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!
35 years ago and I remember it like it was yesterday! Birth totally natural even though I was termed an "elderly" primaphara(?) (first time mother), in my late 30s. Pre-natal classes with wonderful obstretician, all of us wanting natural childbirth...although apparently only 2 out of 15 attained it. The one thing that threw me (temporarily) was transition stage, taken by surprise as my body suddenly went out of control, shivering and shaking, lost consciousness and sense of time... maybe this helped me get through it? Anyway, when I came to, changed to squatting position and started pushing and baby came out soon after, It It was so wonderful to be conscious during the actual birth and able to touch baby and bond with her immediately; and she for her part was so alert when born, because no drugs in her system:no crying or screaming just calmly looked around her
My partner and I asked our best friend to be our donor and he accepted with honor. We want to start trying to conceive next year before we move to Oregon so that we have easy access to the sperm and so that I am not so pregnant that I'm too big to help with boxes! I have read this article and all the comments, and a lot of the worries I had about the pain are gone. This will be my first pregnancy/birth and I will be 23. My partner and I are both Vegans and we want to have a natural water birth, so we are birthing and raising our little one very differently than how we were birthed and raised. We want a Midwife and because we are going against the grain, we might desire having a Douala on our side but I'm afraid that it might be expensive to hire one. Any advice?
My method was to relax, relax, relax. Don't fight the contractions!! Breathe through them and let them do their work, just breathe and relax every muscle in your body to the best of your ability. Practice this with leg cramps during pregnancy! Lol no, seriously, I did that, very similar pain and similar remedy. Writhing and screaming only make you hurt more (learned this experimentally also) if you can relax the pain is worst and I'm convinced lasts longer.
*if you CAN'T relax, I meant 😉
I'm hoping you can help me because I'm still trying to make sense of what happened during my 1st birth 6 months ago. I wanted an all-natural birth and hes giving birth in a hospital. By the time I arrived 2 weeks past my due date I was 6 cm dilated and handling the pain well. I progressed to 10 cm in 4 hours breathing through the contractions and kneeling on the bed. They had me hooked up to an IV so I really couldn't move much. Once I hit 10 cm I was not feeling the urge to push but the contractions kept coming and were so painful. They broke my water and I pushed for 4 and a 1/2 hours . When my doctor came back-to reassess she said the baby had not descended at all. It was incredibly discouraging. During this whole 4 and a 1/2 hours nobody at the hospital offered any suggestions on positions or things I could do to manage the pain or speed up the process. It was my 1st baby so I didn't know any better or that this was bizarre. I beg for and an epidural and waited 45 minutes to get 1. At no point did my contractions slow or space further apart they were coming every 60-90 seconds and lasting the same time. Once the epidural started working I began to push for another 8 hours until it wore off. At that point the baby still had not descended and I had AC section. They had to push the baby back in to perform the c-section. I never want to experience anything like that again and was hoping you May be able to help me understand what happened? My doctor Had very little explanation or feedback and I'm still grappling with what happened 6 months later. Any thoughts on what I could do differently for the next birth?
Hey Charlotte. Wow, what a story. Thank you so much for taking the time to share these intimate details of your birth experience. Good job! The first step is to talk about what happened to safe people in your life. I just want you to know that I am amazed at your endurance. 12 and a half hours of pushing?! That's incredible. You are a birth warrior. It's hard for me, not having been there, to say what happened and what you could do differently next time. But I can recommend a couple of things for you to do - 1) request your medical records and 2) connect with a local ICAN group. I think by doing those two things you will have some questions answered and begin healing. Much love to you.
For my second child this thought helped me get through unmedicated: "As soon as he's out the pain will be gone!" This was my light at the end of the tunnel. I could remember from my first birth how immediate the relief was once the baby was out.
Being in the water was the biggest help for my first. With the weight of everything eased a little I was able to focus on relaxing my body, even when things ramped up (I had a much harder time doing that while out of the water). For my second it was similar, and ended up being a slightly shorter labor. My third was fast and intense! What got me through the powerful, seemingly back to back contractions of transition (along with being in the water once again) was KNOWING that I was in transition. I remember consciously thinking, "Things are picking up, I am feeling nauseous...baby is CLOSE!" And boy was she close. Minutes later my water broke, and within the next minute, as I was about to move to "dry land" to deliver, baby arrived faster than I thought possible!
I have been an unofficial doula for a number of births and I agree that the quiet, calm encouragement of "Things are moving, You got this!" can really help empower a mama to stick it out.
Here in France where I am a British expat they have a local epidural - which allows you to get up and walk around as well as being mobile afterwards. I noticed a lot of people said they didn't want epidural due to the mobility and wondered if this is a better option when taking one? Apparently they have been doing them for over 10 years.
I've never had any surgery, accident or broken a bone so I'm really not sure if I can cope with the pain or not! I have to do hospital birth as high risk - first at 39 and too heavy for their liking (just extremely stocky with strong large dense bone structure so have a rugby player physique 🙁 I've not put on more than about 1-2kg throughout the whole 37 weeks I'm at now. But they read BMI so I'm high risk. No water births or anything like that.
I can ball, shower, bath and massage and will most likely end up with the local epidural but will try and put it off as long as possible.
Anyway so sometime in the next 2-4 weeks hopefully!
Interesting! Never heard of that here in Florida. But I'm not surprised... we are often behind the game as far as maternal health goes. Best of luck to yoU!
They are also known as "walking epidural". But of course they do not work the same for all. I have heard some say it knocked them on their ass...so you never really know.
I paced back and forth during my entire 12 hour labor including transition. I took 1 dose of nubain, and it was more to allow me to sit and rest my legs than anything. As soon as it wore off transition hit hard. I still paced , though. I leaned heavily on my husband. Something about forcing my feet one in front of the other and crossing the room kept me focused and steady. It was like symbolic of the journey I was on...or maybe I was literally trying to walk away from the situation! I vocalized a lot too. My amazing nurse started saying '" you're doing SO GOOD " because I guess it was obvious I'd hit transition. I thought she was nuts and was about to say epidural please, but then it was time to push. 15 min later, I met my daughter. I only hope I can be as much of a badass with my son (due in November!) as I was with my first. 🙂
Dear Lindsey, your article helped me trough my third labor so much, like you were my doula 🙂 I was searching for some phisical and mental help on internet and accidentaly find your article. During my 24 hour contraction I was at home, concentrated, doing rekigoligiously everything you wrote 🙂 when thing were getting hard (read, transition came) I went to hospital so brave and convinced that everything will be perfect and fast. So it was. Hour and a half was the time from my arrival to hospital to kissing my lovely son. My comment is a way to say thank you sooo much. Sending love from Serbia <3
I'm so honored to have been part of your journey!
Dear Lindsey,
I had my first baby at the end of April this year and I have to say this article was a life saver!
My contractions started around 9pm on the Sunday and by 11pm I couldn't lie down so I knelt over the bed alternating from my knees to my butt (we have a very low bed) and I noticed my body taking over, I started swaying my hips a lot and that brought some relief, and just being in a kneeling position relieved most of the pain.
When 7am rolled around (no sleep at all) my husband suggested I go have a shower and it was one of the best showers of my life haha. Again I was on my knees with water hitting my back and it was amazing, I could've stayed there all day.
At 9am we called the midwife and I had my hubby drive some tennis balls into my back (again, amazing) the midwife arrived around 10am and I was at 3cm so she gave me some gravol so I could sleep and she left (she assumed it would be a while before things got moving and didn't want to crowd me) and about an hour later I was being hit with back to back contractions and I couldn't move without getting hit with another one. I remembered this article and thought "oh boy here we go" I kept saying to myself "be brave be brave be brave this is normal everything is fine" and my hubby being SO calm (continuing with the tennis balls) kept me super calm. We called the midwife again and she made it with an hour to spare, my water hadn't broken but baby had moved down and I was pushing without really noticing what was going on (my midwife asked "are you pushing already?? And I said "I don't know?!?!?")
My water finally broke and baby was out 2mins later! Grand total of 18hrs start to finish, and I couldn't have done it without the strength I received from God, my amazing hubby, and this article! Thank you so much for all you do!
Wow Becky! Thank you so much for leaving this comment. I'm so happy for you! You were SO BRAVE!
My first birth was med free in the hospital however I do not feel I really experienced transition as I didn't feel ready to push when the OB decided it was time to rip my baby out. I was left traumatized due to her unprofessional negligent behavior. My second birth was an ecstatic healing homebirth/freebirth. I feel being in the privacy and safety of my own home made all the difference (I spent most of my birth in the hospital alone in the shower). So if you need your privacy to relax and let go (as most do) I recommend looking into homebirth or even freebirth first and foremost. I had a birth pool which I got in near the end of labor after moving around my home, squatting, and bouncing on my birth ball(which was amazing). I had low light with candles lit since it was night as I labored (low light is very important). Once I got intoy pool things started to pick up. My waters released and my contractions intensified. I moved around the pool to find a comfortable position, eventually sitting up against the wall of the pool where I got a brief rest, drink and head rub from my partner...then it was time...I nearly tensed up and started to move forward...but I whispered to myself "no", as I knew that would gete nowhere. So I leaned back and got the urge to push (first one was to get some poo out the way ... totally normal...no shame). I had a bit of an out of body experience as I felt like I could see my babies head emerging. I knew the only way out was through. I can't say how many pushes I gave as it was all instinctual and quick. But before I knew it my baby was out arms stretched and eyes wide open. I am expecting my next in October and hope to slow the pushing down a bit and focus on breathing my baby down. I think this baby needs that were as my last wanted to come fast and furious....she is quite the little firecracker!
It's so interesting to read all these stories! My sweet boy was born in May, and transition was certainly my own personal hell. It seemed like no matter what position I tried, I was making everything worse. The doctor who was in the room was really helpful with suggestions, but as I said, nothing worked until I sat on a ball, leaning over the bed with my head on a pillow and my husband applying counter pressure to my back (I had all back labor which I pray to God to never have to experience again). At one point, soon after moving to the ball, I did yell out because I felt so helpless, but the doctor and my husband kept reminding me to breathe through it, and that really helped. Focusing on breathing through the pain and reminding myself to keep my hands open instead of fists and my jaw relaxed is what got me through it. Prior to moving to the ball, I did look at my husband and said "I'm done, get me the medicine. Now." He and the doctor said I was doing great and that I could do it, but I demanded it. We agreed to check my progress and decide from there. I was at 9.5 cm and the doctor said "this baby's going to be here before we can even get the anesthesiologist here!" I think that's when I moved to the ball and really buckled down to get that last half a centimeter gone so I could push. Thankfully, I only had to push for 10 minutes and my little guy was in my arms in a total blur. It's all so worth it, but man do I hope to not have back labor next time around lol
I had a quick birth but I got really sick and was throwing up the whole time. The only way I got through everything was silence and I picked something to focus on in the room. I focused on the Samsung label on the DVD player and just breathed every time I had a contraction. I wanted an epidural but didn't get one because my anesthesiologists got coded and couldn't give me one in time. It was tough but I did It!
My first birth was a home-birth and I knew from the beginning that i would have to embrace it all however it would come. I labored in the water through transition, my mother gave me sips of coconut water and my husband rubbed my shoulders. I found that suspending myself in the water and swaying from side to side was very relieving - for a while. Then i had to change positions with my head in my arms on the edge of the pool kneeling. Once I reached 10cm my midwife told me I'd have to get out of the water to push her out since we needed the help of gravity and I was beginning to relax too much haha! It was the most painful counter-intuitive thing for me to stand up (the sudden pressure was insane!) and climb out of the pool but 30 mins later I pushed her out! I found water very helpful during that birth.
I had my water broken at 930 pm and by 130am I was in transition. I had terrible back labor so I decided to use the shower.in the labor room. I had a shower chair in there and sat on it between contractions. My husband stood behind me and used the shower head to efflage my back between contractions. During contractions I would stand up, widen my legs and squat slightly which helped the baby descend. He helped me with my brething but at the most intense part of the contraction I vocalized whatever animal sound came out of my mouth. Lol. My husband used pressure points on my back to counter the pain and I held the shower head on my lower belly during contractions. I was in the showe for 2 hours - only coming out at the request of my midwife (who was check the heart rate every 15 mins while I was in the shower) because I was getting dizzy and exhausted. It really did help though. I kept remembering this post during that time when you feel like you can’t take it anymore and want to give up, you are almost there! Laughing gas was ok for helping me between contractions. However it made me hyperventilate because I couldn’t vocalize and had to have completely controlled breathing. My son was born at 430am after an hour of pushing and I felt incredibly empowered and exhausted that I was able to do it without the epidural.