CHAMPAGNE AND THE FETUS EJECTION REFLEX
The more I try to combine what I learnt from my experience of hospital birth and from my experience of home birth, the more I am convinced that the best way to protect the perineum, to avoid a serious tear and to eliminate the reasons for episiotomy is to deviate as little as possible from the physiological model. In other words it is to create the conditions for an authentic fetus ejection reflex (1,2).
I am often asked to clarify the difference between the fetus ejection reflex and the well known Ferguson’s reflex (3). The Ferguson’s reflex is related to mechanical conditions: the pressure of the presenting part on the perineal muscles. A real fetus ejection reflex can occur long before the descent of the presenting part, or long after. It can start before complete dilation or after complete dilation. Usually it does not occur at all because the prerequisite is complete privacy. I am familiar with this 'reflex', in the context of home birth, when I follow the progress of labor from another room through the sound the woman is making, while her husband/partner goes shopping, and when there is nobody else around other than an experienced, motherly, silent and low profile doula. I cannot remember one case of an authentic ‘reflex’ in the presence of the baby’s father. During the 'reflex' there is a short series of irresistible, uncontrollable contractions, with no room for voluntary movements; the laboring woman can be in the most unexpected postures (often asymetrical, bending forward)
I have interpreted this reflex as the effect of a sudden spectacular reduction in neocortical activity, making possible the release of a complex hormonal cocktail. The release of high levels of hormones of the adrenaline family is suggested by the sudden expression of fear (often a very short episode of fear of death) (4) that precedes the irresistible contractions, and by a sudden tendency to grasp something and to be upright. The most helpful thing to do in terms of facilitating the fetus ejection reflex is just to interpret this sudden expression of fear (kill me...let me die, etc.) without interfering: reassuring rational words – a stimulation of the neocortex - would inhibit the reflex. The release of a high peak of oxytocin is of course suggested by the sudden power and efficiency of the uterine contractions.
We must keep in mind that the term 'fetus ejection reflex' was originally used by Niles Newton, when she was studying the factors influencing the birth of mice (5), i.e. mammals who do not have a neocortex as powerful as ours. The 'reflex' can occur among humans, on the condition that the activity of the neocortex is dramatically reduced, so that the human handicap is overcome.
I learnt from a powerful fetus ejection reflex induced by a cup of Champagne. This was around 1980 in the hospital in Pithiviers, France. A woman in not-yet-hard-labor was in a double bed room. Her room-mate, who was already celebrating the birth of her baby, gave her a cup of Champagne. The unexpected effect was a sudden series of so powerful contractions that the second mother’s baby was born on the way to the birthing room. My interpretation was that the bubbles speeded up the absorption of alcohol, so that there was an immediate effect on brain activity that other sorts of wine cannot have. Anyway, the capacity Champagne has to release inhibitions has been widely tested, whenever the goal is to create an erotic or not-too-formal atmosphere. Recently I met Dominique Marquette, an experienced home birth midwife and a native of Epernay, the famous specialized wine center in Champagne. When preparing for a home birth, she always suggests the family to keep a bottle of Champagne in the fridge, officially to celebrate the birth afterwards. In fact, now and then, in precise circumstances, she offers a cup of Champagne to the woman in labor, in order to release inhibitions. The conclusion of such anecdotes and of such theoretical interpretations is not that laboring women should be routinely offered a cup of Champagne. In the age of evidence based midwifery we must wait for the results of prospective randomized controlled studies evaluating the ratio of benefits to risks…
I have never had to repair the perineum after a real undisturbed fetus ejection reflex. One of the many reasons is probably that in such a context the mother is more often than not bending forward, for example on hands and knees. In such postures, the mechanism of vulva opening is different from what it is in other postures. First the anterior part of the vulva opens more quickly; then the deflexion of the head tends to be delayed and, when the face is coming out, the chin is more lateral. I use this opportunity to mention that, if by chance there is a first or even second degree tear (usually because there has been no authentic fetus ejection reflex) I do not stitch it. If the mother does not spread her legs at all during the first two weeks (avoiding looking at the perineum, avoiding the lotus posture, etc.) the cicatrisation will be perfect.
One of the advantages of the term fetus ejection reflex is to underline the similarities between the different episodes in our sexual life. As Niles Newton pointed out (6), in the milk ejection reflex, the sperm ejection reflex and the fetus ejection reflex there is always a sudden explosive release of oxytocin. This release of oxytocin is always highly dependent upon environmental factors.
Michel Odent
Christmas 2002
References:
-1- Odent M. The fetus ejection reflex. Birth 1987; 14: 104-105.
-2- Odent M. The Second stage as a disruption of the Fetus Ejection Reflex. MidwiferyToday. Autumn 2002: 12.
-3- Ferguson JKW. A study of the motility of the intact uterus at term. Surg Gynecol Obstet 1941;73: 359-66.
-4- Odent M. Fear of death during labour. Journal of reproductive and infant psychology 1991; 9: 43-47.
-5- Newton N, Foshee D, Newton M. Experimental inhibition of labor through environmental disturbance. Obstetrics and Gynecology 1967; 371-377.
-6- Newton N. The fetus ejection reflex revisited. Birth 1987; 14: 106-108.