Transition - AKA that "I can't do it!" moment

What is it?

At some point, almost all women in labour have a little bit of a panic or a meltdown. They usually cry, "I can't do this!" Midwives hear this phrase a lot.

What causes it?

Transition is caused by a surge of adrenalin in response to labour sensations.

This is a little bit different to a adrenalin surge because something has frightened us. That is something we want to avoid if at all possible. This is different - it is unavoidable.

The further into labour you go, the more the rational bit of your brain disengages. This, combined with the adrenaline spike, can result in behaviours that can be alarming to see if you aren't forewarned.

Why does it happen?

There are several reasons:

• To change your contractions from opening to "pushy".
• To prompt you to a more upright position - this ensures a clean line of descent for your baby and adds gravity to your pushes.
• To make you alert to any threat in the area - you and your baby are vulnerable as they emerge and in the period just after.
• To make you alert to meet your baby, as well.

How do you spot it?

As a birthing mum, you might not! Your rational brain is (hopefully) pretty well disengaged by this point.

As a birth partner, there are several things you can watch out for.

• Contractions are good and strong, long and close together! Physically, this is very intense. It's also usually short, and a good sign baby should be here soon.
• The labouring woman might want to change position and will usually lead to her getting more upright, or opening her pelvis more. Support her in this!
• Shakiness
• Throwing up
• Anxiety, self-doubt, a loss of control
• She might lose her inhibitions - she might suddenly declare she's too hot and strip down to her birth-day suit for instance.
• She might want to change where she is (I'm going home!). If she is already at home, she might request to transfer. She might change what room she is in - wanting to go to the toilet by herself is quite a common one. (Support her! Going to the toilet is usually a good thing!)
• Speaking of change... She might also change her mind about something she has been really firm about previously. This might be a genuine change of heart, or it might just be what I like to call, "a wobble". I will talk about how best to support this in a moment.
• As labour moves ahead, and the rational part of the brain disenages, most women talk less, and their focus shifts inward. Near the end, it can look like they have suddenly "woken up" again. They seem more lucid. Don't be fooled - that's the adrenalin at work! Her rational brain is still disenagaged.
• Being irritable. Top tip: prepare for her to snap at you. Take it on the chin. She genuinely can't help it. Those "funny" moments on TV and film where a birthing mother shouts, "just get it out!" or "never come near me again!"? Transition. If she is going to give you a right hook, it will be now. Duck.

What's the best way to support a mum in transition?

• "Don't wake the mother!" (Michel Odent) In other words, don't engage her rational brain. If at all possible, don't try to explain things just now. Don't distract her. This is a delicate moment - hold it gently.
• Touch. If she can tolerate it, soothing touch can bring enormous comfort without engaging the "wrong" bit of her brain. Hugging, hand holding, massage - these can all help more than many people realise.
• Simple words of love and encouragement. Such as:

I love you

I'm proud of you

You're amazing

I'm right here with you

You're safe

Things to remember

• It is usually unpleasant and tense, but it is also short!
• It is a positive sign of progress. Your baby is likely to be here soon.
• We've all been there! It sucks, but we've all done it, thinking we can't... and you will too
• This is physiological, unavoidable, and outside of your control. I hear so many mums say, "I was doing so well until_____ and then I lost control, I panicked". This is part of the process, and no commentary on success or failure.
• It is not just the strength of contractions that can be challenging, but the emotions we experience as well. We run the gamut of human experience during birth. Yes, it's an intense physical experience, but it's not just a physical experience.
• There is only so far you can prepare for this. There is an element it's impossible to prepare for, especially if you are a first time mum. You will just have to experience it for yourself.

Things to remember for partners

• Don't try to rationalise with her just now. "But, honey, you can't leave, you're about to have a baby..." That part of her brain isn't engaged right now.
• This is not a good time to discuss things or make decisions. If at all possible, allow time for this to pass. Maybe she has said all through pregnancy she wants to avoid an epidural, and then right and the end, she asks for one. This is tricky - how do you know if this is just a wobble, or a genuine change of heart? A good general rule is to support through three more contractions, and then ask her what she wants to do. Often (not always, but often) this is enough time for it to pass.
• Be mindful of language throughout labour, but especially now! Choose words that will lift her up, encourage her, and support her in her goals. In the epidural example I just used, you wouldn't say, "OK, now do you want that epidiural?" In her current vulnerable state, as she hovers between two worlds, this is a leading question. The key words in that sentence are "want" and "epidural". She is likely still racked with self-doubt (labour often does this to us). Ask in a neutral way - for example, "What would you like to do next?" If she still asks for one, it's likely this is a genuine change of heart. Keep in mind at this late stage it might not be possible, or doctors might advise against it - now is a better time to discuss this than smack bang in the middle of transition, though.

So... are you ready?

Wise ones:

❓️ What was your experience?

❓️ Did you experience any of these signs?

❓️ Did you recognise what was happening at the time?

❓️ How were you supported through it?

❓️ What advice would you give to a first-time mum and her birth partner about this phase of labour?

Please share your thoughts and experiences with me in the comments! And please share this with a mum or dad-to-be. I hope they find it helpful!

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