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Spontaneous Birth Reflex / Natural Expulsive Reflex

Maternal-Fetal Ejection Reflex

Research taken from:

  • ACDM ~ California College of Midwives ~
  • Characteristics of Clinical Competency
  • June 2001 Technical Bulletin #5

~ Maternal-Fetal Ejection Reflex ~

Designer Genes program a natural “labor saving devise”, the fruit of a physically and psychologically undisturbed labor in a healthy mother

There is a large difference between undisturbed spontaneous labour and birth. At a spontaneous birth (and by spontaneous I mean where the birth is undisturbed, natural and ‘with the body’) the spontaneity can be seen as a naturally advancing process combining biological and psychological resources making the birth tolerable for the woman and safe for the baby. It is accompanied by a dramatic increase in childbirth specific hormones – endogenous oxytocins – to stimulate uterine activity and beta endorphins (the source of the “runner’s high”) providing natural pain relief for the mother.

Maternal hormones also trigger hormone production in the foetus to prepare it to breathe independently and maintain its body temperature after birth. The understanding of this reveals the problems that can arise when trying to provide medical care to a large percentage of healthy women who, if undisturbed, will have labours graced by a “labour-saving” mechanism — the spontaneous birth reflex.

In recognising this phenomenon Dr. Michael O’Dont first named it the Fetal Ejection Reflex. It is now common to add the word Maternal to the name to make it clear that the baby does not, independent of the mother eject itself from the body but rather the birthing mother allows the spontaneous energy to run through her to safely birth the baby. Dr O’Dont was trying to identify the biological mechanism responsible for rapid, apparently easy deliveries. 

The normal spontaneous birth reflex is the “physiological” process (biology + psychology) that makes birth mechanically successful, physically tolerable for the birthing mother and safe for the baby. At a certain time after the cervix is fully dilated the mother experiences a dramatic event in which the body simultaneous opens up (relaxes normal muscle resistance) while forcefully propelling her foetus downward. This reflex overcomes the usual soft tissue resistance and takes advantage of momentum to press the baby down and out. This reflex has the exact same biological chain of events as vomiting but in the opposite direction. It is a natural response similar to a reverse sneeze, or the way our body naturally moves food through itself. Historically speaking it was the inclination of second or more time birthing mothers to have very quick births that scared obstetricians and caused them to bring mothers in early and induce them by artificially rupturing the membranes.

A crucial part of the Maternal Fetal Ejection Reflex (MFER) is the psychological comfort of the mother. Michael O’Dont described this as creating psychological circumstances for the mother so she “feels secure and unobserved at the same time”. He observed that the birth attendant’s first responsibility is not to disturb the natural process. For many mothers her need to be undisturbed is balanced by an equally powerful need to be in the right place and have family members of great psychological importance, as well as the doctor or midwife present, before she can permit, at least at a subconscious level, the labour process to unfold. For those who prefer hospital care, these mothers must have arrived at the hospital before the MFER can complete itself.

The MFER is a constant exception to the rules of labour as expressed by Friedman’s Curve*, which graphically represents labour as a relentlessly slow and painful process. Most importantly, this linear concept sees labour and birth as solely dependent on hard work and the ability of the mother to tolerate the pain rather than using her internal resources to help with or surrender to her labour. 

The picture society has of labour and delivery is one of incredible effort in which the mother labours with slow incremental progress. The MFER is almost the opposite of that expectation. While it is impossible to predict who will experience the MFER many birth attendants have observed that a calm or confident mother is more likely to do so than a fearful, anxious one who feels greatly unsure of herself or is afraid of birth.

A true MFER appears to provide the calm that can only be matched in a medical setting through the use of an epidural. Often (but not always) the MFER is enhanced by submerging the mother in deep water after she has reached 5cm dilatation and letting her and her husband or partner focus together with as few caregiver interruptions as possible (vaginal examinations for example). Dr O’Dont describes this as permitting the mother to feel secure and unobserved at the same time. Unfortunately this spontaneous birth reflex is easily disturbed and often (but not always) obliterated by medication during the delivery period.

The MFER appears to represent in birth what sex researchers Drs Master and Johnson identified as the orgasmic plateau, that is to say a state of being during which an overriding internal mechanism triggers a series of discrete but perfectly timed and attuned events of physiology which fire off in domino fashion when the conditions are right. Hence the term orgasmic birth. At this point it is a natural reflex and happens regardless of the individual’s wishes so, during labour this means that even if
contractions seem painful or the mother is clearly anxious, the labour will be briskly moving and result in a normal spontaneous vaginal delivery without anaesthesia and often, without significant perineal trauma, perhaps even before the doctor or midwife arrives.

The MFER is very much a primitive natural instinct and it is the neo-cortex part of the brain (the most recently developed) along with the disruptions of a disturbed birth (examinations, bright lights, loud noises, unfamiliar people etc) that can prevent the MFER from happening as birthing mothers often feel very far from “secure and unobserved”. The MFER is often not recognised as it can follow a lengthy and even painful latent stage. For hospital births it may include both induction and epidural before this fast-finish. 

The MFER often comes at the end of a long, psychologically difficult latent phase, it is not necessarily perceived by either the mother or the midwife as a “fast birth”. 

There are five elements for a successful normal spontaneous vaginal birth and a long latent phase appears to set up the circumstances so that all five elements are present. The five elements required are as follows:

  1. A healthy Mother, a normal pregnancy & a spontaneous onset of labour at term
  2. An understanding of the physiological and psychological aspects of spontaneous labour and birth by both parents and practitioners
  3. Physiologically appropriate response by family and professional caregivers to the normal physical, biological and gravitational demands of spontaneous labour and birth
  4. Psychologically appropriate response by family and professional caregivers to the emotional and psychological needs of the mother to the normal stresses and sensations of labour and birth
  5. Willingness of the mother to accept pressure of uterine contraction and the anxiety of not knowing how much harder the process may be or how much longer the process may take.

The absence or severe dysfunction of any of these elements can generate symptoms that may ultimately require medical or surgical intervention.

Unfortunately for most women nowadays, undisturbed labour in which all five elements can be present is rarely seen.

*Dr. Friedman did his residency in the 1950s. He was not a man to suffer fools gladly and he considered a lot of his superiors to be fools. He felt that they made medical judgments based on their intuition and not on science, so he set out to accumulate the research data necessary to give the profession a firm scientific foundation.

Dr. Friedman used his spare time to compile detailed observations about every labouring woman who came through his hospital. His aim was to find out what ‘normal’ labour looked like. Using observations from tens of thousands of women, he created a curve. Women who followed the curve were almost certain to have a vaginal delivery. Women who fell off the curve were more likely to need a C-section.

Dr. Friedman was the first to say that you should not section a woman in latent phase (when contractions have started but the first stage of labour has not yet been reached) because a long latent phase was not a sign that the baby doesn’t fit. He insisted that you should not section a woman in the active phase of labour unless she failed to make a certain amount of progress in a certain amount of time. When Dr. Friedman used to tell stories about the genesis of the curve, he would express the utmost disgust for doctors who would say, “She looks like a C-section to me”.

Dr. Friedman was very anti forceps. He concluded, correctly, that forceps hurt babies and should be banned. He used to travel around the country testifying for the families of children who had been injured by forceps. When he would appear, the family would win.

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