A Doula guide to the transition stage of labour
What is transition stage?
Transition follows first stage of labour, and is literally the transition time between the fully open of the neck of the womb and the foetus ejection reflex, if this reflex is given the space in which to happen. The foetus ejection reflex is a short series of irresistible pushes during which the baby is born.
An experienced doula or midwife will easily spot transition, but a less experienced birth companion may be taken by surprise at the change in the labouring mum.
A mum who has been coping well with contractions may suddenly appear to fall apart. Typically she may cry, or say that she can’t do this any more. The coping mechanisms that she has been using in labour may not work any more. She may suddenly need to change position, which is completely natural and is nature’s way of getting baby into position for birth. She may vomit at this time too. This is a completely normal reaction to the hormonal changes taking place, and the body readying itself for the final ‘push’!
How does it feel?
For the mother, transition can feel like you are reaching rock-bottom. (It doesn't always feel this way, and you may not even experience or notice your transition stage) You have been doing so well, but can quite suddenly become overwhelmed by the force of the labour and feel lost within it. Loved ones may have been a great help during the first stage, but it can feel for a short time like no-one can help you, no-one can reach you or make it better.
You may feel utterly convinced for a very short time that the only thing to do is to go to hospital, and have a Caesarean section because you certainly aren’t going to be able to push this baby out!
Thank goodness this transition time only lasts minutes, and it is important to remember that it does have a very definite purpose of its own.
Do you remember transition stage?
Why is transition so hard?
The way to get through first stage is definitely relax, relax relax. Of course you can walk around, adopt any position that feels comfortable, be upright as much as you can, but throughout it all, avoid tensing up. Tensing up will work against the involuntary action of the muscle fibres of the womb and this can cause the sensation of contractions to feel painful.
The hormones of first stage promote a state of consciousness which supports relaxation, but when the mother is nearing the time that her body is going to expel her baby, and she is going to bond with and care for it, her state of consciousness needs to change, and transition stage is nature's way of effecting this change in consciousness.
Transition is the big upheaval time. Inside the mother’s body physiological changes are taking place, hormones are waking mum up, readying her for birth. Up until now, it has been beneficial to keep adrenaline production as low as possible, so as not to interfere with the flow of oxytocin, the love hormone which governs labour and birth.
Now, at transition, adrenaline comes into play, and as it is the ‘fight or flight’ hormone, it can actually induce a feeling of antagonism and fear. In one part of the world there is a culture where it is traditional to scare the mother with a loud noise just around the time that the baby is ready to be born. Ancient rituals show knowledge of this hormonal situation, realising that a surge of adrenaline is what promotes birth. If all is going well and the mother isn’t too distressed, some birth attendants maintain that it is better to let the mother go through that short stage without too much overbearing reassurance.
Being there for mum is important. Adrenaline surging through her body can make the mother feel suddenly thirsty. In any case its always good to be prepared with an easy to eat snack and a refreshing drink that she would enjoy, for any time during labour that she wants a little energy boost. She may not need it, but if she does, a sip of fluid and a little snack will make all the difference to her energy levels, and may make a great deal of difference to the outcome of the labour in terms of coping at the very last stages with pushing baby out.
How does it really feel?
You CAN do this!
For mums, this is the time to embody your inner Goddess! Feel free to roar and grunt, groan and wail as you need to. These sounds are not so much cries of pain but the reflection of what is going on inside, reaching down to the primal levels of being, which govern processes like birth.
When the adrenaline surge of fear hits, it may knock you sideways for a moment or two, but don’t worry, you will quickly regroup. Keep in mind that this is a good development, the next big step towards your baby’s birth. Ride the changes, reach out and ask for cuddles and love from those around you, that’s what they’re there for and it will make them feel great to give to you. Keep your humour, there’s a lightness and energy and generosity in humour that carries us through hard times. Let go, trust your body, draw on your birth companions; baby is nearly here!
Practical ways a partner can help in transition
- Have a bendy straw ready, so whatever position she’s in she can have a drink. Adrenaline can cause a sudden thirst.
- If the adrenaline surge causes her to get the shivers, she will love you forever if you’ve remembered to have a pair of fluffy warm socks to hand.
- Ice chips can be refreshing and hydrating to suck if she’s been sick and her mouth needs refreshing.
- A flannel soaked in cold water can be really refreshing on the face and neck.
- A hair tie and brush is great for this time because it can freshen you up to have your hair tied back away from your face.
- Remember some handy snacks, biscuits or crisps are easy, and a fruit juice will boost sugar levels if it's been a while since she last ate, as well as keeping her hydrated. This can really help her to have the strength to push.
- Have a bowl handy, just in case it all comes back up again!
- This is an intense time. If you don't have a doula to remind you, have a drink and something to eat for yourself. She'll need you to be strong, so look after your basic needs for food and drink.
Understand more about the hormones of labour
Ina May Gaskin is a highly respected midwife who understands how to connect with women in labour and bring out the inner strength that enables a low-tech, fulfilling and amazing birth experience. All of Ina May Gaskin's books contain lots of true stories told by the people themselves, which makes for easy understanding of the knowledge she is imparting
Take your pack of bendy straws into hospital with you if you're going in, or keep them handy for birth at home. Drinking through a bendy straw means that the mum to be need not be disturbed whilst she is in a comfortable position like lying forward across a birthing ball or bed, but is needing a cold drink. A small drink of fruit juice towards the end of labour can make a big difference if she hasn't had very much to eat or drink during labour
How can partners best support mum to be through transition?
Well, you can see from the description of transition above, that you are going to have to be ready to hold the space for a vast array of powerful emotions. It may mean calling on all your strength in order to support someone you love through one of the most intense emotional and physical experiences of their lives. Stay calm, be trusting in the process of birth, and this will be transmitted to the labouring mum. She will value this steadiness as her inner core is shaken by the massive energies which are bringing a new life to the earth. Be ready with practical things like helping her to change position, or passing a vomit bowl to her. Wipe her face gently (you may be told in no uncertain terms that she doesn’t want this!) maybe offer her a drink of water. This is where your doula, if you have one, will really prove her worth.
Now is the time when eye-contact can be really important. She may well open her eyes over transition and look around for support and help. She will look deeply into your face for reassurance, and this is where your calm and steady state can make all the difference. Her state of mind and confidence in her own abilities are all she has to get her through and into the second stage of labour.
On a practical level, have a bendy straw ready, so whatever position she’s in she can have a drink. If the adrenaline surge causes her to get the shivers, she will love you forever if you’ve remembered to have a pair of fluffy warm socks close by. Ice chips can be refreshing and hydrating to suck if she’s been sick and her mouth needs refreshing. A flannel soaked in cold water can be really refreshing on the face and neck. A hair tie is great for this time because it can freshen you up to have your hair tied back away from your face.
Revel in your hidden strengths
Transition is an amazing few moments in a woman's life. It is a time when women can experience synaesthesia; one sense can be interpreted by the brain as another and a loving touch can appear to the transitioning woman as beautiful music or a colourful vision. This may sound fanciful, but it is true and is a result of the high level of endorphins (natural pain killers secreted by the brain, very similar to opiates) Labour is usually reported negatively by popular literature and media in general, like most of the female experience of life, but there are hidden marvels in our most challenging experiences, its just that we don't often report them, because we are seldom asked.