The Transitional Stage of Labour

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Written by Sally Underwood

…Almost there – oh my goodness – this is it!!
Labour consists of 4 stages – 

Latent phase; when the cervix ripens, effacement takes place and you get to around 4cm dilated.

First stage; when the cervix dilates from 4cm – 10cm, with regular surges.  The surges will become stronger, longer, and more frequent – usually about every 5 minutes, lasting 40-60 seconds 

Second stage; the birth of your baby

Third stage; the separation and delivery of your placenta and control of any uterine bleeding  

The Transitional Stage of Labour occurs at the end of the first stage – before the second stage. It is a period of change –  of ‘swapping over’ – as your cervix becomes fully dilated (10cm) – of transitioning from the first stage of labouring to the second stage of birthing…. from up breathing and visualisations to down breathing and visualisations…. Exciting stuff but full on…..REALLY!

It is often described as the most dramatic/uncomfortable part of labour, as you experience the effects of a massive surge in adrenalin. As your adrenalin levels overtake your oxytocin levels – you will feel hugely different – overcome – suddenly – very aware!  

With adrenalin in control the muscles of your uterus are forced to change the way they work – remember the muscles of the uterus work in pairs; with the long muscles contracting ,during the first stage of labour and the round muscles relaxing – causing the cervix to draw up and dilate to 10 cms. Now with the onset of the second stage, these roles reverse; the round muscles squeeze baby down and out through the birth canal for birthing, whilst the long muscles relax, out of the way.

With such vast hormonal changes during this period, you will probably experience physical symptoms such as panic, shaking, nausea and vomiting.  You will feel overwhelmed and ‘out of control’.  Women often state that they cannot cope, want pain relief, and that they have had enough and are going home.

Birth partners note:  Often all the supportive techniques that you have used effectively up to now will be a source of agitation during transition.  Indeed, many women often push birth partners away and focus on themselves. I can distinctively remember finding it inconceivable to believe that anyone would ever consider putting themselves through this part of labour again – surely no one would ever opt for another child – vaginally!

Fortunately, the transitional phase is only temporary – it lasts approximately 10-15 minutes (4 or 5 surges). Midwives are aware of the signs of transition and will encourage you to try and adopt different positions to get through the stage.  It can be distressing for your birth partner to observe the transition stage so being prepared really does help. 

 Self-help Strategies for the Transitional Stage

Feelings of panic, loss of control and physical side effects are common, and the support of your birth partner is vital at this time.

  • Keep changing positions, it will be difficult to get comfortable
  • All fours/hands & knees positions help to ease an early urge to push, and reduces the pressure felt in your bottom
  • Try to concentrate on your breathing, or distraction techniques during your surges
  • Try to stay focused during your contractions, keep interruptions to a minimum, close your eyes and concentrate
  • Sips of water will help keep you hydrated and reduce the feeling of nausea
  • Reassurance and support 

Remember that every surge is doing a job and that each one indicates one less to go, and that labour doesn’t last forever. You will cope – other women do – you can and will do it!

The length of the first stage of labour varies between each woman. On average, labour will last about 8 hours for women who are having their first baby and is unlikely to last over 18 hours. For women having their second or subsequent babies this time frame will be considerably shorter – around 4 – 5 hrs.  It is considered it to be normal for the cervix to dilate around a centimetre an hour, with regular strong surges.  The position of your baby inside your uterus and the positions you adopt during labour can affect the length of your labour.

Remember:  Working with your body and adopting upright positions will encourage effective regular surges, resulting in a quicker, less painful labour. 

Your body is perfectly designed to have your baby – but I really do think each birth is amazing and cannot believe that I managed to do it 6 times!

Sally x

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