Transition is the end of the first stage of labour, that is, when dilatation of the cervix reaches between seven to 10 centimetres. From the mother's perspective, it is admittedly the most difficult part of labour. The good news is that it lasts only about an hour, just before baby comes. But what an hour! The symptoms of transition are very real and may be frightening to the uneducated mother. It is however reassuring for the prepared mother. As the severity of the contractions tells her that baby will come soon, she still needs to be constantly supported and reminded that what she is feeling is a definite sign that her body is working well and that baby is now very close.
Transition is definitely hard work, very hard work! "Why does a mother have to go through all this?" many a mother may ask, as if she would be happy to be spared the doom of pain which seems to be inflicted on her, as part and parcel of becoming a mother. Who blames her?
A mother in transition must not be on her own at any time. I cannot agree more with the doctor who said that it is "inhuman" for a mother to be left alone at this time. Several decades after my experience, I am still angry that I have gone through two births, and so two transitions, alone in hospital without adequate support, as husbands and family members were not allowed anywhere near the mother. I could not understand why it had to happen that way, when my own mother, a generation before, talked so fondly of all her births at home, supported by women friends.
At a time when there were no means of communication in the form of landline or mobile telephones, it was rather difficult for a birthing mother to call for help if she happened to be alone, other than go and knock at a neighbour's door or scream for help! If labour went on smoothly without any hitch, it could easily happen for the mentally relaxed, or the naïve mother to be surprised with the sudden birth of her baby when she was in church, or shopping in the village square or alone in a field or at home. For safety reasons, nature does not intend births to happen this way. Transition is a phase in the birth that emotionally causes panic in the mother, much more so when she is on her own. She will automatically seek help and support from the nearest source, and this could easily be done if she knew help was a shout away. The contractions of transition did the trick! The mother, overwhelmed with fear by the intensity of transition, would scream as much as she possibly could, and her cries would immediately bring in the neighbours, suddenly making the mother's surroundings automatically supportive and safe!
So transition has a purpose after all! But, one may ask, is it really necessary nowadays when births are happening so differently? With all the effective means of communication facilities and technology, mothers still scream during childbirth! One generation is not enough to affect evolution and perhaps we shall not be around to see things change automatically in this regard! Education certainly helps, but even nowadays, the intense feelings of transition are useful for the mother to draw her care-givers' attention towards her at such a crucial time, when baby is so close.
Just like mothers having babies generations before, her call for help means: "Please be with me, do not leave me alone. Hold my hand. Stay by my side. Tell me it will soon be over". It is a pity that in most prevailing systems of birth, this cry for help is often misinterpreted. Attending husbands are known to panic helplessly and rush to midwives begging them to "do something!" Instead of a cry for emotional support, the mother's cry is often interpreted as a cry caused by intense physical pain, which may certainly be the truth, as more pain in her body may actually be caused by the mother's same screaming and tensing of muscles. This situation is certainly not ideal especially in a hospital setting where more mothers are perhaps in the same room or ward having babies. Fear and panic will be radiated to other mums.
In a hospital system where painkillers are readily available, a quick, natural solution would be the use of various drugs administered accordingly. The mother's feelings of transition are usually "fixed" or quietened down with effective painkillers. The dulling of her cries with sedations may indicate that she is not in pain anymore. The caregivers do not hear her cries anymore, so with the problem seemingly solved, they feel better because they have "helped" her in their own way. In fact, they feel sure that their act of kindness was just what she needed. They may even decide to leave her peacefully alone to "rest".
After having painkillers during their birth, some mothers comment that the effect of the painkiller they were given dulled their ability to scream, rather than diminished their pain. It was like their mind and body were separated and they could not react to the pain. So, for them, it was really a fake solution. On the other hand, for mothers who are terrified of the birth, separating their mind and body during the birth by drugs is just what they need. They would obviously much rather sleep through and are thankful to be rid of their role of birthing the baby. In such a situation, it certainly is a quick-fix solution, but in the long run, is it the best? Are we helping mothers shoulder parenting responsibilities by taking over their work for them during childbirth? With all the drug addiction happening around us, are we aware of what the long-term effect of drugs on newborn babies can be?
In view of the fact that all painkillers have an adverse effect in various degrees on both mother and baby, it may be wise to see what other techniques work efficiently in this difficult, albeit short part of labour. The educated mother will be aware she is nearing transition when she feels any of the following signs:
Contractions get stronger, longer and closer together, usually one minute long, three minutes apart, and needing special techniques to keep up with.
Feet get cold. It is useful to wear warm socks.
Hot flushes are felt in the head, needing frequent sponging.
The mother becomes moody and dependable. She may behave very differently than her norm. Her partner may be at a loss at how to react. In spite of his good intentions and good will to offer help, he may be told off several times, so it is good for him to be prepared and not react too negatively!
She becomes sweaty and yet cold. This feeling is very similar to running a temperature.
The mother experiences an uncomfortably dry mouth. If there is time, she may be encouraged to wash her teeth quickly to freshen up. Otherwise she may be hydrated with frequent sips or sponging her mouth.
She feels burpy and nauseated. The mother often throws up, but the good news is that she often dilates further and quicker after this happens.
She experiences shaky legs. She may not be comfortable at all in bed as lying down increases her pain. Yet she can barely remain upright for long because her legs can barely support her.
She certainly feels heavy - in more sense than one! Encouraging her to change positions for better circulation is a good idea both for her and for her baby. Changing positions, even slightly, is by no means easy, and the mother needs help.
What helps at this stage? To be frank, practically little does! The birthing mother needs to be reminded that this short period of helplessness brings her closer to seeing and holding her baby. Her support persons may master techniques that are useful at this stage. We shall discuss them in the next article.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.
Transition is definitely hard work, very hard work! "Why does a mother have to go through all this?" many a mother may ask, as if she would be happy to be spared the doom of pain which seems to be inflicted on her, as part and parcel of becoming a mother. Who blames her?
A mother in transition must not be on her own at any time. I cannot agree more with the doctor who said that it is "inhuman" for a mother to be left alone at this time. Several decades after my experience, I am still angry that I have gone through two births, and so two transitions, alone in hospital without adequate support, as husbands and family members were not allowed anywhere near the mother. I could not understand why it had to happen that way, when my own mother, a generation before, talked so fondly of all her births at home, supported by women friends.
At a time when there were no means of communication in the form of landline or mobile telephones, it was rather difficult for a birthing mother to call for help if she happened to be alone, other than go and knock at a neighbour's door or scream for help! If labour went on smoothly without any hitch, it could easily happen for the mentally relaxed, or the naïve mother to be surprised with the sudden birth of her baby when she was in church, or shopping in the village square or alone in a field or at home. For safety reasons, nature does not intend births to happen this way. Transition is a phase in the birth that emotionally causes panic in the mother, much more so when she is on her own. She will automatically seek help and support from the nearest source, and this could easily be done if she knew help was a shout away. The contractions of transition did the trick! The mother, overwhelmed with fear by the intensity of transition, would scream as much as she possibly could, and her cries would immediately bring in the neighbours, suddenly making the mother's surroundings automatically supportive and safe!
So transition has a purpose after all! But, one may ask, is it really necessary nowadays when births are happening so differently? With all the effective means of communication facilities and technology, mothers still scream during childbirth! One generation is not enough to affect evolution and perhaps we shall not be around to see things change automatically in this regard! Education certainly helps, but even nowadays, the intense feelings of transition are useful for the mother to draw her care-givers' attention towards her at such a crucial time, when baby is so close.
Just like mothers having babies generations before, her call for help means: "Please be with me, do not leave me alone. Hold my hand. Stay by my side. Tell me it will soon be over". It is a pity that in most prevailing systems of birth, this cry for help is often misinterpreted. Attending husbands are known to panic helplessly and rush to midwives begging them to "do something!" Instead of a cry for emotional support, the mother's cry is often interpreted as a cry caused by intense physical pain, which may certainly be the truth, as more pain in her body may actually be caused by the mother's same screaming and tensing of muscles. This situation is certainly not ideal especially in a hospital setting where more mothers are perhaps in the same room or ward having babies. Fear and panic will be radiated to other mums.
In a hospital system where painkillers are readily available, a quick, natural solution would be the use of various drugs administered accordingly. The mother's feelings of transition are usually "fixed" or quietened down with effective painkillers. The dulling of her cries with sedations may indicate that she is not in pain anymore. The caregivers do not hear her cries anymore, so with the problem seemingly solved, they feel better because they have "helped" her in their own way. In fact, they feel sure that their act of kindness was just what she needed. They may even decide to leave her peacefully alone to "rest".
After having painkillers during their birth, some mothers comment that the effect of the painkiller they were given dulled their ability to scream, rather than diminished their pain. It was like their mind and body were separated and they could not react to the pain. So, for them, it was really a fake solution. On the other hand, for mothers who are terrified of the birth, separating their mind and body during the birth by drugs is just what they need. They would obviously much rather sleep through and are thankful to be rid of their role of birthing the baby. In such a situation, it certainly is a quick-fix solution, but in the long run, is it the best? Are we helping mothers shoulder parenting responsibilities by taking over their work for them during childbirth? With all the drug addiction happening around us, are we aware of what the long-term effect of drugs on newborn babies can be?
In view of the fact that all painkillers have an adverse effect in various degrees on both mother and baby, it may be wise to see what other techniques work efficiently in this difficult, albeit short part of labour. The educated mother will be aware she is nearing transition when she feels any of the following signs:
Contractions get stronger, longer and closer together, usually one minute long, three minutes apart, and needing special techniques to keep up with.
Feet get cold. It is useful to wear warm socks.
Hot flushes are felt in the head, needing frequent sponging.
The mother becomes moody and dependable. She may behave very differently than her norm. Her partner may be at a loss at how to react. In spite of his good intentions and good will to offer help, he may be told off several times, so it is good for him to be prepared and not react too negatively!
She becomes sweaty and yet cold. This feeling is very similar to running a temperature.
The mother experiences an uncomfortably dry mouth. If there is time, she may be encouraged to wash her teeth quickly to freshen up. Otherwise she may be hydrated with frequent sips or sponging her mouth.
She feels burpy and nauseated. The mother often throws up, but the good news is that she often dilates further and quicker after this happens.
She experiences shaky legs. She may not be comfortable at all in bed as lying down increases her pain. Yet she can barely remain upright for long because her legs can barely support her.
She certainly feels heavy - in more sense than one! Encouraging her to change positions for better circulation is a good idea both for her and for her baby. Changing positions, even slightly, is by no means easy, and the mother needs help.
What helps at this stage? To be frank, practically little does! The birthing mother needs to be reminded that this short period of helplessness brings her closer to seeing and holding her baby. Her support persons may master techniques that are useful at this stage. We shall discuss them in the next article.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.