ļ»æEpisode 168 - Understanding your wonderful birth reflexes
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:25] Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. Not only am I a midwife with 18 years experience and most of that time was spent attending home births. So I've also got a PhD in midwifery and I come to you today with a basket of knowledge about birth, but more importantly about physiological birth. That's where my experience is. In this medical birthing world, it's very rare for midwives to be able to see physiological birth so much that they understand it and recognize it. And more importantly, get to learn new and exceptional things about birth. Because when you watch it unfold physiologically and you're not fearful and you're not judgmental and you don't have expectations on that birth, you get to notice how things truly unfold when we don't interrupt it. And so I've had a very unique midwifery career here in Australia. I trained as a midwife at a time when becoming a private midwife and attending home births was a lot more simple than it is today with regards to the regulation and legislations.
[1:36] But it was more risky to be a midwife professionally because there was no insurance, but there was also no restriction on midwives attending home births. So that's what I did. And except for one year of working as a student in the hospital, my whole career has been watching women birth physiologically at home most of the time. And this means that I've gathered a very unique midwifery skill set that is not rooted in medicalised ideas of birth. So I'm an expert in supporting physiological birth and definitely not an expert in hospitalised or medicalised birth. I don't know how to be that kind of a midwife.
[2:20] Being a midwife in a hospital requires a completely different midwifery skill set or clinical skill set than what I have. So there are not many other Australian midwives who haven't had hospital experience and that uniquely positions me to be able to make comment about physiological birth and how I've witnessed it unfolding over the last 18 years. So I'm coming to you in this episode not only from an academic perspective but I understand birth from a different level of knowledge that can be experienced if you're watching birth in a hospital.
[2:57] And this is just what I've witnessed and gathered over time. So it's with this knowledge and perspective that I bring you this topic today about our inherent, inbuilt, involuntary birth reflexes. And I'll specifically be looking at the Ferguson reflex and the fetal ejection reflex, which I will explain throughout the podcast that they are two profoundly different things with different functions and different mechanisms.
[3:25] And lots of people use these terms interchangeably. And today I will argue and defend the position that they are two different things, both physiological in nature, but both very different. And I always have known that this would be new to a lot of people. I was going to call this episode the Ferguson reflex versus the fetal ejection reflex. But I have been told people aren't going to know what you're talking about, Mel. It's not a very click-baity headline.
[3:56] So it's called understanding your wonderful birth reflexes. But we're really doing a Ferguson reflex versus the fetal ejection reflex. And if you haven't heard of birth reflexes before, you're not alone. They don't get much attention because they're largely physiological functions that can only truly be seen when the process of birth is honored and where the midwives can be present enough to intuit what the woman is experiencing. So when I told my social media followers and rebels on my mailing list that I was doing this topic, so many women had these aha moments where they realized that they'd experienced one of these two reflexes or both, the Ferguson reflex or the fetal ejection reflex, all both together.
[4:46] They can happen together. They're two separate things. And it helps give women some validation of their own birth experiences. So here we go. let's look at the Ferguson reflex versus the fetal ejection reflex and let's start the conversation about the Ferguson reflex and then we'll move on to the fetal ejection reflex but importantly before we go any further the first point to remember is that the fetal ejection reflex is not the Ferguson reflex.
[5:16] These are often used interchangeably but they are two distinct different things. They aren't the same or we can't call one the other. So I see it a little bit like when someone calls the vulva a vagina. So you can't just use the word vagina to describe your whole vulva. The words aren't interchangeable. They are distinct and different. And you can't just use the fetal ejection reflex for the Ferguson reflex all the other way around. Ah why is she going on like this all right now I have one more fun factoid before we really get into this now during my research for this episode I did a google search for the Ferguson reflex I always like to start the research process for each podcast episode with a little google search just so I know what people might be finding when they search the internet on any given topic So I did that for the Ferguson reflex and there is this Wikipedia article on the Ferguson reflex and I opened it and it started with the words, the Ferguson reflex, and then in brackets said next to it.
[6:23] Also known as the fetal ejection reflex, to which I audibly gasped, thought, what? What? And I wondered how this atrocity could be changed.
[6:37] So then as I looked over the page of like, you know, how do you submit a, you know, a query or a request or whatever. And then I noticed a little button on the page which said edit. Well, that piqued my curiosity because I did want to edit this Wikipedia page. So I clicked the edit button and to my surprise, the page opened up into an editable version and I just replaced the words that were in brackets, also known as the fetal ejection reflex, and then I changed them to not to be confused with the fetal ejection reflex. So at this very moment, if you Google the Wikipedia page for the Ferguson reflex, it now says not to be confused with the fetal ejection reflex in the opening line because I just changed it. Ha!
[7:29] Who knew you could just update a Wikipedia page like that? It's done. That felt like a step forward for humanity's understanding of birth, and forevermore, the internet will not confuse the two. Ha! So there you go.
[7:44] All right, that point's been made. They are different, and now Wikipedia has been corrected, and we don't ever have to confuse the Ferguson and the fetal
[7:53] ejection reflex ever again. But what are they? Let's start with the Ferguson reflex. So the Ferguson reflex was first discussed in an article in 1941 by James Kenneth Wallace Ferguson, hence Ferguson reflex, but it's more accurately described as the utero pituitary reflex. So the utero part being your uterus and the pituitary part relating to your pituitary gland, which is in your brain. And in labor and birth, one of the functions of the pituitary gland is to release oxytocin, which is the hormone that gives you contractions and it impacts on the activity of your uterus. It does way more than that, but for this discussion, I'm just highlighting that particular function of the pituitary gland. So they call it the utero-pituitary reflex, which indicates that the two are involved, the uterus and the pituitary gland, and that it's a reflex. So there must be communication between these two structures, which generates this uteropituitary reflex, or what can be called the Ferguson reflex.
[9:03] And the Ferguson reflex relates to when the baby's head descends or moves down towards the exit, vaginal exit, during labor. So basically, your cervix is coming out of the way. Your baby's trying to be born. It's being moved down. And this movement stretches your cervix and the tissues in your pelvis and then the pelvic structures. And it stimulates some receptors that are in this area to create what we call a feedback loop between the uterus, utero, and the pituitary gland, so utero-pituitary reflex in your brain. And that increases oxytocin and it changes the contraction pattern to be stronger and more expulsive. So if you heard the pushing out your baby episode 167, you'll know that the birth phase of labor involves your uterus changing its function. And so instead of having the purpose of opening your cervix and drawing the cervix up into your uterus, once the Ferguson reflex is stimulated, your contractions become stronger and the function of your uterus changes. And its new function instead of opening is to push out your baby, to push your baby down.
[10:21] So this reflex, the Ferguson reflex or the utero pituitary reflex results in the normal uncontrollable spontaneous urge to push so if you're a woman who's ever been told no no don't push don't push and you think I can't stop pushing my body is making me push I'm getting a spontaneous.
[10:44] Uncontrollable involuntary urge to push and it just feels like your body is taking over so this is involuntary. You are feeling the Ferguson reflex. So it's like your uterus is trying to vomit your baby out. The same feeling you get when you're going to vomit, when your body has a mind of its own and the contents of your stomach just want to come out without you having anything to do with it, except to submit to the process, open your mouth and let it happen. And so this is the same idea of the Ferguson reflex except your uterus is trying to vomit out your baby and your job is to accept your fate and let it happen.
[11:23] That's the Ferguson reflex and the fetus ejection reflex or the fetal ejection reflex is another thing altogether. Technically that Ferguson reflex that we just talked about should happen to most women but I'll be honest it doesn't happen for all women including for myself and some of my clients have certainly not felt that uncontrollable urge to push and if you're in the care of an experienced midwife who understands physiological birth, there's things that you can do to help navigate that if you're not feeling that overwhelming urge with the Ferguson reflex. So sometimes you have to do things to encourage your baby to move down into your pelvic structures to elicit that Ferguson reflex. And there are some things that can interrupt that. So for some women, they might need to change positions, do some fancy work with spinning babies or have a sleep and just wait it out. For me, I got some acupuncture during labor for the purpose of moving my baby down to stimulate contractions and to stimulate the Ferguson reflex. And certainly that did the trick. When I felt my baby down, there was this definite.
[12:33] Involuntary guttural urge to just bear down and push my baby out. And because I was fully dilated, I didn't have an urge. It had been quite a number of days. So we thought it'd be nice to intervene in that process.
[12:46] So that's the Ferguson reflex. And now let's talk about the fetus ejection reflex. And this is something that Michelle Odont, and if you heard episode 166 of the Great Birth Rebellion podcast, I did an ode to Odont, who left this earth a few weeks ago. He was 95 and an absolute pioneer in the modern birthing world. So he wrote about the Ferguson and Reflex and was quite interested in the reflexes of birth as part of his body of work. So the Ferguson Reflex was first written about in 1941. And remembering, it was probably known a long time before 1941, but because men were the only ones really allowed to study and write things down at this time and then have things published, we only got to learn about what our bodies doing birth from male doctors and researchers at this stage.
[13:45] So women and midwives probably really did already know about the expulsive efforts of your body during birth, such as the Ferguson reflex. But then in 1966, so what's that? 1941, 1966 is where the research started on the fetus ejection reflex. That work, 1966, on the fetal ejection reflex were animal studies. It wasn't until later that Michelle O'Don in 1987 revisited the term or the fetal ejection reflex and rescued it from oblivion is his wording. And he applied this to the idea of human birth, of birth for people, for women.
[14:32] And he did this based off having read the research on the fetal ejection reflex and the Ferguson reflex, and then watching women give birth and asking questions about if mammalian birth for animals had some resemblance to mammalian birth for humans. So this fetus ejection reflex was written about in a paper called Experimental Inhibition of Labor Through Environmental Disturbance. And it was by Niles Newton, Donald Fushi, and Michael Newton. And in this paper, the authors explain that it is, and this is a quote, it is frequently assumed to be desirable that the parturient, another word for labouring woman, to be kept calm and undisturbed during labour. That was one of the opening lines of their paper in 1966, which means they already knew they had an understanding that it is frequently assumed to be desirable not to disturb the labouring woman. That was the basic understanding. So this paper opens with this sentence, which we all know then was to be common knowledge that the best course of action to help keep women calm during labour was not to disturb them.
[15:47] This isn't just a regular article. Michelle O'Donnell said the same thing.
[15:52] Calm environment with low stress. Don't interrupt the woman. So good start, 1966. Not a bad start. So then they go on to say, so basically we know that it's most desirable for women to be calm and undisturbed. And then in their paper, they go on to say, however, controlled studies on the effect of disturbance applied experimentally appear to be lacking. Okay, so what they're saying is no one studied science. The impact of disturbing labor yet. There's lacking evidence on what happens when you disturb labor. So their intention was to disturb the labor of mice to see what happened. So their main beef is that we haven't got enough research to understand what happens if they're disturbed. And so right up front, they give you the impression that they're planning on working out what happens when you disturb. They wanted to do a controlled study and measure this in 1966.
[16:48] So they explained that if you disturb any other mammal during labor, that any environmental disturbance may alter the course of labor. And the authors described some animal studies that they observed, including some dogs. So this is the early studies, 222 laboring dogs and 17 of them experienced labor dystocia due to what they called nervous voluntary inhibition of labor. I mean, it's a great term, nervous, voluntary inhibition of labor. So after being placed in an unfamiliar environment during labor, their labor didn't start progressing again until the dogs became accustomed to their new surroundings. Sounds a bit familiar. Some women talk about when they leave their home and go into hospital, they find that their labor stalls and slows and it takes time for it to start up again. And there were other studies, these poor animals, there were some other studies done on pigs which showed the same impact that the disturbance had on their labors except the difference was that in the pigs they noticed that the delay in labor caused by disturbing them made the pigs appear aggressive, agitated and apprehensive and the behavior didn't settle until they stopped the disturbance.
[18:06] Which they described, after which there was no longer evidence of emotionality. So the pigs were pissed. They were really cranky about being disturbed because, well, not only did it alter their labor, but it altered their state, mood state. So, so far, this checks out for women too.
[18:26] So then they wanted to test what they observed, and they said that the purpose of the study is to test the effect of disturbance on the speed of labor. Stick with me, we are going to talk about the Ferguson fetal ejection reflex. This is groundwork, okay? So using controlled experimental methods, they decided to use mice as the test mammal and they explain that.
[18:51] Testing this on animals takes out the issue that women's level of preparedness and level of education has on birth. So they decided that because the mice kind of couldn't prepare and couldn't cognitively engage in the process of labor and birth, that it was a more controlled experiment because you were taking out those factors that impacted on birth outcomes. So they knew that the mice couldn't prepare mentally. and so they were measuring just the impact of disturbance on pure physiology.
[19:25] So they waited till the group of mice went into labour and they divided into the two groups, control group, which were not disturbed at all and left to do their thing. And then after the birth of the first pup, the pregnant mummers, the mice mummers, were either left to labour and birth as they had been and this acted as the control group and the other half of mice were exposed to a disturbance during their labor and after birth of the first pup. So the disturbance that they chose was to pick them up and hold them in in their cupped hands for a minute. So they said that this disturbance did not subject the animal to any physical pressure. They weren't kind of holding them tight or restricting them but it did It can constitute a total change in visual, tactual and olfactory environment. So kind of like when a woman moves from laboring in her nice, comfortable, familiar home and goes to hospital. This represents a disturbance. So half the mice got picked up and held for a minute after their first pup was born.
[20:32] So then they timed the birth of each pup in each case in the control group and in the disturbed group. So that was experiment A. And then they did experiment B, where they used mice that were used to being handled in the group that was going to be disturbed. So they thought, well, maybe if the mice are used to being handled, maybe they won't, that won't have an impact on their labor and birth, like the ones who were disturbed the first time.
[20:59] So while the mice in experiment B were also disturbed, the difference was that they were used to being held. So that disturbance was more familiar to them than the mice in experiment A. But a long story short, in both experiments, the mice who were disturbed, regardless of which group they were in, had labours that were approximately twice as long as the ones who were left alone. The mice that had been handled before didn't seem to be more calm in labour. When disturbed than the mice who had never been handled. So they concluded that disturbing a mouse or potentially a mammal in labor changes how their body functions and they made comment about the differences in pushing the pups out and what they observed. Now here we go. This is about the difference in how their pups were pushed out. The researchers noticed that they called a complex uterine response was triggered by disagreeable stimuli that frightened the animal or caused them to feel pain. In this circumstance, they noticed a sudden increase in uterine activity, and they explained that should perceived danger be presented, there may be the resulting speeding up of the birth as a result of this immediate strong contraction of the uterus, causing the animal to quickly eject or expel their pups, and then that frees the mother to move or fight.
[22:23] So what they're saying is, if we apply this to human birth, is that the difference between the Ferguson reflex and the fetus ejection reflex is that the Ferguson reflex is part of normal physiology of labor and to be expected. And the other is a fear response designed to quickly eject the baby so the laboring mother can fight or flee perceived danger if we're to make conclusions from this paper. Now, remember, this is kind of the beginnings of this discussion. This is not the full discussion. So they proposed that in a fierce state, mammals could eject their babies. And I know I've heard stories from women who have told me things like this, like they've been told by their care provider, if you don't push the baby out
[23:08] in this next push, I'm going to cut an episiotomy. And the fear of that occurring creates a hormonal response that accentuated the power of her uterus and maybe it's shot out of her body. And I've also heard this, you know, occurring under threats of instrumental births and caesarean sections that women feel so much fear or disturbance by what their clinician is suggesting that their body responds with a fetus ejection reflex or a fetal ejection reflex.
[23:35] So this is where there was this first academic study of the impact or disturbance and fear in labor, albeit in animals. but what the world didn't realize. So while they were doing controlled experiments on what happens to mice when you disturb them, there was a global uncontrolled experiment going on at the time where every woman was encouraged to leave their homes and go to hospital, give birth. And no one thought to measure the impact of this disturbance on women. Only the mice received the opportunity at a controlled experiment about that. So we women just had to do what we were told without any scientific evidence. But this got Michelle O'Donnell thinking. He was practicing obstetrics at the time, and he thought that maybe the fetal ejection reflex, as it was applied in birth studies, was applicable in human birth also. So in his first article, written in 1987 about the fetus ejection reflex, so Michelle O'Donnell applied this term of the fetal ejection reflex to the physiological.
[24:47] Humans. So in his article, The Fetus Ejection Reflex in 1987, he discusses this theory of physiologic fear, where the fetus ejection reflex is initiated by a surge of adrenaline and catecholamines. And this reflex then results in an extremely fast birth and immediate ejection of the baby as a survival mechanism initiated by a threat close to the end of labor. And Michelle says that in the 20 years since 1966, when the article was first written, he writes more than 20 years later, he suggests that we save the term fetus ejection reflex from oblivion, stating that he was more and more convinced that this phase should be a key to triggering a radically new understanding of the process of human childbirth. So this is where he starts to explore the difference in the fetal ejection reflex. And he starts to introduce language of physiology in relation to the fetal ejection reflex. So in this article, Michel Ojeant says what I've already repeated, that the fetus ejection reflex must not be confused with the Ferguson reflex.
[26:01] That the Ferguson reflex is triggered by the pressure of the presenting part of the baby on the perineal muscles. In other words, he says local factors. So while the fetal ejection reflex is not triggered by local factors, so it's not triggered by that physical pressure, it's triggered by something else completely. And so he knew that the two mechanisms were fundamentally different.
[26:26] However, in this article, the fetus ejection reflex, Michelle notes that not only has he seen the reflex being triggered by fear or sudden cold, for example, after a woman exits the pool, but also in the circumstances where something scary is happening. So he proposes that the adrenaline and catecholamine response of the scary situation or the cold triggers a fetal ejection reflex but what he noticed as he started to go into birth scenarios that weren't medical he noticed that in the absence of fear or a scary circumstance or cold that the the reflex was still triggered he was still seeing the fetal ejection reflex in the absence of something scary or cold or a trigger.
[27:18] So he started questioning the fetal ejection reflex as a fear response after noticing that it was a common occurrence during home birth where the women were seemingly calm and comfortable. And in the article, he talks about how he observed that women would suddenly become agitated and then a huge few contractions would ensue and the baby would be born under circumstances of what appeared to be the fetal ejection reflex. And so in this article, the 1987 one that he wrote, he proposed a theory of physiologic fear and encouraged the reader to not assume the emotionality of childbirth to be a negative thing. So here he starts to introduce the idea that maybe a little bit of physiological fear is not a bad thing. Maybe we're looking at the emotionality of childbirth all wrong. And that perhaps the adrenaline of this final stage and the feeling of what he called physiologic fear was a normal component of labor. He thought that because of his observations of the fetus ejection reflex happening in both hospitals and then also in home birth where the women were less disturbed and they had less reason to be scared, it made him start to question the fundamental elements of the fetus ejection reflex.
[28:38] And he questioned women about it And he explains that some women remember that just before the storm, they had a short period of real panic and that it's artificial to consider fear as a specific emotion which precedes the fetal ejection reflex and that there's a more complex mixture of emotions that a woman meets in this moment that can be strong and sudden. And it's an emotional response that then triggers a hormonal response that can then cause a fetal ejection reflex. So he encouraged the reader away from just assuming it was a fear response into the idea that maybe there's physiological fear or terror during birth or a genuine real panic that maybe we shouldn't look at the emotionality of that negatively.
[29:30] But then starts to invite us to consider, well, maybe there's a complex collection of hormones that go along with the fetal ejection reflex, which makes sense because we're complex human beings.
[29:42] So he started to introduce the idea of looking at the fetus ejection reflex potentially as a negative thing in a moment of fear, but in the right circumstances could be the result of a positive birth experience that was generated by a different emotion, but still with the moment of adrenaline and some naturally occurring stress hormones that peak right before birth that have the resulting fetal ejection reflex. So he noted that anything that allows for a peak of adrenaline late in labor triggers a faster birth. And adrenaline naturally does increase at the end of labor anyway. So perhaps where the birthing environment is ideal and the full expression of the adequate amounts of adrenaline and catecholamines are able to express themselves because labor physiology hasn't been disturbed, then perhaps this creates an environment for the physiological fetal ejection reflex. So Michelle ends this article by saying, the fetus ejection reflex can happen only when the attendants are conscious that the process of labor and birth is an involuntary process and that one cannot help an involuntary process. The point is not to disturb.
[30:57] So he ends his article by saying, leave it alone, let labor unfold as it needs to, and maybe we create the circumstances required to elicit the fetal ejection reflex.
[31:13] So we start the article with this idea that maybe the fetal ejection reflex is a fear response. Ending it with Michelle introducing the idea that the fetal ejection reflex is a peak physiological response that can only be experienced in scenarios where birth is undisturbed or where it's so disturbed that the woman is frightened enough to eject her baby.
[31:38] Now, Michelle Adant later wrote about the fetal ejection reflex in the year 2000. So he would have been 75 years old at the time. And the article is called insights into pushing the second stage as a disruption of the fetal ejection reflex in which he explains that the passage toward the fetal 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 observer helper guide or support person it can be inhibited by vaginal exams, by eye-to-eye contact, or by the imposition of change on the environment. It does not occur if the intellect of the laboring woman is stimulated by the use of rational language. So if you say, now you are at complete dilation, you must push. That's his words. He's saying that this kind of rational language interrupts the fetus ejection reflex. Is saying the fetal ejection reflex does not occur if the room is not warm enough or if there are bright lights and the typical fetus ejection reflex is easy to recognize it can be preceded by a sudden and transitory fear expressed in an irrational way like kill me let me die and so on that's his words like but it could be things like oh my gosh I don't want to do this oh like an overwhelming feeling.
[33:06] In such a situation, the worst attitude would be to reassure with words.
[33:12] So this short and transitory expression of fear can be interpreted as a good sign of a spectacular increase of hormonal release, including adrenaline, and 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 a need to grasp something. The maternal body has a sudden tendency to be upright so for example if the woman was previously on hands and knees her chest tends to be vertical and some other women will stand up to give birth more often than not leaning on the edge over edge of furniture. The fetus ejection reflex is usually associated with a bending forward posture. When a woman is bending the mechanism of opening the The vulva is different, this is what he's saying, from what happens in other positions. And he says, in this position, the risk of tears is eliminated. I don't know. But that's what he says. So, Michelle reports to have never seen a perineal tear occur when a woman experienced the fetal ejection reflex.
[34:21] And finally, this beautiful article that I believe all of you Rebels listening should read in full, and it is available in full in the resource folder. So for those of you who are on the mailing list at melanethemidwife.com, you'll have access to the resource folder for this podcast, which is where I put all of the resources that I use to make every single podcast episode, and I make them available to you. And it gets mailed out. The link gets mailed out every week. But in the resource folder is a back catalogue of all the resources from previous episodes. So if you want access to those, just join the mailing list. The details are in the show notes below. So this article that I'm talking about was written by Michelle O'Donnell and Orly Dahin. And it's called Not Just Mechanical Bodies, Birthing Consciousness and Birth Reflexes. And it was written in 2022. Now, Michelle O'Donnell died a few weeks ago on the 19th of August, 2025. So that means he co-wrote this article at the age of 92.
[35:26] Let's just acknowledge that. So this article is available in full text and let's not let these words go to waste. This is the last article I'll include in this episode, but you can see the full resource list in the folder. So this article, not just mechanical bodies, birthing consciousness and reflexes. I read this one after I read all the earlier texts. So I tried to read and research chronologically to understand the development of these ideas. So this is the more recent article that we have on the Ferguson reflex versus the fetal ejection reflex.
[36:01] So I read this article after writing the part of the podcast that you have just heard. And in the article, the authors dedicated two paragraphs to the concern that they had about the Wikipedia article on the Ferguson reflex and how inaccurate it was. And they cited the fact that 94% of medical students use Wikipedia to supplement their formal education. And Michelle O'Donnell and Ollie Darhan expressed concern that the inaccuracy of the Wikipedia article would lead to ongoing confusion about the Ferguson reflex. So I was a little bit chuffed to know that in the process of writing this podcast episode that I'd solved that problem. It's just a little fun anecdote. And I wish I could tell Michelle that I updated the Wikipedia page and continued his work in a very small way like that.
[36:55] So forevermore, 94% of medical students will no longer read that the Ferguson and the fetal ejection reflex are the same. So I was kind of a little, I had a little giggle when I read that article. So this article really brings everything together. It makes the distinction that the Ferguson reflex represents the moments where the most powerful rhythmic uterine contractions initiated by high levels of oxytocin during the birth process help the woman to respond to her own instinctive urge to push the baby out. In this article, more so than in the previous ones, the authors make reference to the purpose of the Ferguson reflex in helping the woman respond to her own urge to push. And this article confirmed my thoughts on not interrupting the woman's own birthing process and allowing her to submit and surrender to the process of birth because her body is sending her on a journey and by us not suggesting that she override her instinctive birthing behavior we're allowing the full expression and use of this Ferguson reflex so this article makes reference to the Ferguson reflex as the mechanical response to the baby moving down which then prompts the woman to act accordingly instinctively along with the Ferguson reflex and that this is a helpful reflex that helps a woman push out her baby.
[38:25] So in this article, the authors make reference to the Ferguson reflex being associated with the urge to push, where the woman also has some instinct to get involved. However, the distinction between that and the fetal ejection reflex is that while the fetal ejection reflex also requires and involves powerful rhythmic contractions that are initiated by oxytocin, just like the Ferguson reflex, it does not involve the voluntary pushing of the woman. So when their fetus ejection reflex is triggered, the baby is just spontaneously ejected out of her vagina with no pushing efforts needed. Whereas with the Ferguson reflex, there seems to be an accompanying instinctive urge to push that takes over. And I've definitely experienced this in my own births. When the Ferguson reflex took over, I felt an urge to push.
[39:18] And when I went with that urge that I was kind of being prompted to do by my body, it felt so right and so productive and very satisfying. And I think if I had resisted the urge to push, I don't think I would have enjoyed pushing my baby out as much as I did. Going with the urge and submitting to that instinctive pushing urge felt very satisfying and it added to the enjoyment of that moment for me. So in some of the older research papers that I spoke about too, they made mention of experiments that they did on bunnies where it was noted that with the Ferguson reflex that the rabbits also did instinctively add their own pushing efforts to the birth of their babies. But when they gave the rabbits an epidural during labor the Ferguson reflex was still activated so their babies did come down so their their bodies did activate the Ferguson reflex and move their babies down but the rabbits didn't have the sensation so they didn't add the extra pushing on top of the Ferguson reflex and the researchers noted that the babies would sit in the bunny vagina for longer before being expelled than when they didn't get that instinctive urge to push along with the Ferguson reflex. So when they had the epidural, they didn't get the sensation to add any additional kind of efforts to the pushing.
[40:43] The Ferguson reflex was still there, but when they didn't have the epidural, they did add some pushing. So that kind of, I guess adds a little bit of animal research to the idea that maybe there is a physiological urge to push when birth physiology is on it.
[41:02] So in this article, we'll go back to the 2022 one by Darhan and Odond. In this article, not just mechanical
[41:11] bodies, they talk about birthing consciousness and birth reflexes. So then the authors move on to discuss the different pushing efforts that are involved in each reflex. And they reiterate what we've already mentioned, particularly in episode 167 of the Great Birth Rebellion podcast, where we talked about pushing out your baby. And they explain in this article that it is better for women and their babies to lean into the Ferguson reflex urges to push your baby out rather than any kind of coached pushing. So this was something that was already agreed upon by researchers back in the 1980s. We're over 40 years later now where a man, Michelle O'Donnell, at the age of 92 feels that he needs to say it again. and I'm sorry we made you work so hard right up until the age of 92. So honestly, most of the time I believe that the maternity system just does not want to change for the good of women. We knew back then in the 1980s that coached pushing was not a good idea. They reiterated that in this research. And O'Don and Dahin share the same sentiment, saying that unfortunately, management of the second stage often follows traditional obstetric protocols rather than evidence-based practices.
[42:28] They said it okay so then they go on to explain the further differences between the ferguson and fetal ejection reflex explaining that the ferguson reflex relies on physical and mechanical experience of birth playing out for the woman and that this reflex is triggered by the pressure of the baby moving down and this triggers the urge to push so it's a mechanism and then again in the 2022 article, the authors moved further away again from the idea that the fetal ejection reflex is a fear response, which is what earlier authors alluded to.
[43:05] But Michelle O'Donnell fundamentally believed that if a woman's needs during labor and birth for quiet and dark and private and an undisturbed space was truly honored, that her natural physiology would be to have the fetal ejection reflex, or at least that her physiology would create a circumstance for a more rapid birth that didn't require excessive maternal effort. So he saw the fetus ejection reflex as a physiological process rather than a fear-fueled phenomenon. And this is how he rationalized it as he started to see the reflex play out in undisturbed home births. And the authors in this article speak of the Ferguson reflex as being predominantly physical or a mechanical experience, but the fetal ejection reflex as a psychophysiological state.
[44:00] Meaning that it's reliant on the psychology and the consciousness of the woman. And they believe that the woman's birthing consciousness is a highly positive altered state that women can experience during undisturbed birth. And it's the hormonal high of birth that women exist in when we feel safe, warm and undisturbed. And so women enter this altered state of consciousness during labor and birth. You know, we call it like labor land or she's gone into the zone. They kind of shift into this less verbal state.
[44:41] And Michelle O'Donnell calls this what he calls a healthy dissociative state during labor. That's the state you need to get into in order for your physiology to function as it should. So if left undisturbed, if the woman is left to dissociate and fully enter the altered state of birth and the altered state of consciousness that's required for labor and birth to unfold efficiently, then her reflexes, the Ferguson reflex, and the fetal ejection reflex have an opportunity to fully express themselves in the most physiological way because the woman is in an ideal state of labor flow. And they also make the distinction that the Ferguson reflex is more likely to occur at full dilation, whereas the fetal ejection reflex can happen any time, explaining that birth with an authentic fetal ejection reflex can occur unexpectedly. Unexpectedly, however, an intrusion such as loud noises, bright lights, stress, feelings of being unsafe or observed tends to activate the woman's neocortex in her brain, which interferes with the woman's special state of mind. And then that results in failure to trigger the fetal ejection reflex.
[45:59] And this explanation reminds me of a birth that I was at once as a private midwife. The woman was a client of mine and she was planning her third baby at home so this was the first time she'd had me as her midwife at her third baby though so she went into labor and she gave me a call.
[46:18] Suggesting I should come and obviously it was her third baby so I did not delay assuming that the birth was going to be quite rapid and when I arrived I didn't really get the impression that she was in the type of labor that was going to result in birth soon. I thought she might still be in early labor and that also maybe my presence wasn't needed at this time so I explained that to her in as few words as possible because she was laboring that I might maybe go home and that perhaps she could take an opportunity to try and have a rest and then labor would keep progressing. She agreed and she thought maybe she maybe called me too early. So I only lived 15 minutes away so we agreed that she could just call me back when things changed.
[47:02] At the time I asked her if she wanted me to check her cervix to confirm if it was okay for me to leave. You know sometimes labor the sort of slower, quieter labor patterns can actually be a sign of the rest and be thankful phase that I've come to be familiar with that happens towards the end of labor, results in basically the woman having a sleep when she's almost fully dilated, and then she wakes up and pushes her baby out. So part of me thought, maybe she's in the rest and be thankful. Maybe I'd missed the whole dilation phase of her labor, and now she was resting and getting ready to push her baby out. So before leaving, I wanted to make sure that, you know, I had read the circumstance accurately. So I was reluctant to leave as she was in the rest of me thankful phase. So I did offer, you know, do you want me to check what your cervix is doing.
[47:52] And she agreed. She's like, yeah, let's check before you go. And I checked and she was two centimeters dilated, which kind of in my head, I thought, yeah, that checks out with what I was thinking in terms of the labor pattern. So I left all my gear there and I just kind of headed home with the plan to return later. And about 10 minutes after leaving, I was still in my car. Her husband rang and he's like, um, I think you better get back here. Something big just happened. She thinks the baby's coming out. So I just immediately did a U-turn and I went back to the house. And when I arrived, the woman was sitting in the hallway, on the hallway floor with her baby in her arms and the placenta in a bucket next to her. She just looked up and smiled at me. She said, the baby came. And I was like, oh, amazing job. And I said, and the placenta. And once everything had settled and I got her comfortable and warm and,
[48:43] you know, she shared what happened. And she said, about 10 minutes after you left, I got a huge contraction and it felt like my cervix completely opened. And that's when they called me. And I commented because I wondered had I got the vaginal examination wrong, the cervical examination wrong. She said, no, I clearly felt my cervix open right up. And then in that one contraction when they rang and then the next contraction in one go the baby came out and that was quickly followed by the placenta.
[49:20] And she said the baby just shot out she you know that's what she felt and I suppose that me leaving was just thing that she needed in order to give birth but this is my most vivid birth experience that I can remember of the fetal ejection reflex and it checks out with the description that Michelle O'Donnell gives in these early articles. So about this, the authors explained that since birth is instinctive, intimate and private, blocking some socialized inhibitions is likely to be a necessary condition for a natural birth. So inhibition blocking enables the relevant parts of the brain to release the different hormones that are needed for reducing pain and fear and nervousness and stress. And this enables the birthing process to proceed optimally. So what they're saying is that the woman must feel able and comfortable to release her inhibitions, release your inhibitions, the song, in order to allow the birth process to flow easily. And that the woman would not be able to do this in the presence of strangers or where there are interruptions or disturbances. So.
[50:35] They're really framing the fetal ejection reflex to be a unique hormonal cocktail that's very influenced by the external environment. So here, Odon and Dahan explain that the Ferguson reflex is solely a mechanical and biophysical process and is a reflex based on the features of uterine physiology and its mechanisms, just the mechanics. In contrast, the fetal ejection reflex is a psychophysical phenomenon, highly correlated with the woman's state of mind during the birthing process. So there's this crucial difference between the two reflexes. One ignores consciousness and the other does not. And this is why they called their article, not just mechanical birthing bodies. We are not just machines. Our labor and birth success relies on our conscious minds and instinctive reflexes, all of which need adequate nurturing and protecting.
[51:33] Now, the authors go on to claim that the modern birthing room is not aligned with nurturing these reflexes, not either reflex. In modern birthing rooms, the woman is described only in terms of her uterine contractions and cervical dilation. She's viewed as a machine that produces contractions and a measurable change in her cervix. And the process is measured only by physiological terms while ignoring the psychological and environmental factors that can promote physiological birth. And the authors argue that if women's birthing consciousness and their state of mind were honoured during the birthing process and where the care provider would protect her physiology and not interrupt the process of giving birth, that women will be having faster and easier birth experiences because of the physical and psychological mechanisms of birth that we have with these reflexes.
[52:34] But the reflexes, the Ferguson reflex and the fetal ejection reflex, are more likely to be preserved and experienced and utilized if we allow less disturbance in the birth process. But instead, we've reduced women to machines that push and breathe and act on demand during their births. And so we've lost the opportunity to witness the reflexes. And women are not afforded the ideal birth circumstances in order to experience and respond to these reflexes at all. They're surrounded by well-meaning care providers who mean to take their focus off their internal reflexes and take orders during the birthing process that somehow we seem to know better than the woman's own body.
[53:18] So it's an indictment on modern maternity care that we're still using coached pushing. And my hope and prayer for women and their care providers is that we would honor the birthing process so that women and their babies can experience better outcomes and easier births. So to summarize the basics of what I've discussed here, the Ferguson versus
[53:42] the fetal ejection reflex are two completely different things. The Ferguson reflex appears to be elicited by the pressure of the baby moving down into your pelvis that triggers some receptors in your pelvic structures, which sends messages back to your pituitary gland to say, make a whole bunch of oxytocin. The oxytocin acts on your uterus and elicits some stronger contractions that push your baby down into your pelvis. And accompanying this is an instinctive response from the woman to start bearing down under the influence of the Ferguson reflex. Women undisturbed can respond to the Ferguson reflex as they desire. Now the fetal ejection reflex is positioned as something different to the Ferguson reflex. The Ferguson reflex is thought to occur usually at the point of full dilation where the baby is able to move past the cervix and down into the.
[54:38] Pelvis. The fetal ejection reflex is thought to be able to happen at any time during labor and involves no pushing involvement from the woman. The baby is simply ejected from the woman's body without her involvement or effort. And while the Ferguson reflex appears to be a physical experience, the fetal ejection reflex is more likely elicited out of the woman's birthing consciousness and the release of her inhibitions, which allows for a complex hormonal cocktail that facilitates a fetal ejection reflex. It's considered a psychophysiological experience to have the fetal ejection reflex. So no longer are we only seeing the fetal ejection reflex in reference to a fear stimulus. So historically they used to say the fetal ejection reflex is a fear response where women eject their babies under the influence of adrenaline, thinking that they might need to flee or fight. But Michelle O'Donnell is arguing that perhaps the fetal ejection reflex is a full expression of normal birth physiology, and that we'll only start to be able to benefit from this capability of our bodies if we stop disturbing women in labor and birth.
[55:57] So that has been this week's episode of the Great Birth Rebellion podcast, where I looked at the fetal ejection reflex versus the Ferguson reflex. I'm your host, Dr. Melanie Jackson, and I will see you in the next episode of the Great Birth Rebellion podcast.
[56:13] To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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