Transition

This is the phase between Established Labour and the Birth, where the cervix dilates from 7 or 8 centimetres throught to 10 centimetres or full dilatation. Contractions are at their most powerful and intense, and come close together. Transition can be only a few contractions long, or it might last for a couple of hours.

It is at this point that the body spontaneously releases nor-adrenaline. The release of this hormone in the presence of the existing chemical cocktail swirling around in the woman's blood stream, triggers the expulsive contractions which will push the baby out. Nor-adrenaline 'wakes up' the woman at the most intense point in the labour process. Transition is often the 'crisis point' for labouring women, for this reason.

The process

Transition is a distinct phase due to the fact that the woman's body now starts to release the hormone nor-adrenaline. Nor-adrenaline is the hormone which drives the body’s expulsive birth reflex and so the woman's body is getting ready to push the baby out.

During transition contractions are at their longest (60 – 70 seconds), their strongest and are very close together (2 minutes), sometimes they are even on top of each other, or with double peaks. These contractions are so powerful, they can open the cervix rapidly and the last couple of centimetres of cervix is pulled up into the uterus in a relatively short space of time.

If the waters haven’t gone yet, they may go now because of the force from these powerful contractions. This brings the baby’s head directly onto the cervix, triggering a strong release of oxytocin which results in heavy, intense and sustained contractions.

The baby moves deeper into the pelvis and completes its rotation to bring its back to the mother's the front.

Women who have been in an altered state of consciousness during Established Labour, tend to ‘wake up’ again in Transition, due to nor-adrenaline release. This can make Transition an extremely challenging time. It is often the time when many women want to give up. These responses can be a good indicator that the baby’s birth is not far off.

What you could do to help yourself

Your body will release nor-adrenaline in preparation for the birth, this will wake you up and make you more reflective upon the experience of your labour. Even though nor-adrenaline will 'bring you round', your brain is still bathed in some very powerful neuro-chemicals (oxytocin and endorphin) and things will not feel normal. Women often become very fearful in Transition, this is due to the effects of the hormones and not necessarily because anything is wrong. If you start to feel fearful for yourself or your baby, try to remember that this can be a normal response to the hormones driving Transition.

You may find that the distraction techniques that worked for you during Early Labour will be helpful again now for example:

• concentrating on your breathing and deliberately slowing it down;
• counting as you breathe out to slow your breathing down;
• using learnt relaxation techniques.
  

You could remind yourself that the new intensity is a sign that labour is progressing and that it is a normal part of the process.

If you feel panicked, close your eyes or pick something to focus upon, remind yourself that this will end with your baby in your arms.

It is very hard to get comfortable in Transition, trying something new will take your mind off things and buy you time. Getting into the shower or the bath / birth pool could provide you with the comfort you need until your body begins to push your baby out.

What partners can to do help

The suupport you provide to your partner in Transition will increase her chance of experiencing a normal birth. Do not be surprised if her resolve crumbles now. She might start saying things that really don't make sense like,  'I'm going home', or 'I'm not doing this any more'. She might ask you to make it stop, to fetch the anaesthetist or to just get the baby out. The crisis she is experiencing is real, but it is related to the change in the hormonal balance of the labour rather than because something is wrong. Her body's nor-adrenaline release has brought her back into her head at the most intense part of her labour. She might say that she doesn't care about her preferences for the birth now, and that if you let her have an epidural / a caesarean, she isn't going to mind about it. Women will often ask their partners for permission to make the choices they had hoped to avoid.

So how do you handle this? The answer is that it isn't easy.

Ideally you will have a midwife with you who can help you to support your partner through Transition. She will be able to reassure you that what you are witnessing is normal and she will be able to tell you that this is just Transition. Many women who have been asking for help with the pain of labour, will stop once they know that they have reached Transition. They know that the birth is close.

• Help your partner to normalize what is going on – ‘You’re doing really well, this is just Transition’, ‘Your labour is progressing’, ‘You’ll will be meeting your baby soon.’
• Help her to regain her focus – to take one contraction at a time. Support her to stay in the here and now.
• If there is any time between contractions help her to relax, massage can be useful here.
• Be there physically. Women often need strong physical support in Transition to help balance the turbulence they are feeling internally.
• Distract her mind - refocus her upon her breathing, use learnt relaxation techniques if you have them.
• Try something new like the bath or the shower - this can work wonders in Transition.

If your partner really wants to give the epidural a go and you know that she had wanted to avoid it, you can try telling her that you will help her to arrange for the anaesthetist to come, but first you are going to try all the other forms of pain relief, for example:

• focused breathing;
• a TENS machine;
• learnt relaxation techniques;
• massage and touch;
• the shower;
• the deep bath;
• and, the 'Gas' (Nitrous Oxide and Oxygen).

If you have planned to have your baby at home or in a Birth Centre, the fact that you will have to transfer out in order to access the epidural can make this process easier. The thought of transferring can be a big dis-incentive.

If you have exhausted all possibilitiies above, you might feel that it is time to call the anaesthetist. Asking your midwife or doctor for a vaginal examination at this point could give your partner all the encouragement she needs to hang on until her pushing contractions begin. It is possible that she is already 8 or 9 centimetres dilated.

It can often take a little time for the anaesthetist to arrive, and then....your partner might just start pushing before the epidural can be sited.