First Stage Labor: Transition
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Sweet Peas, Pods & Papas: All About Birth, B@@bs & Babies

First Stage Labor: Transition

One of the topics we spent some time on last night is the stage of labor between Late First Stage and Second Stage – the short and important phase of Transition.
 
My goal for our Bradley Method® classes is to help a coach identify transition as it happens so that he can be the rock that the mom needs, and give her the encouragement that she needs as she asks for it and/or demonstrates that it’s time for him to step up his game.  I also hope that the moms in our classes accept that this is another necessary part of labor and that they are willing to turn inwards and touch their core strength and embrace it to help them welcome their children into the world.
 
As I have discussed before, labor was designed for a reason.  As such, transition is part of the process that a woman must experience as part of the labor process.  It is an emotional journey as well as a physiological one.  Let’s look at the physiology first.
 
So what is the physiological experience of transition?  It is a time when the body is undergoing chemical and hormonal changes to switch from positioning the baby in the uterus for their exit, to physically pushing the baby through the exit and welcoming baby into the world.  The cervix is dilating from 8 to 10 centimeters – the very last work it’s going to do to get out of the way and clear the opening for the birth canal.
 
The uterus is changing the type of contraction from a massaging type to an expulsive type.  The body is making its final preparation for welcoming the baby – the oxytocin that stimulates mom’s contractions is also going to help her bond with her baby.  There may be a surge of adrenalin for the energy she needs to wake-up from her trance state of late first stage to be aware for her pushing stage.  There is a wash of prolactin to aid with breastfeeding.  To top it off, there are endorphins released for natural pain relief – Mother Nature is quite kind in that she provides pain relief for the pain she is also causing! 
 
Interestingly, if a mother is having an epidural, the endorphin cycle is cut off, which is why some women report a tremendous amount of pain after the epidural wears off.  On the other hand, most unmedicated mothers are all smiles after the discomforts of labor subside with the birth of their babies.
 
Some women exhibit physical signs of transition, which include cold feet, vomiting, hot flashes, nausea, cold sweats, shaking and/or burping.  It is important to check the more alarming physical signs against other physical signs like temperature and blood pressure to evaluate whether mom is in transition or showing signs of a possible complication.
 
The emotional signs most commonly associated with transition are confusion, crabbiness, stress, giving up or asking for medication.  In consideration of all the hormones and changes the body is undergoing, it’s easy to see why the mom might be acting like she is out of her comfort zone.  Nothing that she has been doing is necessarily comfortable up to this point, and now there is an added chemical component on top of the physical stress her body is already enduring.
 
In regards to contractions, besides the fact that they are switching from a progressive action to an expulsive action, they may also start to increase in frequency.  A mom may feel like she is having a three-minute contraction. These are also referred to as a “double-peak” contraction, or call it however many peaks your experience.  The reality is that they are all still about a minute long, but the rest period disappears.  In looking back, I can remember the distinct feeling of being washed over as in a wave – it would get strong, then subside; and then without a break, start to increase again. I guess you could say there’s more of a lull instead of a rest period.  They are still manageable – the good news is that although there is no break, they still vary in intensity throughout the course of the contraction.
 
Coaching needs:
Given all the literal transition that is going on, what is it that a mom needs right now?  She needs what ever she asks for.  If she asks for silence, grant it.  If she asks for help, tell her you are there to help her.  If she wants to be touched, touch her in her favorite place.  If she doesn’t want to be touched, don’t even think about it!
 
It’s important for coaches to have a plan in their head for these particular situations:  practice makes prepared.  If you want a “play book” for labor, write a page for possible actions you could take in the particular situation you find yourself:  what are things you could do if mom doesn’t want you to talk to her?  What if she asks for help – what will you say or do?  What can you reminder her of if she says she gives up and can’t do this anymore?  How will you help with relaxation if she doesn’t want you to touch her?
 
If you are not a writer, that’s okay, too.  You can run through a mental play-by-play ahead of time.  Take the time to replay these scenarios in your mind, so that you act confident and able when she needs you during this vulnerable point in the labor.
 
As a coach, your attitude needs to be calm, confident and reassuring to guide mom through this short, yet necessary point in the labor.  Also keep a positive attitude – try not to be offended by anything she says, because she doesn’t mean it.  Your calmness and reassurance give us the resolve to see it through to the end.  Most importantly, remember that transition is normal and it means that your baby is really close to being born.  If you think she wants to hear this, tell her this, or keep it to yourself and point it out the transition point later after she is happily holding your baby.
 
Emotional component:
In regards to preparing moms to cope with transition, here is the good news – it doesn’t last very long at all – maybe ten to thirty minutes.  It is a point in time will you will feel completely out of control.  It is time to let go and surrender to your labor.  I am not sure that anyone knows for certain why surrender is important – is it because you have to admit that this process is bigger than you are?  Is it so that you allow your baby to take over and allow them to do the driving?  Is it an acceptance of the mantle motherhood? I am guessing that it is different for all of us.
 
The thing about transition is this – the process of going through it, of connecting to your innermost self and coming through on the other side, makes a person feel like they can conquer the world.  In a biblical sense, I would liken it to a “walk through the darkest valley” (Psalm 23:4) – you are in despair and you feel lonely.  No one else in the room is feeling what you are feeling at that point in time.  Before you know it, you realize that you made the decision to gather your strength and you are pushing your baby with calmness and determination.
 
My own personal experience has been one of an outward emotional display during transition.  I must add the caveat that transition is different for everyone and each labor. I had the privilege of attending one of our student’s births, and the only sign of transition she showed was a physical one – she burped!  She didn’t get short tempered, she didn’t say, “I give up” or “I can’t do this” – she just burped.  As a coach, you want to be familiar with all the signs so that even the most benign one gets you mentally prepared to move to the next stage of labor.  And as the mom, knowing the signs of labor would be benefit this situation so that the next set of cues are a welcome step instead of an unpleasant surprise because your body “skipped” what you heard might be this big, earth-shattering event.  When she told her birth story, it was apparent that this mom went through her emotional transition – she had internalized it and accepted her labor and moved on without causing a big scene – that’s transition, too.
 
Most of us will find that we reach a point where we are seeking our inner strength.  Going for this “walk” and coming through it with a decision to finish the work with confidence and a strong sense of being able is the biggest joy I have ever had – and I got to walk it three times!  On my longest days, I remind myself that if I could give birth, I can do anything.  It is a confidence that carries through to your nursing relationship, your parenting and the ability to meet the emotional needs of your child and your growing family.
 
I have not seen much written about transition, so I wonder if how varied our experiences are.  Out of sheer curiosity and to further my own understanding, I encourage you to share your personal story in the comments section, or send me an email:  what did you grapple with when you had transition in your birth story or stories?  How did you feel afterwards?
 

Disclaimer:
The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

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