Transition Phase

You are probably already aware of the three most commonly talked about stages of labor – the first, second, and third stages of labor – but you might be wondering where the transition stage fits into the mix.

There are three labor stages, but the first stage of labor is broken down into three phases:

First stage of labor. This stage consists of early labor, the active phase (active labor), and the transition phase of labor. During the first stage the cervix goes from being closed to being fully dilated or open. When the cervix is fully dilated, this is sometimes referred to as being ‘complete’
Second stage of labor. The second stage is the pushing stage of labor, which starts from the time the cervix is complete and ends with the birth of your baby
Third stage of labor. This stage involves the birth of the placenta and membranes and the control of bleeding after birth.

What is the transition phase of labor?

The transition phase of labor can be both physically and emotionally challenging for many women. The transition phase occurs at the end of the first stage of labor as your body is getting ready to birth your baby.

It is a distinct phase where the cervix dilates or opens to its full capacity to enable your baby’s head and body to pass through into the birth canal. It usually occurs when the cervix is between about 7 and 10 cm dilated.

As you enter the second stage, a series of strong, intense, and involuntary contractions will begin to build, pushing your baby down to ensure he is born safely. This is often referred to as the fetal ejection reflex (FER).

Although this phase occurs during the final stages of cervical opening, transition isn’t usually confirmed by the numbers alone. For example, just because the cervix is 8 cm dilated, it doesn’t necessarily mean you are in transition. Transition is a more complex process and involves a delicate physical and hormonal balance.

Why is it called transition phase of labor?

It is known as the transition phase of labor because your body is literally transitioning from one stage to the next: from the first to the second stage of labor.

The body is moving through labor, from focusing on the shortening, softening and opening of the cervix with regular tightening’s and contractions, to the stronger, powerful more intense contractions needed to start pushing and move your baby through the vaginal opening, to be born.

It is a period of both physical, emotional, behavioral, and hormonal change.

What happens during the transition phase of labor?

Due to the physical changes that occur during transition, the mother’s adrenaline levels increase dramatically. This is what brings about the distinct behavioral changes that are characteristic of the transition phase.

The spike in adrenaline and the associated behavioral changes that occur are nature’s way of protecting both mom and her baby. They act as a primitive safety mechanism, signaling to the mother (and those around her) that her baby will soon be born.

Hundreds of thousands of years ago, before women had a cozy home, hospital, or birth center, birthing outdoors in the wild would have left mums and their babies very vulnerable. With potential predators around, the mother would need to be in a place of safety to birth her baby to maximize their chances of survival.

These physical and emotional changes signal to the mother that she needs to be in a place of safety to protect her baby that is soon to be born.

In a modern day scenario, despite the lack of physical dangers around us, the primitive part of the brain still works in the same way. These behavioral changes can be a signal to the mother’s labor partner or birth professionals that the birth is not far away.

What are the signs of transition in labor?

For most women, transition will bring about a series of distinct physical and behavioral changes. For some, however, transition will appear quite unremarkable and they will move through without showing any obvious changes.

Common transition phase of labor symptoms:

Strong, regular, intense painful contractions. As labor progresses and you enter transition, contractions are likely to feel at their most intense
Cervix is 7cm or more dilated
Heavy mucus-like vaginal discharge or show. This might appear blood-stained as the tiny blood vessels surrounding the cervix are disrupted as the cervix dilates in this final phase
Shaking, chills, hot flushes, or sweating. Changes in temperature regulation are common
Intense rectal pressure or need for bowel movement. As your baby’s head moves lower, it begins to put pressure on the rectum creating a feeling of needing to go to the toilet
An instinctive urge to push. As your baby moves lower, the head begins to put pressure on your pelvic floor muscles, creating the urge to push or bear down
Nausea or vomiting. Digestive upset is common as the digestive system slows down
Feeling emotionally overwhelmed or feelings of self doubt. Adrenaline can create feelings of panic and self-doubt
Time distortion. A surge of endorphins in active labor creates a strange perception of time or a dream-like state
Feeling withdrawn or becoming more vocal. Women tend to go one way or the other – either verbalizing concerns or doubts or sinking further into themselves and becoming withdrawn
Irritability. The intensity during this phase demands focus and concentration; therefore, outside distractions can be frustrating
Sensitivity to noise or touch. During this phase our senses are heightened and so is our sensitivity. Noises or touch can feel distracting at this point
Increased need for support. This can be feel like a vulnerable time, so reassurance from your birth partner or support person is key during this time
Request for pain medication or epidural anesthesia. This stage is often the time when many women ask for pain relief, before the pushing begins. Overwhelming physical sensations can lead them to reach out for medication to help
Feeling out of control. It is normal to feel like your body has taken over at this point. The best thing to do is just ride the wave.

How far apart are the contractions during transition phase of labor?

As you enter transition, the pattern of your tightening’s will be around 3-4 strong contractions in 10 minutes; due to the spike in adrenaline, though, it is normal for them to ease slightly.

High levels of adrenaline will work against your natural levels of oxytocin. During transition, many women will experience a change in the pattern of their contractions. It’s ok to experience less frequent contractions and for them to slow down slightly for a period of time.

Don’t be disheartened by this; it’s what’s supposed to happen. Remember, earlier we discussed how transition is your body’s way of ensuring you’re in a place of safety to birth your baby. This slight slowing down of your labor pattern makes sure you are able to do just that.

Take advantage of this slower pace to regroup and re-energize! The contractions will pick up again when your body feels physically and emotionally safe for your baby’s birth.

Why do you throw up during transition?

During transition, blood is diverted away from non-essential organs and systems. This means that your digestion will slow down because your body is focusing on birthing your baby.

Adrenaline will also cause your blood pressure to rise slightly, which can make you feel nauseous.

There are big physical sensations happening during this final intense phase of active labor. Your body has a lot to deal with all at once.

Unfortunately for some, the combination of all of these things can mean that some women are sick with their tightening during this stage.

If this happens to you, don’t worry. Although it might not be pleasant, it’s normally a good sign that your baby is well on the way.

To make sure you don’t become dehydrated, keep taking sips of water (even if you do bring it all back up again). Try to remain positive; it’s likely the sickness will be short-lived.

How long does the transition phase of labor last?

The transition phase of labor is usually the shortest of them all. Every woman’s labor is different, though, and if you have had a baby before it is likely to be shorter than if you’re having your first baby.

Typically, this phase will last somewhere between 20 and 60 minutes for most women, before it moves on to the active pushing stage.

How do you get through transition phase of labor?

Many women – especially first time moms – fear this phase of labor, due to its intensity and the sense of entering the unknown.

There are several things you and your birth partner can do, however, both before and during labor.

Keep these things in mind:

Knowledge is key. Understanding how your body works in labor will help you feel more in control in the moment, as you’ll known what to expect. Do your research, take a prenatal class or ask people who have already gone through it what was helpful for them
Know your options. Knowing the things that are important to you in labor will help you stay focused if things become intense, or go slightly off plan. This doesn’t mean you can’t change your mind, but knowing the options available to you, and what that means for your care, will help you make an informed choice at the time
Ask for what you need. This is likely to be easier in early labor, but it’s important to ask for what you feel you need, when you need it. Only you will know how your body feels in the moment
Choose your birth team wisely. Don’t feel pressured into having people you don’t feel fully comfortable or relaxed with at your birth. Choose a friend or a family member who you know will support your choices. Make sure it’s someone who can act as your advocate if you feel unable to in the moment. That’s why it’s also important to make that person aware of your birth choices
Use water. Water supports your body’s natural processes and is a great way to reduce your labor pain. Warm water is comforting to tired muscles and keeps them relaxed; it also helps release endorphins that act as your body’s natural pain relief
Change positions. Being able to move freely while you’re in labor will not only help you feel more comfortable but will help your baby descend through your pelvis in order to be born. Generally, upright or forward leaning positions create more space in the pelvis for your baby’s body to pass through
Use breathing exercises and relaxation techniques. Breathing techniques and relaxation tools will calm and refocus your mind and help keep your adrenaline levels in check. They will also act as a method of distraction. Practicing for a few minutes a day, in advance, will help make these exercises more effective when labor begins.

At what stage of labor do the waters break?

Your waters can break during any of the three stages of labor. For some women, the waters might be released during early labor and could be the first sign that labor is beginning.

After the waters have broken, you might start to experience mild contractions as the uterus begins to tighten and the cervix begins to go through changes and open up.

Some women might have a few hours of contractions before the membranes break. As your labor progresses and your baby’s descent progresses, the greater the chance of your waters going, due to the pressure exerted on the sac of waters.

A small number of babies are actually born in their sac. This is known as an en caul birth, and it’s thought to bring babies good luck throughout their life.

Although the transition phase can seem overwhelming, the best tip I can give you, as you approach your birth, is to trust your body. Trust that your body knows how to birth your baby.

It can feel challenging at times, and it’s easy to lose faith during this final stage. But remember that your body is uniquely designed to protect you and to birth your baby safely.

For more tips on how to get through transition read our article How To Get Through Transition Without An Epidural | All You Need To Know.