• The Fit Midwife

Second Thoughts.....

“I can’t do this"

"I want to go home"

“I’ve changed my mind”

“I don’t want to do this anymore”

I am pretty sure most of you said or thought at least one of these things at one point during your labour. As midwives we generally like these moments in your labour. It usually indicates that you are progressing towards fully dilated and will be ready to birth your baby soon. And some of the things you say are pretty funny....

We call it ‘transition phase’. It does exactly what it says on the tin. In this phase of labour you are transitioning between the first and second stage of labour. The first stage is from 4cm to 10cm. The second stage is the pushing/birthing stage.

Transition is often described as the most intense or painful stage. It usually occurs between 8 and 10 cm. This phase is only temporary and lasts approximately 10-15 minutes (4 or 5 contractions). In some women the transition stage may last longer unfortunately.

During transition, your body releases a flood of adrenaline, waking you up so you are alert and lucid. Which is why transition is often a crisis point for most women. Think about it…. In the wild, adrenaline triggers the fight or flight response, so mammals can move themselves and birth their young safely to avoid predators. It is no different for us. Your body knows what is about to happen and it responds in this way to ensure the best environment for birthing your baby.

The Signs of Transition:

Like any pregnancy or labour, every woman’s experience of transition will be different. For some women, the shift from active labour to pushing is unremarkable. There is no defining transition and they are simply ready to push. Others experience it all…..

Emotional Signs Of Transition:

- You may completely (for want of a better phrase) lose your shit!

- The ‘I’m done/I can’t’ statements: You may suddenly wake up out of the endorphin soaked haze you’ve been in for some time, and just decide you can’t have this baby today. Or ever. Or you need drugs right now.

- You become be incredibly irritated by everything and everyone around you. Your partner just cannot do right for doing wrong. This is often the part where they get told to f*ck off and reminded they do not understand at all and that this is all their fault.

- Some women become incredibly focused and almost withdraw into themselves. They may find it difficult to communicate although they will say later they could hear and understand what was being said, they just couldn’t respond.

- Restlessness and just not knowing what to do with yourself, wanting to be touched then hating it, wanting company then telling everyone to buggar off.

Physical Signs Of Transition:

- Nausea

- Vomiting

- Shaking or trembling

- Sweating, having hot or cold flashes

- Dry mouth

- Feeling strong pressure in your bottom

- Long, frequent and intense contractions

Talking of that pressure in your bum it is worth mentioning by the time your cervix is fully dilated and transition is over, your baby has usually descended more into your pelvis. This is when you might begin to feel pressure, the kind you get if you have to poo. Some women begin to bear down spontaneously – to “push”. Some babies descend slightly earlier, before your cervix is fully dilated and you may feel the urge to push before you are actually fully dilated. If this happens you will be encouraged to breathe and blow by your midwife to prevent you pushing prematurely because that just never helps.

If you've had an epidural, the pressure you'll feel will depend on the type and amount of medication you're getting and how low the baby is in your pelvis. If you'd like to be a more active and aware in your pushing stage, ask to have your epidural dose lowered at the end of transition.

Attention all birth partners:

Often all the supportive techniques (I am mainly talking about visulaising your cervix opening like a flower when it feels like it is exploding like an atom bomb) that you have used effectively up to now may be a source of annoyance during transition.

I have seen a hypnobirthing CD ripped from the player and hurled across a room because... "I hate that CD woman, she thinks she knows everything". We all laughed afterwards at what a good throw it was as it lay in pieces after hitting the wall.

Most people do not plan for transition. If I had £1 for every time a partner told a mum to ‘remember her breathing’ and she tells them ‘I’m bloody breathing, stfu!’ then I would be writing this from my villa in the Maldives. Your partner may push you away. Don’t take it personally. It is really difficult to see a loved one in pain. But just be there and hold their hand... or stand at a safe distance.

During transition women are very open to suggestion. When Doctors or Midwives cannot identify or appropriately cope with this stage they can often offer medication of intervention to expedite the stage. This can lead to accepting intervention that you previously did not want…. epidurals, breaking of waters etc. This is where your birth partner (and hopefully your midwife) can advocate for you. Believe me, if you get to transition with your waters intact then rupturing them just because you are transitioning is not appropriate. All decisions need a rationale. Transition is normal.

Top tips for coping with transition:

  • Change positions…. Move around and try and find another comfortable position. Will you find it?? Maybe not. But it will kill some time. Also, if you don’t try you won’t know if there is a better position for you during your labour. Grit your teeth and move!

  • Encouraging words….. Your partner and midwife should be encouraging you in ways that suit you. “You can do it” gets really old really quickly. Yes I hear myself saying it and roll my eyes. I am guilty here too. But instead try asking to be reminded that this is normal, that it is the shortest phase, that you will meet your baby soon. Words like these will help slightly more.

  • Being focused….. Have you ever started an exercise class or run and found that near the end you just want to pack it all in. Your body is tired and muscles sore. But you push through that mental barrier? Well that is exactly what happens in labour too. What happens if you give in?? Lots of interventions and medications that you didn’t want. Use that to remind you of your end goal.

  • Control your environment….. lights down, minimal people, music on if you want it. I once looked after a lady who had the same Courteeners song on for her entire transition and singing the words helped her focus as she swayed from side to side clinging on to her partner. Still one of the coolest births ever for me too.

Transition can be a crazy time. I won't sugar coat it.... It will really hurt. It can bring out a side of people that resembles the exorcism of Emily Rose. But whatever gets you through is good by me. The key for transitioning is most definitely having a good support system and a good midwife. We don’t mind taking the abuse, it’s water off a ducks back and we know how to facilitate the transition stage. We know how to relax you and how to distract you.

In your birth plan perhaps make a list of things that you think may relax or distract you during this stage. Anything at all. A list of tools for the midwife and your partner so they will hopefully annoy you that little bit less if you do encounter this intense stage!

Nikki xx

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