Fetus ejection
reflex and the art of midwifery
Is the art of midwifery the art of
creating the conditions for a fetus ejection reflex? The phrase
"fetus ejection reflex" was originally introduced by
Niles Newton in the 1960s, when she was studying the effect of
environment on the birth of the mice(1). I found it relevant in
the 1980s to rescue the term from oblivion and to use it for humans
as well(2). Today I consider this "reflex" as the necessary
physiological reference from which one should try not to deviate
too much. During the powerful and irresistible contractions of
an authentic ejection reflex there is no room for voluntary movements.
A cultural misunderstanding of birth physiology is the main reason
why the birth of the baby is usually preceded by a second stage,
which may be presented as a disruption of the fetus ejection reflex.(3)
All events that are dependent on the release of oxytocin (particularly
childbirth, intercourse and lactation) are highly influenced by
environmental factors.
The passage towards the
fetus ejection reflex is inhibited by any interference with the
state of privacy. It does not occur if there is a birth attendant
who behaves like a "coach", or an observer, or a helper,
or a guide, or a "support person"(4). It can be inhibited
by vaginal exams, by an eye-to-eye contact, or by the imposition
of a change of environment. It does not occur if the intellect
of the laboring woman is stimulated by a rational language ("Now
you are at complete dilation; you must push"). It does not
occur if the room is not warm enough or if there are bright lights.
A typical fetus ejection
reflex is easy to recognize. It can be preceded by a sudden and
transitory fear expressed in an irrational way ( “kill me”,
“let me die”, etc.). In such a situation the worst
attitude would be to reassure with words(5). This short and transitory
expression of fear can be interpreted as a good sign of a spectacular
increase of hormonal release, including adrenaline. It should
be immediately followed by a series of irresistible contractions.
During the powerful last contractions the mother-to-be seems to
be suddenly full of energy, with the need to grasp something.
The maternal body has a sudden tendency to be upright. For example,
if the woman was previously on hands and knees, her chest tends
to be vertical. Other women stand up to give birth, more often
than not leaning on the edge of a piece of furniture. A fetus
ejection reflex is usually associated with a bending forward posture.
When a woman is bending, the mechanism of the opening of the vulva
is different from what it is in other positions. The risk of dangerous
tears is eliminated. After a typical ejection reflex, the placenta
is often separated within some minutes.
