How to Get Through Transition Without an Epidural
It is 100% possible to get through transition without an epidural! This article is FULL of wonderful information about how to do just that. Let's go!
What is Transition?
Birth becomes most challenging right before pushing, during the transition phase of labor. Transition is typically the shortest portion of labor, but also the most dreaded and feared. Contractions are long, strong, and close together.
This post is third in the series "The Stages of Labor: How to and Helpful Tips". The first stage of labor has three parts:
- Part 1: Early Labor
- Part 2: Active Labor
- Part 3: Transition
Today we continue our journey through the first stage of labor. In previous posts, we discussed early labor and active labor, and in this post we'll learn all about the transition phase of labor, especially how to get through it without epidural.
Transition Without an Epidural - You Can Do It!
Like I said above, the transition phase of labor is the shortest but the most intense portion of labor. Transition got its name because it is the part of labor where women transition from stage 1 to stage 2. Stage 2 is pushing. Transition happens right before you start pushing.
Symptoms of the Transition Phase of Labor
If you are experiencing the following symptoms, you may be in transition! Good job, you're getting closer to meeting your baby!
- Very long contractions lasting around 90 seconds
- In comparison, the average active labor contraction is around 60 seconds and early labor is only at 30 seconds
- Contractions are close together, around 2-3 minutes apart
- Instead of completely going away contractions sometimes "double peak"
- Women feel like they're not getting a break. You may hear her say, "I'm not getting a break."
- Hot and sweaty
- Cold and shaky
- Nausea and vomiting
- Crying
- Unable to find a comfortable position
- Contractions increase when changing positions
- Afraid to change positions
- Looking for a way out
- Asking for help
- Water breaking
- Discouragement and/or "giving up"
- Irrational thoughts and behavior (ex: I decided I was going to break my water myself after a failed attempt by my midwife)
- Asking for pain relief/medication
How to Give Birth Without Epidural
Having an unmedicated childbirth is totally possible. There are many ways to decrease the sensation of pain and cope well during a natural childbirth. You can do it!
However, many women receive epidurals from their health care provider during the transition phase of labor because they can't cope and/or their birth team is unable to help them cope. The following are some amazing ideas to add to a birth plan that will get you through this intense portion of birth without epidural.
Remember, you can do it!
1. Change Positions
One of the best pieces of advice I can give you for coping through the transition phase of labor is to change positions. And change often.
Paradoxically, this is also probably the toughest piece of advice to follow during transition. The thing is, during labor when you get in a position that is working for you, or even if its not, it can be hard to change positions.
When I was in labor and I moved, it sometimes caused additional contractions. I wanted my contractions to go away, or to be less intense, so therefore I thought that if I just remained still things would get better.
However, in order to end the contractions, labor ultimately needs to crank up, get more intense so that you can push your baby out. At some point, you have to decide to accept labor, accept that things aren't going to go away, and bravely embrace the sensations of birth, because those are what will bring your baby and bring the end.
Thoughts From My Birth
Here's an excerpt of my thoughts during my second birth, a homebirth.
Oh. My. Gosh. I was in so much pain. My contractions weren’t stopping. They would peak and then peak again. I cried out for somebody to help me get up and save me because I was in so much distress. After that contraction was over I did a little internal self-talk.
“Lindsey, you need to be brave. You need to get up and move.”
And so I got up and moved. I was brave. My baby was born not long after that.
Be encouraged! By being brave and changing positions you might find a more comfortable position and it also might speed up your labor - which is what we want, right?
TIP: The first contraction after a position change can be hard to cope through. If you change positions and it feels AWFUL, try it for three more contractions. If after three contractions it still isn't working, try something new. Sometimes after three contractions you may find that it is actually working for you. Yay!
Here are some positions to try during the transition phase of labor.
- Sitting on the bed
- Standing and leaning into a birth partner, bed, table or wall
- Sitting on a ball
- Leaning on a ball (standing or sitting)
- Peanut ball
- Toilet
- Shower (The shower is the PERFECT place to be in transition. It's so helpful for labor pain!)
- Tub
- Squatting
Head on over here to read more about positions to try during labor for a faster, more comfortable birth.
2. Encouragement is Key
A common signpost of being in transition is feeling like you can't do it. You might say...
- "I can't do it."
- "If I have to do this for another ______, there's no way I can do this." (Remember, labor math doesn't exist!)
- "Someone help me!"
- "I need an epidural. No really, someone get me an epidural."
You know what? When my doula clients start saying these things I know 1) we are getting close to pushing and 2) I need to increase my support and encouragement.
Encouragement during the transition phase of labor is VITAL. If a woman does not have a team of support to rely on, she will often turn to medication.
What to Say
This does not have to be! Here are some suggestions for encouragement during that last bit of intense labor.
- "You get to meet your baby soon."
- "Feeling this way means you're progressing."
- "You're getting closer to your baby."
- Use Penny Simkin's "Take Charge Routine"
- "You are doing it! Right now!"
- Reminders that what she's feeling is normal.
- Read Mother Rising birth affirmations or bible verses for birth
Check out this article for more ideas of what to say and what not to say to a woman in labor!
During transition I often felt like something wasn't working correctly. It seemed like things were hurting far worse than they should and that I wasn't progressing quickly enough. The cost was far outweighing the perceived benefit.
I found it helpful for people to remind me that things were progressing normally, and in fact they weren't even going slowly. When you're in labor it is hard to have an accurate sense of time. Reminders and encouragement are so helpful.
3. Maintain Focus
During active labor a mom might be more tolerant of external distractions like bright lights, talking, the tv, and extra guests. However, during the transition things get more intense, which requires a whole other level of focus.
Unfortunately, instead of enforcing privacy and creating a birth space more conducive to focus, many women request epidurals to accommodate their surroundings instead of requesting the surroundings to accommodate her.
Mamas! This is YOUR DAY! Of all your days here on earth, this is your day to tell others how you want things to go. Better yet, have your doula or "birth bouncer" (baby's father, nurse, etc.) enforce privacy for you.
- Ask observers or other unhelpful people to leave.
- Request silence.
- Dim the lights.
- Enforce privacy.
- Turn off the tv.
It is easier to cope through transition and give birth within a focused birth space.
4. Stay Hydrated
Another important part of coping through the transition phase of labor is to stay hydrated. A simple method of staying hydrated is by offering mom sips of ice water between contractions and with a bendy straw.
To help keep mom energized, diluted juices and electrolyte drinks can also be used. Chewing on crushed ice is amazing between contractions. Of course, I love using electrolyte cubes for labor!
Staying hydrated during the transition phase of labor is important especially if mom is vomiting. Dehydration is the enemy!
By staying hydrated you will help keep yourself and baby healthy, give yourself energy and shorten your labor time. STAY HYDRATED!
5. Stop Complaining
It is really easy to complain during labor, especially transition. However, I've repeatedly found relief when I chose to switch gears and stop complaining.
Frankly, nothing was helping anymore and once I decided there was nothing to be done, I stopped whining about it. And instead of complaining and whining, I focused my energy on to other things.
With my second birth I decided to get up and move. With my third birth I decided to start squatting.
By changing my attitude I eased my suffering, became more productive in labor, and helped myself to progress. Who knew, right?
6. Try Something New
During my third birth (pitocin augmentation) I vocalized a lot. It was very helpful!
However, I got to a point where I wanted to crawl out of my skin - nothing was working anymore. My doula's touch irritated me, my vocalizing was not helping things, and I was at a loss.
Here's another excerpt, this time from my third birth where I tried something new.
The vocalizing I was doing was NOT working anymore. Nothing really, was working anymore. I became “that lady” in labor. I’m cold… so they put a blanket on me. I’m hot get it off! Push on my back! No stop! No position felt any better. It was awful. It felt like fire. Fire on my belly and fire on my back. Hot, burning fire.
At one point I decided that I needed a different approach and that I was not coping well. So, I decided to sit on the hospital bed and not vocalize at all. Now, to the observer it probably looked like I was feeling pretty good but it was still terrible. It didn’t get better, the contractions were still hell. However, after doing a few contractions like this I felt a little bit less out of control. My contractions spaced out the tiniest bit (which is probably when Tanashia turned the pit up haha) and I got to doze between contractions. This was my big aha moment during my Pitocin experience. I had the courage to change things up when nothing was working anymore.
Trying something new was scary. However, it actually turned out to be helpful. If you don't know what to do to cope during transition, try something completely new, and possibly a bit scary. It worked for me!
7. Let It Go
My final piece of advice for coping through the transition phase of labor is to just let go. Channel your inner Elsa and just LET IT GO.
As a doula observing births and as a mom experiencing labor, I have found that once we decide to stop fighting labor, but embrace and work with it, our bodies relax and things progress.
Let it happen. Allow your body to open. Let your baby come down.
Giving Birth Without Epidural - YOU GOT THIS!
Ladies, YOU CAN DO THIS!
Don't let anybody tell you that transition is too difficult to birth without epidural. (Sure, epidurals can be used wisely and compassionately. Epidurals absolutely have their place... But that's another blog post.)
You can absolutely, positively have a natural birth! You can make it through transition without an epidural. Birth without epidural is 100% possible! By using the tips, tricks and strategies above you will be well on your way to rocking an unmedicated birth.
Rock on, mamas!
Read the Comments!
For those that had unmedicated births, please leave a comment and let us know how you coped through birth without epidural. If you're pregnant, read the comments. Ladies, these comments are GOLD. Read all about how to have a natural childbirth. You can do it!
I wanted an unmediated birth from the beginning and hired a doula to help. I also used hypnobirthing, which I think made all the difference. It really allowed my mind to shut off and let my body do the work. That was until I hit transition. I just remember the pain was so intense and there was no break. I never asked for an epidural, bc I hate needles, but I remember thinking that I wish someone would tell me about this new alternative to an epidural that would make this stop. When I finally said, I can't do this anymore, my doula just replied, "yes you can, transition is just rough." That's all it took to snap me out of it and realize how close I was to meeting my baby. I didn't realize I was in transition, I just thought I might have hours left of that level of pain. From there with every contraction I would say to myself "come on down baby" and I was pushing before I knew it and only pushed for 5 min.
Yes! Thank goodness for reminders of what's happening. It's so easy to forget.
I'm getting induced today at 4pm...I'm going through so many emotions right now, scared, nervous, excited all at once. I hope I can get through this some of these stories helped. All I can say to myself is that I can do it!!!
Thanks for the tips! I will be 27 weeks with Baby #1 tomorrow. I am hoping for a natural birth in the hospital...mostly because I am terrified of needles, but also because I don't like the idea of being stuck in a bed for so long. The pain, at this point in my pregnancy, doesn't scare me or make me nervous. What does worry me is that I will end up taking the epidural and regret it later. I am hoping to just stay focused through everything, and am researching hypnobirth and relaxation techniques. My husband and my best friend are really supportive of my decision to try med free, so we will see how it goes.
I'm so glad you have a great support system. It's SO important!
I spent the end of active labor and transition in a hot bathtub, alone, with the lights off, with a playlist of my favorite songs going. The warm water helped my muscles relax in between contractions. I had been induced, so I was assuming labor would last like 36 hours. While this wasn't the case, I had the mindset with each contraction that the next one would be worse, and that there were many more coming. Rather than being discouraging, this somehow helped me— it was like pacing myself for a marathon. I was shocked (in a good way!) when it was suddenly time to push. Of course, I had a manual placenta removal after my unmedicated labor and delivery. It hurt WAY worse that anything else— I was ready for meds at that point! But honestly, you forget about the pain once you're holding that baby in your arms.
Great post! (I just found out I'm pregnant with number 2, ssshhhh!) My little guy just turned one, so labor is still a little fresh. I'm planning another natural unmedicated birth with my lovely midwife, but transition is still intense to think about!
During labor, I spent most of the day in an amazing tub, felt pretty good, and actually had a few early pushing urges in there, but I had a little bit to go and I was feeling nauseous, and panicky. My midwife suggested I get out and move and I remember telling her I really didn't want to and I didn't think that I could do it in a very sad way. She suggested the shower. I was having a hard time standing up in there, so I was in all fours in there. My SO (an ex Army guy and police officer) came in and said, "Lisa, look at me. You've got so much more in you! I know how strong you are. Let's go do this" He helped me stand up, wrapped me in a towel and we moved in to the other room. After that, I kneeled on the bed, and it was time to push. I truly believe that moving, and some strong encouragement, is the only thing that got me past that point.
I am scared about going natural as I have tried twice already but was given Pitocin. My contractions have been so intense. But with all 3 pregnancies, I have contracted regularly for months ahead of time. This current pregnancy, I've had them for 20 weeks. I am due in just a couple weeks and still in debate. I don't have a soul or midwife, although I wish I did tremendously for support. My last pregnancy I made it to 7cm and my caregivers were encouraging an epidural as my son was in distress due to my reactions to the transistion. So any and all helpful hints I am open and thankful for as 3rd time has to be a charm!
Good luck to you. I also was refusing epidural until doc told me same thing. I wish I had a different doc, who spent more time with me. I was screaming in transition. I isn't know how far along I was but then it was shift change of nurses and I liked this nurse better so I really listened to her advice.
My waters had broken before my contractions had started so no one checked how far along i was. I was on the labour ward and Hubby was sent home at end of visiting hours so i ended up doing the transition stage alone - pacing the hall. My contractions felt continuous! By the time he was allowed back i was asking for an epidural. My midwife checked and I was 8 cm then and never got the epidural or morphine they offered as the urge to push came. Whether they deliberately delayed i dont know but i managed to do it with only gas and air in the end. I really think all that walking /being upright helped too. Now 30 weeks with my second, so im hoping to keep upright, change positions and remember im nearly there during that transition stage like you suggest!
Thank you! I am 34 weeks pregnant with my first and wanting to have an unmediated birth. Your article gave me a lot to think about and to apply.
You're welcome!
I have delivered six healthy babies. All in the hospital and all but one required pitocin. All were natural births but one in which I had an epidural.
During the transition phase, I seem to cry out for God to help me get through and always I am reminded that I am in a phase that lasts a little while. Time does seem to disappear at this point. I self talk and tell myself that intense pain must happen to get it all to end.
I tend to withdraw inside of myself, completely blocking out everyone and everything (sound, light, etc.) in the room. This helps me cope. During my last two transitions I had nurses who helped me change positions frequently which helped so much more than just lying in bed.
During the last birth, as I was pushing, I had unknowingly tightened up my shoulders and arms. I was coached to loosen them and drop my shoulders, and that helped bring baby's shoulders out.
Btw, my only labor with an epidural was my worst labor.
If you have to be induced with pitocin, I learned to request that they break your water first and only turn on the least amount of pitocin slowly, if breaking your water doesn't help you progress. Avoid letting them break your water and dial up the pitocin simultaneously. That sends you into a time of intense pain too quickly, without being able to work into the pain slowly.
You must have good support people. I totally am the same about the pain and praying out to God. At that point I was really praying out to God in any form please help me get through. I wish I hadn't needed epidural. It hurt to and caused a weird pain along my side so I was uncomfortable 2-3 hours after it had set in
I'm thinking of not using any medication during labor and have been looking for information about how to cope during this time. This article has been much helpful, as reading through it made me picture all of you tips. My guess is that I will forget al the tips as soon as those contractions get stronger but will try to remember your words. Thanks for sharing your experiences.
You might love having a doula! That way you don't need to remember anything. 🙂
17 years ago I had my first child, I was induced and had a epidural. 15 years ago I had my second children, I promised myself after my first child I would never be induced or have a epidural again. Times have changed since then, and in August 2015 I had my third child. I was induced with my third child but it was different from 17 years ago, but again I swore no to a epidural , or any pain medicine. I am British but live in Holland, and in Holland it's not normal to have pain medicine. I mean none!! No gas and air, no epidural, no anything, they like to do it completely natural. After my experiences my view is go natural!! After a epidural you can't stand, you can't shower, you can't get out of bed to get your baby. I hated being useless. I wanted to shower. I wanted to go to the toilet, I wanted to look out the window with my new baby. Labour hurts, but once your hold your baby for the first time its all worth it. The pain goes, and you will still feel human. To get through my labours I showered, I stood under the shower for about a hour or more and let my body do what it was made to do. I moaned. I groaned, I told my husband I could kill him, but I kept strong knowing in the end it would be worth it. with my third baby after coming out the shower the midwife looked at me and told me I could push, three pushes later she was there. In three weeks time I will be induced for baby number four. I am scared about the pain but I know if I trust my body it will know what to do. I don't plan on taking any kind of pain medicine. Just standing under a hot shower and letting my body do its thing. Every labour is different and you never know how you will feel, but I have learnt just when you think 'i can't take anymore' that's when you are ready to push and meet your baby.
What great advice and encouragement! Thank you!
So, I had my daughter on 27 November and thought I would put my experience on the Web. Everything was going fine! I was induced. This was done with a tablet that was inserted in my vagina and left for five hours to help make the cervix "ripe". They repeat this three times throughout the day. I had exactly the same as with my third child. And after my third tablet I was 10 cm. We just had to wait for my waters to break and then I could push. I was feeling strong and breathing through any pain. I was certain my daughter would come before midnight!! I sat on the bed, I sat on the chair, I breathed and waited. After about 4 hours my waters still hadn't broken!! The gynecologist said they could break my waters and push her down as she was not moving down, even though I was for four hours 10 cm. They told me it was dangerous as when the water gets broken the force of water could push the baby's head and umbilical cord down together, and the umbilical cord could get stuck in my pelvis with her head and then I would have to be rushed for c-section as she wouldn't get anything from the umbilical cord because it would be trapped. I decided to let them break my waters. Once my waters were broken the contractions got stronger, but I stayed relaxed and breathed through. After a further two hours of nothing changing, still ten cm and my waters broken I decided I would have pain medicine. I was given a pump and could click on a button when I had a contraction. I was basically given morphine. After about two more hours we stopped the pain relief and tried again to push. I could feel she didn't move!! I knew she wasn't moving down!! I started to panic!! How would this baby come out if she wouldn't move down?? The gynecologist told me that she thought the best plan was a c-section. I knew there was no other way for my daughter to be born and I said ok. As soon as that was said we were running through corridors to the operating theatre. I obviously had a epidural!! On my birth plan was as number 1, no epidural, unless with a c-section. Number 2, no c-section!! So, after my first post saying I am not having a epidural, and my birth plan saying I don't want a epidural, how do I feel?? I was in shock and panic when I made the choice to have a c-section and start therapy to get over the fact I had a c-section. I don't blame anyone!! Things sometimes just don't go as you planned. If you decide to go for naturel birth, just remember sometimes things are out of your control! If I decide to have another child, I will still go epidural free!! I will still go naturel birth!! But if things don't go as planned, I will still be proud of trying!!
Wow, I can't agree enough with all of this. I found it bringing back memories that had been a bit fuzzy despite not having an epidural. Some of the best advice I got while pregnant was to remember that the only way to make the pain stop is for baby to be born. Sounds obvious but keeping it in mind helped a lot. Something that contributed greatly to having a positive labour for me was my determination noto to get stuck on specific expectations. I had read too many stories of women feeling guilty or like they failed because they were not able to have the birth they wanted. My strategy for avoiding that was to visualize the way I wanted things to go but to always reminding myself that it will be why it will be and my my main goal was to have a healthy baby. I can't stress enough how much the support of those with makes a difference. I was really caught off guard by how emotionally vulnerable I became during labou. Haveing the encouragement of my mother and my partner gave me so much strength. When I got to the point where I heard myself say " I can't do this!" the doctor told me she could see the top of his head and that was what I needed. Just to know that he was almost there was like flipping a switch. I became a wild animal, a force of nature. I had no idea how strong I was until I had my son.
I had my first baby earlier this year in May. I really wanted to have a drug free birth. I had a midwife and a doula.My labor was 56 hours long. I was at 6cm for many hours and 8 cm for 6 hours. I had been up for 3 days so after being checked again and I was still at 8cm I just didn't have the energy to keep going. I fought so hard up to that point but I had nothing left. I opted for an epidural and was able to rest for 3 hours before I was ready to push. I know that the was the right decision for me at the time. However thinking about having another baby in the future scares me. I want a entire natural birth so bad. I know I can do but the fear of another long birth scares me.
Hey Shandi! Thanks for commenting and... can I say something? You are a rock star. A warrior! WOW! You labored for so long without an epidural... way longer than I think I could EVER do. WELL DONE! I think it was very wise and compassionate of you to get an epidural at that point. For now, why don't you put a simple practice in place and say to yourself things like this - "I did my best!" or "I am a long labor warrior!" or "I gave it my all!" before you start to think about birth #2, do some inner work and heal from birth #1. Hope that helps!
I am expecting # 9. This comment of healing from the previous experiences was profound and flipped a switch with me. I often feel guilty about not having natural labors, though I've desired one. Of the eight children I've birthed, only one (baby 4) was birthed without an epidural, in which case I remember feeling completely tense and out of control. My last labor stalled and I hadn't slept in about 2 days and walked forever. I too was so exhausted I caved for the epidural and actually gave birth soon after. I need to find some faith in myself that I can have a natural birth and move past traumatic past births. Giving birth terrifies me, but holding those babies right after... nothing compares to that moment, especially skin to skin and nursing for an hour.
I wanted it too. I yelled at my husband cursing bc I was frustrated.
I've had 8 unmedicated births with my 9th little due in May 2017. I've always viewed birth as a long day of work followed by an intensely satisfying outcome or end product. A baby. MY BABY. Rather then think of it as a spa day with the pretty pajamas and scented candles, it was all about the hospital duds and a birth ball. And the bathtub with some serious warm water. 4 of my births were induced and thus the contractions were more intense then my natural contractions. Coming up with a game plan was imperative. Distractions and having my "birth bouncer" do his job made all the difference. I've also had to come up with a plan for the midwives I've ended up with who were not familiar with natural labor. For baby #8, my midwife looked scared. I knew everything was going well despite being intense due to pitocin. After delivery she actually said out loud that I was her first birth in which pitocin was used without pain management. I told her, while nursing my sweet newborn, "eh, it wasn't that bad." She was horrified. I told her to work on encouraging a mama in labor with induction that it can be done without epidural. No joke. She shook her head and went back to monitoring my bleeding as I delivered my placenta. It's work not a spa day... and then you get your baby. What better reward for a hard days work. And it was actually 5 hrs of work.
Great job on doing it natural on pitocin you are one strong mama! Also happy you showed a midwife everything is possible wI think the right mind set!
I love this post! Because I was a VBAC I had to stay on the monitors. But that didn't mean I stayed still and in bed. I took frequent bathroom breaks (didn't even have to go, just wanted to be up and moving), and I was up out of be. My poor nurse (and co-worker) sat on the floor holding my monitor in place so I could stand by the bed. Once transition hit, I stayed in the bed better, but was all over the bed haha. From 9cm until the push before Keegan was born I was kneeling at the top of the bed holding onto the IV guides and rocking my hips. Thank goodness for my Doula, because without her reminding me to relax and breathe, I would have given in.