What is the Fetus Ejection Reflex?

The prevalent culture in modern society is that of dominion over and control of nature, as well as the domination of groups of people by the other groups of people that hold more power. Similarly women and their bodies are dominated by the cultural paradigm of the time, no less by doctors and midwives in the arena of childbirth. Women and doctors alike are bearers of the culture and in settled agricultural societies it has been expedient for the offspring to be warlike and to be bonded to the prevailing culture of the group, not to nature, the individual or the close family. For this reason, it has been common through centuries for midwives and birth attendants to interfere with and control labour and birth.

Such action interferes with the highest peak of oxytocin release a woman and baby will ever experience. Oxytocin is associated with labour, birth, sex, love and attachment behaviours. It appears to play a large role in our social behaviours and modulates conflict or aggressive responses. Michel Odent speaks about the role oxytocin plays in our capacity to love as human beings and that when we interfere during birth, we interfere with perinatal imprints of oxytocin and our long term capacity to experience feelings of deep love and ecstasy. This in turn has extended global implications.

In modern Western culture, technology takes precedence and childbirth mostly occurs in a high tech setting with minimal privacy, exposure to bright light and the clinical obstetric gaze. What puzzles me is why approximately 96% of women will follow cultural dictates and submit to entering a strange medical facility where they will be subjected to all manner of intrusive and invasive procedures by people they barely know. And this at the most vulnerable time of their lives, during labour and birth. The prevalence of abuse, enacted on women in hospitals, is without question. Both Sharon Hodges and Henci Goer have researched and written about cruelty to women in maternity wards (Henci Goer, 2010, Hodges 2009). Yet women continue to enter and/or are ushered into medical facilities, unwittingly influenced by the cultural paradigm and the belief that birth is dangerous and something to be feared. Fear of pain, of the unknown, fear driven by photographic and film images in public media, fear motivates us to seek comfort. The neocortex or thinking brain is thus stimulated by our thinking, sends messages to the more primitive protective parts of the brain to activate the flight or fight mechanism. Perhaps women are escaping from intrusive or anxious family members in their home and community or perhaps they are taking flight from their fear hoping the hospital will remove the risk?

The dilemma is that in flight mode, women are subsequently less able to adapt to a fight mode, once faced with coercive or invasive behaviour inside the hospital. A woman’s cortisol levels are then raised, as are levels of adrenalin. Frequently, just after the admission to hospital, a woman’s labour may cease or slow down. Adrenalin release shuts down the progress of labour. The mother-to-be is not usually free to leave the hospital and return home; her stress levels are high, so she settles in to the situation as best as she can, imprisoned by her choice to be in the hospital and her fear.

It is here, I suggest, that another biological mechanism is triggered, that of ‘tend and befriend’. When faced with a threatening environment, women differ from men in their neurochemical and hormonal response to stress. It is the same mechanism that makes a woman stay in an abusive relationship and it why an abused woman will not leave a marriage. Taylor and colleagues (2000) cite numerous studies that show how stressful events trigger nurturing behaviour in females. Tending involves nurturing activities designed to protect oneself and one’s offspring. Tending others who may appear to be aggressive or more dominant stimulates the sympathetic nervous system ‘freeze’ response. In other words, in stressfull situations women engage socially in order to try and befriend the dominant party to prevent injury or harm to themselves. The high levels of cortisol and adrenalin in this situation act with the release of oxytocin in such a way that a woman will appear less threatening to the ‘predator’ or person in power and enable her to attempt attachment-type behaviours with the ‘other person’. Whether women exhibit ‘fight-or-flight’ behaviour or ‘tend-and-befriend’ behaviour, it is a sign that the neocortex has been stimulated. Bright light is also an adrenalin stimulant and prevents the release of melatonin, a hormone that is like a viola next to a violin in an orchestra. The two hormones complement each other and work in concert to reach the climax of labour: the birth of the baby. The use of language, conversations, questions, explanations, veiled threats, deadlines or ultimatums stimulate the neocortex, further preventing the mother from accessing her parasympathetic nervous system necessary for the primal state of giving birth.

The main lesson here is that physiological birth is an involuntary process, related to activity in the primitive brain and body structures. It occurs best when a woman’s parasympathetic nervous system is operational and she is in a state of trust. A dark, calm, quiet and almost solitary surrounding serves the mother best for labour and birth. Birth is not a voluntary action, like pressing an “on” button for the kettle or turning a key in the ignition switch to drive a car. A woman in labour or giving birth needs protection from any factor that may stimulate the neo-cortical structure of the brain. A labour will progress when a woman is restful, calm and not stimulated. This is why most women will experience labour at night, when it is dark and they are alone. One of my clients wanted a vaginal birth after two caesarians and came to me prior to conception for counselling. She laboured quietly during the night while her husband and children slept. She found comfort in the shower with warm water pouring over her body. At dawn, she woke her husband and said she really needed to void her bowels (poop!) and fortunately he called me (I had mentioned that if she were to mention the ‘p’ word he must call me immediately). I arrived just in time to witness a fetus ejection reflex: a short series of irresistible powerful contractions that resulted in the birth of a beautiful little boy.

Oxytocin is a shy hormone and cultural interference at birth has the potential to be diminished during a critical period for imprinting and/or altering the neurochemical patterns of release. Interfering with this sensitive period around birth may prime the baby to habituate to being disturbed, to not seeking attachment with the mother or exhibiting attachment and instinctive behaviour such as the breast crawl. This interference may appear to have the evolutionary advantage of separating the baby from maternal interactions by inducing more passive and controllable behaviour, thereby bonding the baby to the social group. When we as midwives and doctors switch on the lights so we can ‘see’ the birth, when we touch, when we talk and instruct a mother to push, when we watch or listen with a doptone/fetoscope we have impact on the mother’s as well as the baby’s neurochemical responses at this vulnerable and potentially transcendent moment of birth: the fetus ejection reflex.

Just before a fetus ejection reflex, mothers lose their inhibitions completely and may behave in emotionally explosive ways. Medical birth attendants usually wish to interfere verbally at this point instead of calmly refraining from comment. The fetus ejection reflex is rarely seen in hospitals or by midwives and doctors. It is disturbed by vaginal examinations, fundal pressure, masculinization of the birth environment, electronic monitoring equipment, cameras, even eye contact. I am fortunate, as a homebirth midwife, to have witnessed many instances of fetus ejection reflex, and have learnt from them to be less intrusive and more confident in the physiological design for birth. It may be possible to witness the fetus ejection reflex in a hospital setting if it can be adjusted so that the lights are dim, it is quiet and peaceful, the midwife/doctor does not speak or comment or interfere in any way. A reassuring motherly figure who is quietly and unobtrusively present and only assists when and if needed, is the best kind of birth attendant. The fetus ejection reflex is not a 2nd stage of labour and is usually preceded by a pause where the mother may stop contractions and sleep for several hours or a mother may doze between contractions. The vertex is usually positioned for some time just behind the perineal tissue prior to a fetus ejection reflex. When a mother is breathing deeply inbetween contractions and is resting and calm, babies keep their tone and do just fine. The onset of a fetus ejection reflex may seem sudden and the baby is born after three to four expulsive efforts.

Usually there is a pause of about 2-3 minutes between the birth and the time a mother is ready and able to turn towards her baby. Adrenalin concentrations in her bloodstream diminish suddenly after the birth, making room for a huge bolus release of oxytocin followed later by prolactin release. The mother has given birth and they engage actively with each other IF there is no disturbance. Fetus ejection reflex precedes possibly the most transcendent moments in a woman’s life, the knowledge of herself and her part in creation of another life, the deep rooted discovery that she herself has transcended her fear and can become the roaring lioness that will protect and care for her new baby. New babies require full time devotion. A new mother needs all the love hormones she can generate and likewise her baby. Think of how we could influence the future: one in which humans are adepts at releasing a cocktail of love hormones that facilitate attachment, interaction and co-operation between people and nations.