Transition: The Most Intense Phase of Labor

Transition, unlike active labor, is the storm before the calm that is the pushing stage.  It is by far the hardest part of birthing, but also the shortest.  It is here that a mother's focus might falter.  This is the stage where women may doubt their ability to birth the baby and request medications. They may worry about how long labor will last and how much more intense it will become.  Mothers become suggestible at this time and are the most vulnerable to accepting interventions they previously did not want.  It is at this stage that the birth companion must be vigilant to her emotional needs and be her voice of reason should a cascade of interventions be suggested.

When a woman experiences these feelings, this indicates labor is almost over and the pushing stage will soon begin.  Labor does not keep increasing in intensity.  Once the contractions peak, they don't become longer/stronger but maintain that same intensity.  Mothers should be encouraged to focus on the fact that in between each wave, she feels perfectly normal and to take advantage of this rest period to fully allow the contractions to do their work of increasing the cervix dilation and maneuvering the baby down through the pelvis. In this phase, dilation will go from about 7 centimeters to 10 centimeters of full dilation and 100% effacement. The contractions may last up to 90 seconds and be 2 minutes apart. They may have a double peak or feel as if they come right after another with little respite between them.

WHAT & HOW She 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 women require the most mental, physical and emotional support. They can benefit from any and all relaxation techniques and comfort measures.  If she at any time says, "I can't do this", she is most likely saying she needs to be reminded that she can and is capable of birthing her baby.  Staying grounded in the present will aid these feelings. If she begins to fear what is to come and if birthing will become more intense, then anxiety will rise as relaxation decreases.  Once she says anything along those lines, it's a good indicator that the pushing stage is about to begin, which typically offers much relief from the intensity of transition.

Actively recognizing that she is in transition will help her handle the phase much more comfortably by realizing it is almost complete.  Holding focus on the fact that each contraction is one step closer to holding her child can also be a powerful motivator.  This stage is fast and furious and will soon be over.  Time may also seem distorted which can make this phase of birthing more manageable and pass more quickly. Use of movement and various birth positions can also aid in bringing the baby down and passing through this stage more quickly.

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 efforts at a natural birth. Unnecessary interventions may be suggested or attempted without consent, as the ability to make decisions and verbalize wishes are limited in this phase.  The birth companion is essential at this stage to act as the mother's advocate.  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 the necessary time to evaluate the choices before deciding on a course of action.

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 difficulty stepping back and letting labour unfold, especially as it takes longer than a managed birth.  However, by refraining from unnecessary interventions, risks to both mother and child are minimized.

Above all, remember that transition is but a small part of the birth, although the most challenging. The the next phase, pushing, should bring welcome relief.

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Page Last Modified by Catherine Beier, MS, CBE