question about a birth/determining stage of labor

[Rockies5]

my question: what determines labor stage?

If all signs EXCEPT cms dialtion point to transition what stage is it? shouldn't it be that all signs are taken together to determine where in the labor continuim one is? Oy. Can't you have transisiton at 4cms? isn't transition and those hard, close contractions are what get one's cervix to a 10, no matter when (as far as cms) it starts.

[pamamidwife]

I think it's hard to determine things like this - it's this type of thinking that fuels the medical model. You know? Not saying that this is what you're doing, but the idea that there has to be dilation markers along with how a woman is feeling - even the term "transition" is vague, but often is used to apply to the last few centimeters of dilation. However, is it really important? Are we defining our feelings and looking for validation from another based on these numbers?

[jillmamma]

I am not a birth professional, but I can tell you that my personal experience is that I hit transition at 4 cm both times, and went from 4 to 10 in one hour both times. I KNOW it was transition because I had contractions hard and fast and close together, I was starting to feel like I could not do this much longer, with my oldest I threw up and water broke, and I was ready to push one hour later. So I can tell you, yes, you CAN have transition hit at 4 cm, because it happened to me twice!

[Rockies5]

Originally Posted by pamamidwife

I think it's hard to determine things like this - it's this type of thinking that fuels the medical model. You know? Not saying that this is what you're doing, but the idea that there has to be dilation markers along with how a woman is feeling - even the term "transition" is vague, but often is used to apply to the last few centimeters of dilation. However, is it really important? Are we defining our feelings and looking for validation from another based on these numbers?

You hit the nail on the head. I'm processing a birth I attended at a medical facility recently.

Mom's body and emotions said transition, her dr thought otherwise because of the opening of the cervix.

[DoomaYula]

With my first two births, I started going through transition at 3cm.

Psychologically, it was very disturbing, because the doc/CNM told me I was at 3 and yet I was puking, shaking, having very long strong close ctx. With my first birth, I got an epidural because I assumed I'd be laboring like that for 8 more hours. My twins were born within an hour. With my second birth, same exact situation -- I was experiencing the same feelings and was told I was at 3. My dd was born about 2h later.

This birth, I didn't have a single VE during labor and it was great. (Thank you Charmie!) I felt a little panicky when I felt the urge to push, like I *should* get checked and told by a professional that it was okay to push -- I knew I had only been in labor for just over an hour so I couldn't believe it was already time -- but then I couldn't mistake the feeling of her head right there.

[Charmie981]

When I took Bradley, we were taught that the definition of transition is "the largest amount of dilation in the shortest amount of time," which is what makes it so intense. That definition really resonates with me because I've seen people who didn't have a transition at all....maybe because they never did 5 centimeters in one hour and they were on Friedmann's curve, dilating pretty evenly? I don't know.

I do know that when I went from 5 to complete in 45 minutes with my second, it was crazy intense and I would certainly call it transition, even though it started at 5 and not 8. I think the most intense transitions are the ones that start and 3 or 4 or 5, simply because there's a lot more work to be done in that short amount of time.

I don't ever tell anyone, though, whether they're in transition or not. I mean, really, how helpful would that be, considering that we all think of transition to be the single most intense and painful part of labor (with the exception, maybe, of the ring of fire, which I also never tell anyone they're experiencing)? If someone wants to assign that label to part of their labor after the birth, then they're welcome to do that, but I don't feel like it's part of my job description.

[Rockies5]

Originally Posted by Charmie981

When I took Bradley, we were taught that the definition of transition is "the largest amount of dilation in the shortest amount of time," which is what makes it so intense. That definition really resonates with me because I've seen people who didn't have a transition at all....maybe because they never did 5 centimeters in one hour and they were on Friedmann's curve, dilating pretty evenly? I don't know.

I do know that when I went from 5 to complete in 45 minutes with my second, it was crazy intense and I would certainly call it transition, even though it started at 5 and not 8. I think the most intense transitions are the ones that start and 3 or 4 or 5, simply because there's a lot more work to be done in that short amount of time.

I don't ever tell anyone, though, whether they're in transition or not. I mean, really, how helpful would that be, considering that we all think of transition to be the single most intense and painful part of labor (with the exception, maybe, of the ring of fire, which I also never tell anyone they're experiencing)? If someone wants to assign that label to part of their labor after the birth, then they're welcome to do that, but I don't feel like it's part of my job description.

thank you charlotte I appreciate your thoughts and expereince.

[doctorjen]

I was taught that transition means the last couple few centimeters of dilation preceding second stage of labor - the transition time from one stage to the next, if you will. If that is the case, then transition is by definition around 7-8 cms to complete, regardless of what else is going on.
I think other times transition is used to describe a serious of symptoms - long, intense contractions, vomiting, double peaking contractions, doubt of ability to make it through labor, shaking, etc. In that case, "transition" can describe many parts of labor.
In my practice, I don't use the word at all, not finding it very helpful in either case (to describe how dilated someone is, or to describe the symptoms they are experiencing.) I will say I am pretty much more accurate in predicting time to birth (roughly) if I go on signs and symptoms than if I go on number of centimeters (although I've been proved wrong enough times to know better than to make predictions to the mama!) I'm not so good at looking at a mom and guessing how many centimeters, but I am pretty good at looking at a mom and knowing birth is imminent or some way off yet, if that makes sense. I've tried to impress this on my labor nurses, too, and they are catching on!
I don't care what terms an individual woman wants to use to describe her own experience, though, and wouldn't in the least care when she wanted to call "transition"

[laoxinat]

aaawww doctorjen, have you been reading Ina May?
laoxinat

[Charmie981]

Originally Posted by doctorjen

In my practice, I don't use the word at all..I'm not so good at looking at a mom and guessing how many centimeters, but I am pretty good at looking at a mom and knowing birth is imminent or some way off yet...I don't care what terms an individual woman wants to use to describe her own experience, though, and wouldn't in the least care when she wanted to call "transition"

My thoughts EXACTLY. I'll never forget the birth where I looked at the doula and held up eight fingers, then whispered to her that we'd probably have a baby in an hour. A few minutes later, mom asked me to check and I was REALLY disappointed in myself to find she was "only" 6cm. But her baby was born 45 minutes later! I've learned that I just prefer not to check b/c the centimeters really don't tell me ANYTHING about when a baby will come!!