What people mean by transition

Tommy's gives the clearest published description: "Towards the end of the first stage you start to become fully dilated and your contractions will tend to get stronger and more intense. This is known as transition. It's different for everyone. You may get a strong urge to push or it might feel like a lull and a chance to rest. It might be overwhelming, in which case you'll need support from your midwife and your birth partner to get through it."

That is a complete account in four sentences, and it includes the thing most descriptions leave out: transition is not always dramatic. For some people it is a rest.

Why it is not an official stage

Look for transition in NICE's intrapartum guideline and you will not find it. NICE defines the latent first stage, the established first stage, the passive second stage and the active second stage. There is no transition in between.

That is not an oversight. Transition is a description of an experience rather than a measurable clinical state. NICE's established first stage runs until full dilatation; its passive second stage begins at full dilatation "before or in the absence of involuntary or active pushing". Transition is the lived edge between those two definitions.

Knowing this is useful for one practical reason: your midwife will not tell you that you are "in transition", because it is not something they are recording. They will tell you how dilated you are, or that you are fully dilated, or that they can see the baby's head.

What it can feel like

The published description is Tommy's, and the honest range within it is wide. Reported alongside stronger, more intense contractions:

A strong urge to push, sometimes before anyone has confirmed full dilatation.
A lull. Tommy's names this explicitly — contractions can space out and give you a genuine rest before the second stage.
Feeling overwhelmed. Tommy's again: "It might be overwhelming, in which case you'll need support."
Shaking, feeling hot or cold, or feeling sick. Widely reported around this point, and not a sign of a problem.
Wanting to stop, go home, or change plan. The classic transition moment, and often the clearest signal to a midwife that you are close.

The HSE's description of what comes immediately after is short and accurate: "You will have strong contractions. You will feel the urge to push. Your midwife will guide you on how to use your breathing when you have a contraction."

The pattern worth knowing in advance is this: the point at which you are most convinced you cannot do it is frequently the point at which you are nearly finished. Birth partners are the ones who should read that sentence.

How long it lasts

There is no published duration, because there is no clinical definition to measure. What NICE does define is what comes on either side. The established first stage ends at full dilatation; the second stage runs from full dilatation to birth, with active pushing expected to produce birth within about 3 hours for a first baby and 2 hours for later babies.

By general account transition is the shortest phase of labour. Any specific figure you are given for it is an estimate someone has invented, and this page is not going to add one.

The lull, and why it is not a problem

If your contractions space out once you are fully dilated, nothing has gone wrong. NICE builds this into its definitions: the passive second stage exists precisely because full dilatation and the urge to push do not always arrive together, and it allows the passive stage to last up to 2 hours where a woman with an epidural has been advised to delay pushing.

NICE also advises that "on confirmation of full cervical dilatation in a woman with regional analgesia, unless the woman has an urge to push or the baby's head is visible, pushing may be delayed by 1 hour for multiparous women and up to 2 hours for nulliparous women". Waiting is a recognised option, not a delay.

What helps

NICE's advice for pain in labour applies here, and it is short on gadgets: "Advise women that breathing exercises, having a shower or bath, and massage may reduce pain during the latent first stage of labour." It also instructs staff to "offer all women with delay in the established first stage of labour support and effective pain relief", and more generally to "treat all women in labour with kindness, dignity and respect".

Practically, at this point:

One person, one voice. Multiple people talking is intolerable in transition.
Short instructions. "Breathe out." "Next one." Nothing longer.
Do not offer choices. This is not the moment to review the birth plan.
Change position if you want to. Tommy's notes that kneeling on all fours can help if there is a lot of backache.
Ask about pain relief if you want it. Wanting an epidural in transition is common; whether there is time for one is a question for the midwife, and it is a fair question to ask.

The HSE's pain relief guidance is worth reading before labour rather than during it, because transition is not a moment for reading.

For birth partners

This is the part of labour where support makes the most difference and is hardest to give. Tommy's says the support of a midwife and birth partner is what gets people through it. Practically: stay physically close, keep talking to a minimum, do not take anything said personally, and do not try to jolly anyone along. Fetch the midwife if you are worried.

When to call someone

Your midwife or maternity unit if you are still at home and contractions are coming every 5 minutes or more often, or are regular, strong and lasting at least 60 seconds.
Your local emergency number — 999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if you feel a strong urge to push and think the baby is coming.
Urgently if your waters break, you have bleeding, your baby is moving less than usual, or you are under 37 weeks (NHS).
Your midwife, in the room, if you feel an urge to push and nobody has checked recently. It is worth saying out loud.

The short version

Transition is the end of the first stage, named by experience rather than by guideline. It is short, often the most intense part, and it may equally present as a lull. Tommy's is the source that describes it; NICE does not name it at all. If you feel like giving up, you are usually close.

Transition in Labour