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:
http://www.collegeofmidwives.org/prac_issues01/MFer_01a.htm
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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.