There are many reasons why some women might want to opt-out of pain medications during labor. They might choose a completely unmedicated birth, or choose to birth naturally without an epidural.

Epidurals are an increasingly popular and effective choice of pain relief in labor and are generally considered safe; however, they still pose some risks, and have side effects. Therefore it makes sense that some women might want to avoid them.

For more information, you can read our article Epidural Side Effects | Short And LongTerm Effects.

It is often during the transition phase that many women request further pain relief, due to the intensity of what’s happening in the body at this time.

Here we’ll delve into what transition is and why it’s common for a laboring woman to request pain relief during this phase. You’ll also get some wonderful tips on what you (and your birth support person) can do if an epidural is something you’d rather do without.

What is transition?

You might be wondering What Is Transition In Labour?

There are three phases in the first stage of labor: latent, active, and transition phases.

Transition is the final phase of the first stage of labor.

Transition takes place as the cervix dilates and opens from about 7-10cm, as your body gets ready to birth your baby.

Your body is making the transition from opening the cervix to bringing your baby down and out.

Transition can feel overwhelming, both physically and emotionally. The good news is, it’s normally the shortest phase of labor, typically lasting anywhere from 30 minutes to two hours.

Labor transition characteristics

As we know, transition is the final part of the first stage. Everyone will experience transition differently but this stage is generally characterized by regular intense contractions and some subtle (and not so subtle) behavioral changes.

Some common physical and emotional signs can give you (and your birth team) a clue that you might be entering transition.

What to expect during transition phase

Physical changes include:

Intense labor contractions. These last 60-90 seconds, with a gap of 30 seconds up to 2 minutes
Sweating. Your body is working hard at this point, so it’s normal to feel hot
Nausea/vomiting. The digestion system slows down during active labor as your body focuses on birthing your baby
Shaking/trembling. This is caused by shifts in your hormones and is completely normal
Rectal pressure. As your baby descends lower in the pelvis, the head begins to put pressure on your rectum, making you feel as though you need a bowel movement
Urge to push. Many women feel the need to start pushing as the baby enters the birth canal and the baby’s head puts pressure on the pelvic floor muscles. This creates the urge to push.

You can find out more in 10 Things Every Mama Thinks When She’s At The Pushing Stage.

Behavioral changes might include:

Becoming more vocal. It’s normal for women to be louder or more vocal during transition . This could involve making sounds as they feel contractions, or verbalizing certain concerns. It’s very common for women to announce they ‘can’t do it’, or they need more pain relief
Feeling withdrawn. Conversely, some women become very withdrawn and go into their own little bubble. They become very quiet and don’t feel like talking much
Feeling scared or panicky. This is a very normal feeling during transition; it’s due to a surge in adrenaline. It can leave people feeling like something is wrong
Finding it difficult to focus on anything other than contractions. The intensity of sensations at this point requires a mom’s full attention, making everything else secondary
Feeling irritable. All the senses are heightened during labor, so moms become hypersensitive to certain noises or smells during this transition stage.

Coping through transition without an epidural

If you’re planning a natural birth there are many things you can do to help you go through transition without an epidural. It’s important to remember that an epidural isn’t the only way to manage labor pain.

Plan ahead

If you’re keen on birthing your baby without pain medication and having natural birth, it’s good to take some proactive steps to help you prepare for a positive birth experience. Thinking about your options during pregnancy will stack the odds in your favor when it comes to the things that are important to you.

Preparing your mind for birth is just as important as preparing your body.

Choose your care provider carefully. Suss out your care provider. Is it someone who supports natural birth? Whether this is your first baby or not, if you feel your care provider isn’t supportive of your wishes, then it might be time to look for a new one. If you have pregnant friends, ask them about their care providers too.

You might like to read our article Should You Break Up With Your Maternity Care Provider? 5 Things You Need To Know.

Choose your location. Although the majority of births take place in hospital, this isn’t your only option. Research the other facilities in your area. You might choose to give birth in a birthing center or decide to have a Home Birth, which could be more conducive to giving birth naturally
Know your options. Knowing your options ahead of time makes it easier to make decisions in the moment, if needed
Educate yourself. Knowledge really is power when it comes to natural birth. Educate yourself on what’s happening within your body and what’s normal during each stage of labor
Do your research. Don’t assume all interventions are equal. However common, all interventions – and this includes pain management options – have risks and benefits. Know what you’re signing up for before you commit
Write a Birth Plan. Know what want. Be clear about what’s important to you and why, and share this with your birth support person. Creating a plan doesn’t mean you can’t change your mind, but it does make it more likely that you’ll get the things that are important to you
Choose your Birth Support people wisely. Although it might be tempting to have a certain family member present, be sure you’re choosing them for the right reasons. Are they supportive of your choices? Be sure they can provide support in the way you need it
Speak to other women who have birthed naturally. Actively seek out women who’ve had natural births and ask them about their experience. Get a sense of what they went through and ask whether they have any advice
Positive birth stories. Actively seek out positive birth stories. It’s easy to find negative information when it comes to birth and people will share their own ‘horror stories’ with you (whether you ask them or not). It can feel as though there’s a lot of ‘bad stuff’ that happens in birth but that doesn’t mean that positive experiences don’t happen just as often. It’s sometimes a little harder to find but don’t be afraid to delve beneath the surface and look a little more closely.

What to do in labor

Change positions regularly. For most women, giving birth on their back isn’t usually very comfortable. Choosing upright or forward leaning positions or using a birth ball can help make labor more comfortable and efficient. Changing positions will help get baby into a better position by creating more space in the pelvis to move through; this also makes labor pains more manageable
Use water. Using warm water in labor, or planning a Water Birth, is an extremely effective form of pain relief. It helps by keeping the muscles warm and relaxed, and encourages blood flow to your tissues. Endorphins are also released, which helps us to feel more comfortable in labor
Practice breathing techniques. Breathing techniques in labor work by focusing your mind on your breath rather than on the labor. This method helps release any tension you’re holding on to, which can make your muscles tense up and creates more discomfort
Visualizations. Visualizations help your body relax by giving you something else to focus on. Visualizations teach your brain to associate the sensations of labor with positive images, rather than associating them with pain
Vocalization/sounds. Many women find this technique a little odd at first, but it’s a very powerful tool during labor. It’s great during the latter stages of birth, when things are super intense. Vocalization involves making sounds with your breath as you exhale. Deep low moaning sounds or low sounds work best. They help relax the mouth and jaw and this corresponds with keeping the vagina and the cervix relaxed too. Use these sounds to help you work through your contractions
Positive affirmations. There’s no denying birth can be challenging and it’s easy for doubt to creep in. Positive affirmations are great during these tough times to help change your mindset from doubt or fear to positivity and confidence. Affirmations are short and easy to remember; for example, ‘I trust my baby knows how to be born’, or ‘Each contraction brings me closer to my baby’, or ‘I am strong and capable’
Play music. Create a playlist that make you feel good. Have a variety of music lined up, depending on how you’re feeling in the moment. You might want something upbeat to keep you going and then, at other times, you might prefer something a little more relaxing. Don’t forget to sing along too; singing releases endorphins, which are your body’s natural pain relief.

How do you stay calm during transition?

There are many practical ways to help support you through transition, but sometimes the biggest hurdle is your mindset. Whether this is your first birth, your second birth, or your fifth, calming the mind is often the biggest challenge.

We don’t know exactly how birth is going to go, so it’s natural to have a certain level of anxiety. What we don’t want is for our anxieties to lead the show.

High anxiety levels, fear, and adrenaline can actually change the progression and pattern of labor. Staying as calm as possible is really important, to allow positive birthing hormones to flow, and to enable a positive birth story.

Here are my top tips for calming your mind during labor and transition.

Trust your body. Have confidence in your body. Follow your body’s lead and trust that it knows how to birth your baby
Create a safe space. Create a birth environment that feels calm, relaxing, and supportive. Feeling physically safe in labor is important but feeling emotionally safe is equally important. If we don’t feel safe it’s hard to relax enough to allow our body to do what it needs to do
Feel the sensations. Labor sensations might be intense but they’re not stronger than you. Everything your body is going through is bringing you closer to meeting your baby. Allow yourself to feel everything and don’t be afraid of the power your body is harnessing
Let go of fear. Allow yourself you to ‘lose control’ and really ‘enjoy the ride’. I compare this with riding a rollercoaster; if you hold on really tight, you can feel as though you have more control but in reality you don’t. If you’re brave enough to ride the rollercoaster without holding on and with your arms in the air, you still have the same amount of control but you might just enjoy it a little more and the reward will seem sweeter. I believe the same applies to birth.

What can your birth partner do to help in transition?

A birth partner or doula can be invaluable when it comes to supporting you through this stage of labor. As a partner, here’s what you can do:

Know what to expect. Sometimes transition can feel scary for birth partners witnessing these physical and behavioral changes. Some might be concerned that something is wrong, or their partner is no longer coping and needs further pain meds. Knowing what’s normal for transition will help you recognize those characteristics as they come up
Help your partner change positions. Encouraging a different position, or physically supporting your partner in changing positions can be a big help. Sometimes the idea of moving during transition can feel overwhelming, but it can really help move things along
Make your partner your sole focus. This stage can be challenging and intense and your partner will need you now, more than ever, to help support her through these moments
Be present and emotionally available. As a birth support person, this is your time to shine. Make yourself fully available to support your partner in whatever way she needs
Remove distractions. Distractions such as the TV, phones, or other people chattering nearby can feel really frustrating during transition. Try to minimize any unnecessary distractions to help your partner focus and relax
Avoid small talk. Your partner probably doesn’t want to chat much right now. Allow her the peace and head space she needs to focus on what’s happening
Provide reassurance and encouragement. Words of encouragement go a long way here. Tell your partner you’re proud of her and that she’s doing an amazing job, or remind her it won’t be long until you meet your baby. Remind her she’s safe during this stage. This will help her stay focused and keep calm.

The transition phase is a very primal state and can feel overwhelming if you’re not expecting it. You should know, though, it’s perfectly possible to get through it without an epidural if that’s what you choose. Remember all the signs of transition are positive and are signs that you’ll probably be meeting your baby very soon.

Welcome the experience and have trust in your body. You were made to do this.