You might have heard a woman who recently gave birth say her baby just ‘flew out’, and she didn’t even have to push.
Or perhaps this happened to you when you gave birth: your body just took over and you didn’t feel any bearing down urges. Your baby was born without a midwife or doctor telling you to ‘push’.
Pushing isn’t actually necessary during normal labor and birth. When left undisturbed, a birthing woman can experience what is known as the fetal, or fetus, ejection reflex (FER).
The undisturbed woman labors efficiently and quickly while she is safe, and the final moments of birth are an amazing expulsive effort.
What is the fetal ejection reflex?
The term ‘fetal ejection reflex’ was first used in the 1960s when Niles Newton was researching the effect of the environment on the birth of mice.
In the 1980s, Michel Odent, a renowned French obstetrician and advocate of natural birth, suggested FER was possible in birthing women.
The reflex, also known as the Ferguson reflex, is when a woman’s body expels her baby without actively pushing. The reflex is involuntary: quite literally, her body is doing the work without any thought.
Some women have likened it to a sneeze; once it’s started to happen, there’s nothing you can do to stop it.
When does the fetal ejection reflex occur?
If we look to nature, we can see the fetus ejection reflex occurs naturally when mammals birth in a place where they feel safe and private, which allows them to birth quickly and easily.
Humans have the same needs for birth as other mammals do.
Research shows we need emotional and physical support during labor, but we also need a space that provides us with a sense of safety so we can get on with birthing.
FER happens during the transition stage of labor, when the cervix is fully dilated. Extremely high levels of stress hormones called adrenaline and norepinephrine trigger the reflex, which can come on very quickly.
Before it happens, the mother might be in a sleep state, between surges, with her neocortex (the ‘thinking brain’) completely switched off. The adrenaline wakes her up and makes her very alert.
The contractions push the baby down onto the cervix, which sends more messages to the brain to release more oxytocin. The baby is moved into the birth canal, which stimulates nerves in the pelvis and again more surges of oxytocin are released.
This results in two or three very powerful contractions, which birth the baby quickly, without any active pushing from the mother.
Fetal ejection reflex triggers
FER is a normal part of labor for all women. It can be triggered when:
- The mother feels a threat in the last stage of labor and is close to giving birth. It’s easier and safer to expel the baby than for labor to stop, as would happen if early labor is disturbed
- A mother is undisturbed, feels completely safe and supported, uninterrupted by noise, lights or forced eye contact.
- Mothers are threatened with interventions or feel fear for their babies’ safety in the second stage of labor, and are close to giving birth.
It’s rare to see FER in hospital settings, as women are disturbed by routine procedures or interventions.
During active labor, the birthing person might appear to be in a sleep state between contractions. There could be a pause in contractions for minutes or even hours before the birth reflex happens.
This can cause concern to care providers, who might want to check the baby’s heart rate. If necessary, the midwife should do this quietly and unobtrusively, without disturbing the mother in her labor trance.
The start of the spontaneous birth reflex can happen quite suddenly.
A huge surge of adrenaline floods the woman’s bloodstream and body and, as a result, wakes her out of the labor trance.
Dr. Rachel Reed, author and midwifery lecturer, says:
“The adrenaline is nature’s way of clearing the endorphin ‘stoned’ state women get into, so they can be alert as their baby arrives, and ready to protect”.
Often it’s at this point a woman will express fear and uncertainty, saying she can’t do it, she’ll die or is out of control. These are normal fears in transition but, with FER, she really does feel out of control and the sensations are overwhelming.
It’s important, at this stage, for her midwife and labor support people to avoid telling the mother to push or not push, or to check if she’s fully dilated.
Instead, they should offer reassurance and support, to avoid interfering with the birth reflex. Interference at this stage can stimulate the mother’s ‘thinking brain’ – the neocortex – and as a result, can shut down the labor process.
You might be interested in reading Natural Birth – Tips For Natural Birth Success
How do you push the baby out without tearing?
Many women are concerned about tearing during birth. There is always a slight risk of small tears during birth; mostly they heal well on their own.
In a slow pushing stage, the baby’s head will gradually descend and stretch the perineum (the area between the vagina and anus). Breathing techniques help during this stage and allow the area to stretch.
During FER, your baby ‘flies’ out, and there might not be the time needed for the stretching of the perineum.
Perineal massage can help prepare the area and will help you get in touch with the area your baby will need to stretch to get out.
Waterbirth is another great option, as the warm water softens the perineal tissue, and prepares it for the ‘great stretch’ as your baby is born.
Despite all of this, the fetus ejection reflex is powerful and if your body wants to do it, there is no stopping it!
Is fetal ejection reflex real?
Fetal ejection is real! In my experience as a midwife, I have seen it many times, mainly at undisturbed home births.
As mentioned earlier, the environment makes a huge difference, in making you feel safe and letting your mind be free. Home is the perfect space to allow this to happen.
I have also heard of many women who gave birth on the side of the road or in an ambulance on the way to the hospital. In those cases the FER often takes over the mother’s body and, as a result, the baby comes whether she’s ready or not.
If you have quick labors, that’s more reason to birth at home.
Sarah Buckley in her book Gentle Birth, Gentle Mothering states:
“This reflex makes sense for mammals birthing in the wild, where the presence of danger would activate the fight-or-flight response, inhibiting labor and diverting blood to the major muscle groups so the mother can fight or more likely, flee to safety”.
Today, 96% of births take place in high-tech settings such as hospitals. The idea is to avoid disaster in case something goes wrong.
In these settings, though, bright lights, noises, constant disturbances, and lack of privacy interfere with the spontaneous, involuntary process of birth.
More is not always better. The United States is a clear example, recording some of the highest newborn and maternal death rates in the developed world.
Even in Australia, one in three babies is born by c-section, which is well above international recommendations.
Human beings are the only mammals who need assistance during labor. And, sadly, normal parts of labor are no longer recognized, or even seen, by doctors and midwives.
Can you give birth without pushing?
Women are heard to say, “I wasn’t pushing, my baby was just coming out!” This is FER at its best.
Here are factors that influence whether or not you feel an urge to push:
- The position of the baby
- The size of the baby in relation to the pelvis
- Whether the woman has a fear of birth
- Whether the mother is in an upright situation
- Whether the birthing woman receives coached or directed pushing
- Whether there is an epidural on board
Talk to your midwife or doula about factors that influence pushing in labor and how to be supported during the birth process so you’re more likely to experience FER.
What is involuntary pushing in labor?
When you push in response to the natural urge to push, it’s called spontaneous pushing, meaning you are doing what your body tells you to do.
This natural urge comes and goes several times during each contraction. This occurs quite frequently if your baby is positioned towards your back.
A woman might move into an upright or forward-leaning position, as a series of intense and involuntary contractions occur, moving the baby out of the uterus in three or four expulsive efforts.
There is no ‘pushing’ effort on the part of the woman.
You might like to read Is Pushing During Labor Necessary?
Fetal ejection reflex with an epidural
The goal of an epidural is to provide relief from pain, not total numbness while keeping you comfortable and completely alert during your birth experience.
Unfortunately, most women end up with no urge to push, even though they can feel contractions happening.
Thankfully, the fetal ejection process can happen even if you don’t know it’s happening.
Often this reflex is missing in vaginal births, due to unnecessary interventions or disturbances to the birthing women during labor.
Women chose to birth in hospitals because they believe it’s safer, but they should be aware of the impact the environment can have on the natural process of birth.
Be sure to read Epidural During Labor – Everything You Need To Know for more information.
FER and birth positions
Generally, if you feel safe and supported you will want to move into what whatever position feels comfortable for you at the time of giving birth.
However, once FER has been triggered, it really won’t matter what position you are in – except that most mothers won’t want to be flat on their back!
Fetal ejection reflex – one woman’s story
“With the next push, some other force of nature took over. My brain powered off and a commanding fetal ejection reflex turned on. With both hands, I instinctually clutched the headboard of my bed. My hips and butt lifted up off the bed while my body launched my daughter out of me, faster than I could make any sense of it or get the kids in the room to witness it.
“It was as if her head hit a trampoline in my pelvic floor propelling her right out! There was no easing her out; she blasted out of me and there was no stopping her.
“I knew without a doubt that because she had emerged so fast that I had severely torn, but that was not the case. For the first time in all my births, I had not a single vaginal tear! This was miraculous.
“No, this was physiological! The fetus ejection reflex preserved my perineum. Not enough birthing women get to experience this reflex, usually because their brain is being over-activated and/or their labors are interfered with.
“My baby girl was so chubby, and my cheesiest baby yet, covered from head to toe in God’s natural bacteria-fighting baby lotion—vernix! I was getting in some precious snuggles when my older children rushed into the room. The kids were celebrating, fist-pumping, and relishing in the sight of their little sister.
“My husband was still snapping photos and doing this happy laugh/cry thing he does every time I give birth. It’s like a floodgate release of all the emotions he goes through when watching me labor life into the world. I really love the way he loves me and all our babies.
“The amount of support I felt surrounded with that day so that I could give birth in safety and peace, loved and unhindered, was truly a gift—an empowering experience that my heart wishes for every mother in this world to have when doing the greatest work of their life.
“I felt like a warrior. I had come full circle on this journey through fear, trauma, and doubt, and there I stood looking behind me, past those haunting gates that tried to keep me from experiencing this unspeakable joy again—the joy of bringing a life into the world.
“I am so glad I didn’t allow fear to stop me from meeting this little human that will only make our lives richer. I am so thankful I defused the fear by telling (and re-telling) my story. I am a warrior. I am an overcomer. I am a mother”.
This video is a great example of undisturbed birth with FER