can’t do it anymore or need drugs • feeling rectal pressure (this may feel like the need to have a bowel movement) • having longer (1½ minutes), frequent and intense contractions

This article was originally published in January 2011.

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