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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.

Transcendence and Attachment
Transcendence and Attachment
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.

30 thoughts on “What is the Fetus Ejection Reflex?”

  1. I am pretty sure I had FER last year during the birth of my baby boy. I was induced in hospital and was experienced hypercontractions, through which my Doctor told me would he doing nothing to my cervix, but were very very painful. They refused to give me a delivery suite (I was contracting in front of 3 other couples on observation ward) and I felt my baby was coming the whole time. It was frustrating to be told I wasn’t in labour and not get offered any pain relief. I’m sure it resulted in high adrenaline. I finally got a delivery suite, and was given terbutaline to slow my contractions. I was then told I was 7cm dilated! But on gas and air and 1 hour and 20 mins later, (I wasn’t given any pain relief) I don’t remember much after that, I was in the zone, focussed on my contractions and I suddenly felt a rush and said to my Hubby, mother in law and midwife, he’s coming, and whoosh out he came! No pushing. It was such a relief in the end. I knew something was different to my first labour. My midwives said it was amazing but didn’t even mention the FER. I had to look it up to work out what had happened.

    1. Hi Victoria, Thank you for sharing your story. It sounds like the induction was quite traumatic and no one was really listening to you. Yet you and your baby did it anyway and you were in tune with your body and could not resist the foetal ejection reflex(FER). Most midwives in training in hospitals today are not taught about the FER. So they do not recognise it when they see it. It is rather sad that midwives never get to see the magnificence of women giving birth because their perception is damaged by their training and education. Many midwives and doctors believe that they ‘deliver’ the baby. In reality, it is the mother who ‘Gives Birth’!

      1. Wow, so that’s what happened to me! 7 years ago I was in labor with my 2nd child. In the hospital. It was pretty calm and at 8cm dilated, my entire body bared down. There was nothing I could do to stop it (not that anybody told me to) she was out in 5 minutes.

  2. Thank you for your response! For me it is really important to understand what happened to me. Specially if I decide to have more children. In this situation I gave birth in the bath tub on my knees and hanging on my husband for support. I tried to listen to my midwife because you feel vulnerable and tend to trust in this kind of guidance. I will never know if I would have torn terribly in case I had just relaxed and let my body push even when 5cm dilated. Anyway… my labor was quite a surprise. I was expecting pain and an urge to push towards the end. Well, If I said it was painful I would be lying. I felt pressure and no urge to push voluntarily at all. The only moment I felt real pain was during the circle of fire. Even with all the surprises and weird sensations I wouldn’t change anything. It was a blessing. Thanks for your post and for being so gentle with all your answers and attention.

  3. Hi. I gave birth to by boy a couple weeks ago and believe I experienced the FER. Please help me understand what happened to me! My first contraction was at 9:30pm lasting more than 1 minute and I could barely think through it! Contractions were 3 minutes apart right away. I arrived at the Birth Centre at 00:30am and my midwife said I was 5cm dilated. I immediately felt it! My body startled me by pushing without my consent, totally involuntary. I looked at her and said “I’m pushing and I have no control over it”. She instructed me “not to push” because “it wasn’t time yet”. She said I would tear and my cervix would become swollen and bleed more if I pushed too soon! It was the most bizarre and hard thing to do in my life… I was fighting against my body, trying to hold my baby in and slow down the pushes until I reached 10cm. It was hard and felt impossible! My body pushing and me fighting against it. It wasn’t just an urge to push like we hear so may times. I WAS pushing involuntarily. Please help me understand! Could I have experienced FER? If so, would I have had a bad tear, have a swollen cervix or bleed more if I had just relaxed and let my body push even with a 5cm dilation? By the way I had a small tear on the side of my vaginal labia and did not need stitches. I forgot to mention that my baby boy was born at 3:03am. 5 and a half hours after the first contraction. And I feel like my labor would have been shorter if no interference had happened.

    1. i once had a client who felt the bearing down sensation from the beginning of labour and arrived at hospital bearing down with each surge. When I examined her I found her to be 3 cm dilated. I too suggested that she try and breathe through her surges, but she could not. Half an hour later the baby was born! Her baby was healthy and her cervix did not tear. I was astonished and learnt from this experience that labour is different with each pregnancy and each woman and that my job was to suggest, but not interfere. Midwives believe that they are indispensable to the birth process and therefore try to control it. That is what we are taught in college. It is also what we like to believe. The truth is that women give birth and midwives are dispensable most of the time. To be truly humble and recognise that labour is an involuntary process is perhaps the hardest thing for a midwife to acknowledge. To prevent tearing I usually recommend that a mother lie on her side to give birth, or stand. Squatting opens the hips but can be quite hard on the perineum. The Amish give birth standing with their knees closed and hardly ever have perineal tearing. Kneeling is also kinder to the perineum and helps to slow down that involuntary reflex when it feels too overwhelming for the mother. Ideally an experienced midwife will work with the mother and the process, not against her so that the mother always ‘feels’ right.

  4. This is wonderful. My only question is what is the best position for this to happen? Generally most women deliver on their backs but is there another way that helps the FER?

    1. Dear Rebekah, The best position is the one the mother chooses at the time of the birth and this varies from mother to mother. Occasionally as a midwife, I will suggest a change of position during transition that the mother may find works better for her. I have noticed that most mothers will adopt a sitting and semistanding position spontaneously and give birth in this position. Once the baby is born, the mother will sit down on a pre-arranged padded surface (on the floor)and take the baby into her arms.

  5. This was my last birth- in a hospital. My neighbor drove me and no one made it on time. By far this was the easiest birth ever. No pain meds, no distractions, just me and my labor. I went in at 7cm after sleeping on and off most of the night. I had one very kind nurse who respected my wishes to just be left alone. My dr arrived to catch bare handed at the perfect time. I was there only an hour and a half before my beautiful baby boy arrived earthside. I felt like I could have run a marathon afterwards. I listened to my body and let it do what it was meant to do. I wish every woman could have this same experience.

  6. I’m reading this in the dim lamplight at 05:25. My children and husband are sleeping and I’m gathering my strength to start 4 nightshifts on the trot.
    This beautiful yet extremely powerful piece of writing has hit me hard. For the first time on Saturday night I saw the FER in hospital (I have seen it at homebirths). It was incredible that even in the midst of a medical environment this wonderful mum to be found a quiet space to focus solely on the birth of her baby. A primip who having come to DS at 7cm whose waters went spontaneously at end of second stage who delivered her beautiful son less than two hours later and who had a textbook physiological third stage. And I will never forget how blown away I was by the look of complete and utter love and wonder on her face as she cradled her newborn. That was my 40th delivery as a final year student midwife and I’ll never forget them. It’s making me tear up now just reliving it.

  7. Excellent article. This needs to get out to every expecting mother. I am a pharmacist and a holistic practioner

  8. Great article…I think you may be very interested in reading Stephen Porges work: the Polyvagal Theory. I would love to dicuss with you in reference to this article. Jeanne 610-891-1190

    1. Hello Jeanne

      Interesting that you mention Stephen Porges work – I have a degree in psychology and read his book about two years ago after attending a workshop about cranio-sacral therapy. I loved it and have used it as a reference. Love Marianne

  9. Beautifully put. The real reason for the routine separation of mother and baby at birth, and for society’s discomfort at seeing a young child being comforted and fed at the breast.

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