104
ROUNDTABLE
The Fetus Ejection Reflex
Michel Odent, M.D.
In 1966 Niles Newton, Donald Foshee, and Michael
Newton published a study of experimental inhibition
of labor of mice through environmental disturbance
(1). In their conclusion they proposed the term
“fetus ejection reflex” as a convenient concept for
research in regard to the role of inhibition and
conditioning in labor. More than 20 years later, I
suggest we save this term from oblivion. I am more
and more convinced that this phrase should be a
key to triggering a radically new understanding of
the process of human parturition.
Observations on the Use of Water During Labor
I have had several opportunities to publish my ob-
servations regarding the effect of immersion in a
pool full of warm water during labor (2). Especially
for primigravidas, a warm bath is a way to make
the dilation of the cervix during the period of hard
labor easier and faster. But often, in this environ-
ment, the labor stops progressing at a stage which
precedes crowning. When they feel that the con-
tractions have suddenly become inefficient, most of
the women leave the bath spontaneously. They go
into a cooler place. Immediately there are some
major contractions, often one or two, and the baby
is born. It is really a fetus ejection reflex.
This phenomenon made me curious. I had orig-
inally supposed that a situation which increased the
level of adrenaline (and other catecholamines) would
inhibit the process of parturition, but the opposite
seemed to be happening.
Fetus Ejection Reflex Induced by Fear
To interpret this phenomenon I made a correlation
with several cases of fetus ejection reflex obviously
induced by fear, that is, other situations which go
with an increased level of catecholamines. I thought,
for example, of some women who came to our
hospital because they had a phobia of surgery and
Doctor Michel Odent practices home obstetrics in London. Ad-
dress inquiries to him at 59 Roderick Rd., London, NW3 2NP,
U.K.
BIRTH 14:2 June 1987
were expecting a breech baby. The labor went on
normally up to complete cervical dilation and then
the contractions became inefficient. The time came
when we considered the possibility of a cesarean.
We decided to go to the operating theatre. The
baby was born on our way, in the corridor.
I also thought of the habit which some old French
doctors used to have of saying something frightening
before deciding to use forceps. I have been told that
at the time of horses and iron horseshoes, some
doctors used to say, “Fuites chuuffer les fers!” (Heat
up the iron tools!). This was a frightening way of
saying “Have the forceps ready.” They knew that
it was a possible way of occasionally avoiding the
use of forceps. So fear, as well as coolness, can
trigger a fetus ejection reflex.
Toward the Concept of Physiologic Fear
But there are many cases of fetus ejection reflex
which are not triggered by a sudden difference of
temperature or by some frightening words. The next
step toward an interpretation was to find out what
these deliveries had in common.
I found that a fetus ejection reflex is possible in
a hospital like Pithiviers (3,4), but it is likely to be
very common, indeed almost the rule, at a home
birth. In these cases the first stage of labor happens
in an atmosphere of complete privacy. For example,
the mother-to-be is alone in her dimly lit bathroom
or bedroom, while her partner is somewhere else
in the house. The woman feels safe because an
experienced person is at hand. She feels sure that
somebody will come immediately if she needs help.
She has not been disturbed by vaginal examinations.
Suddenly her voice and attitude become different.
The mother-to-be says a word or makes a gesture
which means, “Help, urgently!” Or else she says
some frightening words to do with death, or sud-
denly behaves as if she is angry (e.g., kicking a
wall). From that time there is a point of no return
[if the mother feels free to shout]. Nothing can
interrupt a fetus ejection reflex, even a big television
camera. (The first birth in the film Birth Reborn by
the BBC followed a typical fetus ejection reflex.)
BIRTH 14:2 June 1987
During the last contractions the woman has a sud-
den, strong, muscular energy, grasping something
or somebody, hanging on to something or some-
body, or needing to have her shoulders supported.
She is suddenly very thirsty (dry mouth caused by
high level of catecholamines. Her face is often ec-
static. Her pupils are completely dilated (catechol-
amines). I have never had to repair a tear after a
fetus ejection reflex. Looking back, some women
remember that just before the storm they had a
short period of real panic. All these observations
suggest that the fetus ejection reflex goes with a
high level of catecholamines. This is how I reached
the concept of physiologic fear.
Perhaps it is artificial to consider fear as the
specific emotion which precedes a fetus ejection
reflex. There is such a complex mixture of emotions
during the process of human parturition. Any strong
and sudden emotion goes with a reduction of neo-
cortical control, which is the prerequisite of a fast
and easy birth.
The fetus ejection reflex must not be confused
with the Ferguson reflex. The Ferguson reflex is
triggered by the pressure of the presenting part on
the perineal muscles-in other words, local fac-
tors-while the fetus ejection reflex can start much
earlier and is not triggered by local factors.
The Effect of Adrenaline During Labor
It is simplistic that fear and adrenaline are factors
which inhibit labor. In fact, experiments on the
effect of adrenaline during parturition gave contra-
dictory and complex results (5,6,7). Generally
speaking, adrenaline inhibits labor. But in some
cases, to the contrary, it triggers a fast birth, or the
inhibitory response is preceded by one or two major
contractions.
As a rule of thumb one can say that during the
first stage any situation which goes with a high level
of catecholamines (e.g., fear, cold) tends to inhibit
labor. However, there is a later stage when a sudden
elevation of catecholamines can trigger a fetus ejec-
tion reflex.
It is not common to refer to the role of fear
during labor. We tend to classify fear as a negative
emotion. However, for physiologists, an emotion is
neither negative nor positive but has a specific role
to play. So fear, by increasing the level of cate-
cholamines, brings more blood to the muscles and
makes fight or flight possible. Where the process of
parturition is concerned, it is easy to understand
that, in terms of survival in a wild environment,
105
when a parturient is threatened by a predator, the
inhibition of labor is an advantage at the beginning,
while the fetus ejection reflex is an advantage near
the end.
The Interconnectedness of Physiologic Processes
The physiologic processes in the perinatal period
are interconnected. For example, I found that the
neonates born at home after a fetus ejection reflex
do not lose weight during the first days after the
birth, as long as there is skin-to-skin contact be-
tween mother and infant and unrestricted breast-
feeding.
Is the fetus ejection reflex a way to prepare for
the “colostrum ejection reflex”? Is the neonatal loss
of weight physiologic?
All these physiologic processes are more depen-
dent upon environmental factors than is commonly
believed, and cannot be studied in the context of a
conventional obstetric department. I needed the ex-
perience of home birth to go beyond what I learned
when practicing in Pithiviers. I needed the experi-
ence of home birth to be convinced that the average
length of labor for a primigravida could be much
shorter than is commonly believed. I needed the
experience of Pithiviers plus the experience of home
birth to dare to propose the concept of physiologic
fear during labor.
By itself, however, the context of home birth is
not sufficient to facilitate the physiologic processes.
The human environment is essential. The fetus ejec-
tion reflex can happen only when the attendants are
conscious that the process of parturition is an in-
voluntary process and that one cannot help an in-
voluntary process. The point is not to disturb it.
References
1 . Newton N , Foshee D, Newton M. Experimental inhibition of
labor through environmental disturbance. Obsret Gynecol
1966;67:371-377.
2. Odent M. Birth under water. Lancer 1983;ii:1476-1477.
3. Gillet J. Childbirth in Pithiviers, France. Lancet 1982;ii:894-
896.
4. Odent M. The evolution of obstetrics in Pithiviers. Birth
Fam J Spring 1981;8:7-12.
5. Pose SV, Cibils LA, Zuspan FP. The effect of 1-epinephrine
infusion on uterine contractility and cardiovascular system.
A m J Obsret Gynecol 1962;84:297.
6. Stroup PE. The influence of epinephrine on uterine contrac-
tility. A m J Obster Gynecol 1%2;84:595.
7. Zuspan FP, Cibils LA, Pose SV. Myometrial and cardiovas-
cular responses to alterations in plasma epinephrine and nor-
epinephrine. A m J Obsrer Gynecol 1962;84:841.