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!
With my unmedicated birth (my second birth following a birth with an epidural for my first), it helped to know in advance that once I felt like I couldn't handle it it meant I was almost done. I kept telling myself "You're almost there." and I wouldn't let myself say outloud "I can't do this!". When thoughts like that popped up I would answer back "You are doing it! You can do it. You're almost done!". It was the hardest thing I've ever done, but the pain wasn't scary because I knew nothing was wrong and the pain had a purpose. Yes, it was still the most painful thing I've ever done, but it didn't cause panic. And, recovery was 100 times better than my epidural birth. I remember saying in the hours and days after birth "I don't even feel like I just had a baby! This is amazing!".
Wow, this is wonderful. Thank you for sharing!
I loved reading this! My first birth was unmedicated, in the hospital...my goal was totally unmedicated/natural and my husband was 100% supportive and was amazing through my entire labor. I had been in active labor for about 3 hours total up until this point: water broke, contractions hit fast after about an hour and then anouthrt couple hours passed between driving to the hospital and actually being in labor & delivery. At last cervix check, I was about 6 cm (I had been 4 cm/90% effaced for 2 weeks prior to that, and before that, I was 2-3 cm/80% effaced for another 2 weeks, so I’d really only progressed another 2 cm). All of a sudden, things got INTENSE. I can totally relate to how you describe transition as feeling out of control and panicky. I demanded a cervix check. Doctor was taking her sweet time. Then I demanded an epidural. As requested, hubby kept asking if I was sure. Had I known I was transitioning I would have felt “better” about the increased sensation and intensity but I don’t trust my body to be moving so quickly. Then, I felt the urge to push. Again, not trusting my body, I became fearful: if I was only at 6 cm, I couldn’t resist pushing and handle the major contractions for another 4 cm. Finally doctor came in...anesthesiologist was still on their way. She checks me: I’m at 10 cm and ready to push she says. She asks if I want to wait for an epidural. Nope, I’m good, the worst was over. So long story short, I learned that I need to listen to and trust my body. Total labor time was 4 hours, including 30 min of pushing. Fast but very intense. Had I been told that I was probably transitioning, I think that last hour would have been more manageable. Again, thanks for the great read! Saving this as I’m pregnant with #2, planning an unmedicated home birth!
Hello Moms! I know this comment is a bit off the wall but I really need some feedback. I decided not to have children early in life and as I grew older and met the most beautiful loving man in my life I began to question my decision not to be a mom. After much thought about finances, love, support, and our future we decided to seriously consider having a child. I began looking into Natural birthing plans and that is when I stumbled across birthing videos. The screaming still haunts me to this day! After first looking at birthing videos I did not sleep for over 72 hours and cried hysterically. Even now while typing this message I hear the cries of moms in labor. I am in utter disbelief about the reality of pain women go though to have children. Because of these experiences I have seen I fear to give birth and not be able to come back from it. I know I could handle the pain and give birth because that is what our bodies do- survive and it is what we must do. So I know it can be done but the way my mind will be altered after experiencing that level of pain I fear will damage me and the way I see the world and would end up damaging how I mother. I cannot fathom, comprehend, understand, in any way, why so many women give birth again if it is as painful as I see and hear. I TrueType don’t understand and we have decided not to have children. I applaud every mother and the love and sacrifice they have for their child. You are truest warriors!
Can anyone please help me understand why this level of pain is ok? Why is it acceptable over and over again? If it is so painful to cry, scream, beg for death then how HOW are so many of you willing to do it again?
As you can see this is truest haunting me and any of your experiences shared are appreciated.
I am pregnant with my 9th baby. I am thankful to have had natural unmediated births so far. I could write a lot about my birthing experiences, but I think I will simply speak about the best labor.
I obviously had experienced several other births, but by the 5th I realized I really had to focus on relaxing. For me tensing up made things worse, so each contraction, I would have to remind myself not to clinch my fist, not to clinch my jaws, to relax my shoulders, things like that. I did also try to focus on what my body was doing or needing to do. I thought on verses of strength and perseverance. I was handling things so well I was afraid when I got check I'd be told I was at a 4 or 5 , but I was at a 9. I cried. A little while later I decide to try to labor in the tub a bit. A few contractions of sitting in the tub I heard a big pop and baby was ready to come out. It was beautiful.
So I would say, if you're able exercise during pregnancy, eat and drink during labor for strength and energy, don't focus on the pain, and focus on relaxing your muscles. You'll be better equipped. Also, having a spiritual help like the verses really helped me too.
With my first baby, I had An epidural but it only worked for a short time and then I felt everything during transition and pushing. Being afraid and not mentally prepared for that pain was very hard! Something that really helped me was I had my husband give me “Indian burns” on my arm (twist with both hands in opposite directions on the forearm). It was painful but in a good way where it distracted my brain from other pain going on in my body. But I was Diagnosed with CPD Cephalopelvic disproportion, had 39 stitches and pushed for 2 hours. It was a very traumatic experience and as I’m reading more about natural births, I’m learning how it could have gone so much differently. My 2nd baby I had an epidural too which worked like a charm but I had a bad reaction which put me back in the hospital a week later. Also the OB didn’t even show up. I’m pregnant with #3 and really hoping for a natural home water birth! I’m freaked because of what I experienced With baby #1. How do I know If I’m committed enough for that marathon? I know I could do it, but clearly I’m fine with epidurals! I just Want this one, my last one, to be different. A faster recovery, no allergic reactions, my support team there for me the WHOLE time, and to be a beautiful sacred experience. But I’m freaked out
Both my babies were unmedicated births. and both were fast, second being much faster and the pain, more intense. Worth it in the end but everything you wrote really resinated with me. I said all of those things, especially "Help Me!" With Kiyan, my second, I truly felt like I went into a panic attack mode. I felt I couldn't breath and was going to die. But, as you said above, once I changed my thinking, decided to be quiet and turn into myself, I found a deeper strength and before I knew it he was here. Thank God for my supports. My mom, sister, midwives and amazing, hilarious, sweet, scared and loving husband. I'm so glad I persevered both times. Thanks for your terrific blog!
Thank you for this great article and all the wonderful stories underneath it. I had my first in July of last year and am days/weeks away from having my second.
I had to think about what I did during transition. I spent the first 10 hours laboring at home just fine. That was really the best part of labor, safe, exhausting (I couldnt sit down, the contractions were too intense), and comfortable (at labor can be). When I felt like I had to push we went to the hospital, 6 cm. But there was a bunch of things wrong with my son. Basically I went into panic mode. I was having panic attacks between the contractions as I thought my son was going to die. I asked my husband if I said I can't do this any more and apparently I did, though I dont really remember that. In 2 hours I was 9.5 and felt like I really needed to push. I do remember while pushing asking how much longer it was going to take. In hindsight I find this extremely hilarious as I only pushed for 45 mins. The entire birth was unmedicated and now as the second one comes I'm trying to prep for another unmedicated birth.
I'm a little worried how I'll handle the pain this time and also about the speed of the second labor. I want to stay at home as long as possible, but I'm not quite ready for a home birth yet. Reading over the tips is helping me feel more in control about getting through labor this time. And another cute and adorable baby is on its way to join our family! Thank you!
Oh my goodness! I just read every single comment and feel so much better than i have felt in months about this! I am 41 yrs old and 4 mos pregnant with my 2nd child. They will be 18 years apart (go ahead and laugh, i know its like a sick joke! i am so excited though)and so it's been quite a while since my drug free birth of my daughter at 23 and Im Scared! This really helped me add ive been telling the doctors and family that i want a c section which isnt logical at all and all fear and vanity based. My labor and delivery went quite smooth really, except that my husband was a clam and didn't offer any verbal support or cheer me on (ex husband) and i had to rely on an amazing nurse to help me through. That and it hurt like nothing else could and leave me still alive! I guess i feel i may not be able to do it this time since I'm 41 and I'm worried my body won't recover. Also, i live 1.5 hours from a town with a birthing hospital so we have a drive. !!!
You can totally do this! Hire a doula. 🙂
When we arrived at the hospital I was already at a 6-7 and began to transition within the next 30 minutes. During labor I noticed that I gravitated towards an elevated hands and knees position with my hands on the ottoman at home and on the bed at the hospital and my knees on the floor. At the end I remembered your blog post about the benefits to changing positions during transition and even said out loud to my husband in between contractions, “I need to change positions.” He asked, “is this position not comfortable?” I said “it is, but if I don’t change positions I’ll never have this baby.” (This was around the same time that I noticed my contractions getting much closer together and much more intense). We moved to a standing, slow dance position and I IMMEDIATELY began feeling ‘different’. I called the nurse in and asked her to check me. She said that I was a bulging 8 and during my next contraction my water broke. I began involuntarily pushing as soon as my water broke. The nurse wanted to check me once more to make sure I was close to a 10 and asked me to get back in bed. I (irrationally) told her to check me on the (wet, cold, tile) floor. I don’t remember this but my husband says he and the nurse had to pick me up and put me on the bed to check me. I then pushed for 30 minutes in an upright position with my hands on the elevated bed for about 30 minutes and then she was here. I ended up having a 13 hour natural hospital birth and I credit a lot of it to you and your blog posts and the things I learned here.
I had recieved an epidural because I was physically not handling the pain well at all, and the doctors could tell it was having an affect on my baby. Anyway, I received the epidural at around 8:30 AM, and by the time I was having the transitioning pain, my epidural wasn't doing anything for me! I had maxed out for the epidural where I had been on it so long, and ended up going through transition and the delivery feeling EVERYTHING! At that point it had been roughly 10 hours since I first received the epidural, and after an hour of pushing hard, I mean HARD, and receiving oxygen, I finally delivered my daughter. She unfortunately was delivered facing my inner thigh because the cord was around her neck, though not constricting her. SHe also relieved her bowels in the birth canal, therefore the nurse immediately began massaging my stomach, and my midwife stripped the placenta immediately. This was to decrease my chance of getting a bad infection from the poo. As soon as my placenta was removed, all my pain was gone, and at which they went ahead and handed me a screaming baby girl 🙂 I am pregant with my fourth baby (2 miscarriages prior), and hope to try some of these tips, tricks, and empowerment to get through the pain to hopefully keep me from stalling like I did with my daughter. I still have back related pain from the epidural from 3 years ago, so I really want to avoid it at all costs!
Wow, what a story! Have you considered hiring a doula this time?
With my 5th baby, I remember looking at my husband and telling him I had hit 7cm. The "double contractions" were there to stay. I had the head of the bed raised and I sat on my knees facing the head of the bed and leaned into it. When I needed a change of position, it was a modified child's pose that I found was most comfortable. I alternated between the 2 until the nurse finally agreed to check me...and then she was racing around and calling the Dr because she hadn't believed me when I told her it was close (he was my fastest labour and delivery by far but also my most complicated). Squatting position helped a lot to get me to 6cm along with my husband putting pressure on my lower back and hips.
Hi! I have to tell you, this article was part of the reason I was able to have an unmediated birth! The part about staying in a position for 3 contractions was super helpful and kept me in the game and open to trying new positions. Thank you so much for sharing your knowledge and experience...it was literally a game changer for me. ❤️
Wow, thank you for this comment. I'm so grateful it was helpful and made all the difference! I am so glad!!
I had a really terrible flu two weeks before my first baby was born, and I had him in a birth center - LOVED my midwives and other birth attendants. It was absolutely the most affirming environment I could've imagined giving birth in. Because of how severe my cough was when I had the flu, I was already 5 cm dilated when I got my very first contraction. I had prodromal labor for two days, but once I hit 6cm, it was less than 4hrs before J was born. Transition was a very mentally dark place for me – I kept trying to pray throughout my labor, but was undergoing an enormous amount of spiritual attack, including genuinely believing that I was making mistake by having a baby. It took me a long time to come to terms with that, and I think partially because of that I had a challenging bonding experience with our son for the first six or seven weeks. To manage the pain my husband poured water down my back and did counter pressure and then I had a very short pushing experience too.
Now I'm pregnant with baby #2 and planning another low intervention natural birth, but the mental darkness of labor still haunts me a bit. I really like your advice to "decide to be brave" and I'm definitely going to tell my husband about that and post it in my labor room. Thank you!
I had back to back contractions with my second 6 hours before I needed to push. It was the most intense and painful experience I've ever been through. I was in the tub, and I had 2 or 3 back to back. I was crying begging for an epidural and had to wait several more hours before I could get one. I'm now pregnant with our third baby and wanting to have a different experience!
I hope you do! I highly recommend a doula. But maybe you have one already. 🙂
I had 2 unmedicated births and am due with my 3rd baby next month. Having my mom give me back rubs and apply strong counterpressure to my low back is what got me through transition! She was a life saver!