Transition

Transition is the storm before the calm that is pushing.  It is by far the hardest part of birthing, but also the shortest.  It is here that your focus might falter.  This is the stage where you may doubt your ability to birth your baby and feel like you need medications.  You may feel worried about how far you have left to go and how much more intense it will become.  You will be suggestible and at this time are most vulnerable to accepting interventions whether they will be helpful or not.  It is at this stage that your birth companion must be vigilant to your emotional needs and be the voice of reason should a cascade of interventions be suggested.

Find hope in the fact that if you do experience these feelings, remember that this means you are almost there.  Labor does not keep getting harder and harder.  Once the contractions get to a certain level, they don’t get any longer/stronger.  Focus on the fact that in between each wave, you feel perfectly normal.  Let them do their work. In this phase your dilation will go from about 7 centimeters to 10 centimeters of full dilation and 100% effacement.   

WHAT & HOW YOU MAY FEEL

• Contractions that are Longer and More Intense
• Nausea
• Time Distortion
• Hot/Cold Flashes
• Uncontrollable Shaking
• Intense Pressure
• Rupture of Membranes
• Loss of Modesty
• Loss of Appetite
• Irritability
• Loss of Resolve
• Need for Emotional Support

BEHAVIOR & ATTITUDE

• Feeling Out of Control
• Foggy
• Averse to Distractions
• Disoriented
• Self-Doubt

OTHER SIGNS & SYMPTOMS

• Vomiting 
• Rectal Pressure
• Inability to Find Comfortable Positions
• Unable to Talk
• Difficulty Breathing

MANAGEMENT STRATEGIES

This is the time to pull out every trick in your bag. You can benefit from any and all of the relaxation techniques and comfort measures.  If you at any time you say, “I can’t do this”, what you are really saying is that you need to be reminded that you can, and are, capable of birthing your baby.  Bring yourself back to the present.  If you begins to fear what is to come and if birthing will become more intense, then your anxiety will rise as your relaxation decreases.  If you say anything along those lines, it’s a good indicator that you are almost ready for the pushing phase that usually offers much relief from the intensity of transition.

If you can actively recognize that you are in transition, you will be able to handle the phase much more comfortably because you know it will soon be over.  Hold your focus on the fact that with each contraction, you are one step closer to holding your child.  This stage is fast and furious and will soon be over.  Time may also seem distorted which can also help you manage this piece of your birthing.

WHAT YOU MIGHT DO

• Change Positions Frequently
• Focus Your Mind on the Present
• Use Water
• Get on Hands and Knees
• Remember to Breathe
• Use Visualization
• Focus on the Baby

WHAT YOUR Birth COMPANION MIGHT DO

• Cold Compresses
• Massage Techniques
  
• Emotional Encouragement
• Cue Phrases
• Tell Her She's Almost Done
• Keep Her Focus on the Present
• Keep Her Environment Calm and Quiet
• Whisper Affirmations

This is the stage where an unsupportive care provider may undermine your efforts.  Needless interventions may be suggested or even forced upon you, knowing that you cannot resist nor make good choices.  The birth companion is essential at this time in preventing this from happening.  If such interventions are suggested, have the birth companion start by asking why it's being suggested, what the options are, and if the situation is an emergency.  If not, then take your time to evaluate your choices.

Realize that most doctors and nurses have never seen a natural birth.  They are not skilled in letting labor take its own course.  They are trained to intervene at each stage, whether it's needed or not.  This interference isn't usually coupled with bad intentions but is usually due to ignorance in normal birth.  They have a hard time stepping back and letting labour unfold, especially since this takes longer than a managed birth.  However, by refraining from unnecessary interventions, you minimize the risks to both you and your child.

Remember that transition is but a small part of the birth and the next phase, pushing, should bring welcome relief.