of and Rational for Collecting Statistics
on the “Maternal Fetal Ejection Reflex”
The term “Maternal-Fetal Ejection Reflex” describes an accelerated active labor and birth that progresses three (or more) times faster than the expected increments of progress (i.e. Friedman Curve). I asked the NARM ~ CPM statistical study to add the Maternal-Fetal Ejection Reflex to their statistical collection form as I believe this shortened time-table represents the biologically normal spontaneous birth reflex. Under its beneficent influence childbearing is mechanically successful, physically tolerable for the mother and safe for the about-to-be-born baby. I assert that it would be “normal” for most women if western culture had not focused on the pathologies of childbirth for the last 100 years, resulting in an exaggerated and pathological fear of childbearing. A high level of fear appears to block spontaneous physiological function. Without the counter-balancing knowledge of the M-FER, the media portrays normal labor and birth as too dangerous, too difficult, too unpredictable and too painful to tolerate in our “modern” times, an anachronism of the “bad old days”, to be happily replaced by a nice neat “safe” Cesarean section (an idea promoted by the current president of ACOG).
French obstetrician Michael O’Dont first used the term “fetal ejection reflex” in reference to a fast and apparently “easy” delivery. His use of the term focuses on second stage only and did not factor in an accelerated active labor. I added the word “maternal” to acknowledge that the fetus does not, independent of its mother, ‘eject’ himself but rather it is the mother who permits the freight train of spontaneous energy to run thru her for the purpose of efficiently liberating her baby. This expanded definition is consistent with Dr. O’Dont other theories about the role of primitive brain in facilitating the spontaneous processes of labor and birth and the negative influence of the neo-cortex and a host of institutionally-originating disruptions such as bright lights, loud noises, unfamiliar people, unnatural anti-gravitational positions and frequent disruptions. A crucial facet of this spontaneous birth reflex seems to be the psychological component, especially the emotional comfort of the mother with her situation. Michael O’Dont described this as creating circumstances for the mother so she “feels both secure and unobserved at the same time”. He observed that the birth attendant’s first responsibility is not to disturb the natural process. The M-FER appears to be the fruit of an undisturbed natural process.
I noticed the statistical significance of this natural “labor-saving “ phenomenon when I began recording all my statistical outcomes as required for the CPM 2000 project. Rather than a rare event I counted 30 (out of the last 40 mothers) who enjoyed some version of this accelerated labor. Other midwives in our peer-review group also described similar observations. What obscures the recognition of this discrete physiological event is that it so often follows anywhere from 4 to 48 hours of piddley prodromal labor or a lengthy painful latent labor. Like a form of foreplay, this long latency process (“forelabor”) seems to set up the circumstances so that all the “elements for success” are simultaneously present. Latent labor gets everyone gathered, involved and geared up to attend to the biological, emotional and social needs of the mother and baby. The marriage of biology to psychology with its necessary association to sociology (right people present and the wrong people not) is necessary for spontaneous physiological function. This includes adequate production of both oxytocin and beta-endorphins. Once this criteria is met, the latency period sooner or latter is abruptly replaced by an accelerated labor in which primiparas go from 4 (or less) centimeters to delivery in 4 hours or less (43 minutes for one mother!). A multipara progresses from 4 centimeters to delivery in 3 (or less) hours.
Unfortunately, a long desultory phase distracts us from appreciating this “order of magnitude” shift which results in an active labor many times faster than what textbook identify as “normal”. Because a fast photo-finish often comes on the heels of a psychologically difficult latent phase, it is not perceived by either the mother or the midwife (and certainly not by the doctor!) as an unusually fast labor and birth. Unfortunately this spontaneous birth reflex is not recognized by obstetrical medicine and is easily disturbed and often (but not always) obliterated by the medicalization of parturition.
The Maternal-FER describes an overriding internal mechanism which triggers a series of discrete but perfectly timed and attuned events of physiology which fire off in domino fashion when the conditions are right. Biologically speaking, the Maternal-FER seems to be the childbirth equivalent of what human sexuality researchers Drs Master and Johnson identified as the orgasmic plateau, resulting in an accelerated active first and second stage (usually 3, even 4 times faster than Friedman’s ‘1 centimeter per hour’ Labor Curve). For these lucky mothers, labor and birth is a finely-tuned physiology event akin to a slow motion sneeze. First time mothers tend to delivery as if it was a second baby and do not push very hard or for very long as this reflexive mechanism efficiently overcomes the usual soft tissue resistance and takes advantage of momentum to efficiently press the baby down and out. The M-FER stands as a constant “exception” to the rules of hard work as expressed by Friedman’s Curve. Dr Friedman’s graph portrays labor as a linear process ~ inexorably slow, always painful, solely dependent on the incremental hard work of the mother to tolerate the pain ~ rather than acknowledging an innate ability that might make it possible for a woman’s to “facilitate” her own birth process by surrendering to spontaneous physiology.
Additional thoughts on the M-FER are available on the www.CollegeofMidwives.org web site, which has a “search” feature (search for “M-FER” or “fetal ejection”) or you may use the URL:
Five Elements of success for
“normal spontaneous vaginal birth”
1. Healthy Mother/normal pregnancy/spontaneous onset of labor at term
2. Understanding the physiological and psychology of spontaneous labor 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 labor 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 painful sensations of labor and birth
5. Willingness of the mother to accept pain 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 systems will generate symptoms that will ultimately require medical or surgical intervention which may incidentally lead to iatragenic and nosocomial complications.