CHAMPAGNE AND THE FETUS EJECTION REFLEX

The more I try to combine what I learnt from my experience of hospital birth and from my experience of home birth, the more I am convinced that the best way to protect the perineum, to avoid a serious tear and to eliminate the reasons for episiotomy is to deviate as little as possible from the physiological model. In other words it is to create the conditions for an authentic fetus ejection reflex (1,2 . I am often as!ed to clarify the difference between the fetus ejection reflex and the well !nown "erguson#s reflex ($ . The "erguson#s reflex is related to mechanical conditions% the pressure of the presenting part on the perineal muscles. & real fetus ejection reflex can occur long before the descent of the presenting part, or long after. It can start before complete dilation or after complete dilation. 'sually it does not occur at all because the prere(uisite is complete privacy. I am familiar with this )reflex), in the context of home birth, when I follow the progress of labor from another room through the sound the woman is ma!ing, while her husband*partner goes shopping, and when there is nobody else around other than an experienced, motherly, silent and low profile doula. I cannot remember one case of an authentic +reflex# in the presence of the baby#s father. ,uring the )reflex) there is a short series of irresistible, uncontrollable contractions, with no room for voluntary movements- the laboring woman can be in the most unexpected postures (often asymetrical, bending forward I have interpreted this reflex as the effect of a sudden spectacular reduction in neocortical activity, ma!ing possible the release of a complex hormonal coc!tail. The release of high levels of hormones of the adrenaline family is suggested by the sudden expression of fear (often a very short episode of fear of death (. that precedes the irresistible contractions, and by a sudden tendency to grasp something and to be upright. The most helpful thing to do in terms of facilitating the fetus ejection reflex is just to interpret this sudden expression of fear (!ill me...let me die, etc. without interfering% reassuring rational words / a stimulation of the neocortex 0 would inhibit the reflex. The release of a high pea! of oxytocin is of course suggested by the sudden power and efficiency of the uterine contractions. 1e must !eep in mind that the term )fetus ejection reflex) was originally used by 2iles 2ewton, when she was studying the factors influencing the birth of mice (3 , i.e. mammals who do not have a neocortex as powerful as ours. The )reflex) can occur among humans, on the condition that the activity of the neocortex is dramatically reduced, so that the human handicap is overcome. I learnt from a powerful fetus ejection reflex induced by a cup of 4hampagne. This was around 1567 in the hospital in 8ithiviers, "rance. & woman in not0yet0hard0labor was in a double bed room. 9er room0mate, who was already celebrating the birth of her baby, gave her a cup of 4hampagne. The unexpected effect was a sudden series of so powerful contractions that the second mother#s baby was born on the way to the birthing room. :y interpretation was that the bubbles speeded up the absorption of alcohol, so that there was an immediate effect on brain activity that other sorts of wine cannot have. &nyway, the capacity 4hampagne has to release inhibitions has been widely tested, whenever the goal is to create an erotic or not0too0formal atmosphere. ;ecently I met ,omini(ue :ar(uette, an experienced home birth midwife and a native of <pernay, the famous speciali=ed wine

center in 4hampagne. 1hen preparing for a home birth, she always suggests the family to !eep a bottle of 4hampagne in the fridge, officially to celebrate the birth afterwards. In fact, now and then, in precise circumstances, she offers a cup of 4hampagne to the woman in labor, in order to release inhibitions. The conclusion of such anecdotes and of such theoretical interpretations is not that laboring women should be routinely offered a cup of 4hampagne. In the age of evidence based midwifery we must wait for the results of prospective randomi=ed controlled studies evaluating the ratio of benefits to ris!s> I have never had to repair the perineum after a real undisturbed fetus ejection reflex. ?ne of the many reasons is probably that in such a context the mother is more often than not bending forward, for example on hands and !nees. In such postures, the mechanism of vulva opening is different from what it is in other postures. "irst the anterior part of the vulva opens more (uic!ly- then the deflexion of the head tends to be delayed and, when the face is coming out, the chin is more lateral. I use this opportunity to mention that, if by chance there is a first or even second degree tear (usually because there has been no authentic fetus ejection reflex I do not stitch it. If the mother does not spread her legs at all during the first two wee!s (avoiding loo!ing at the perineum, avoiding the lotus posture, etc. the cicatrisation will be perfect. ?ne of the advantages of the term fetus ejection reflex is to underline the similarities between the different episodes in our sexual life. &s 2iles 2ewton pointed out (@ , in the mil! ejection reflex, the sperm ejection reflex and the fetus ejection reflex there is always a sudden explosive release of oxytocin. This release of oxytocin is always highly dependent upon environmental factors. :ichel ?dent 4hristmas 2772 ;eferences% 010 ?dent :. The fetus ejection reflex. Airth 156B- 1.% 17.0173. 020 ?dent :. The Cecond stage as a disruption of the "etus <jection ;eflex. :idwiferyToday. &utumn 2772% 12. 0$0 "erguson DE1. & study of the motility of the intact uterus at term. Curg Fynecol ?bstet 15.1-B$% $350@@. 0.0 ?dent :. "ear of death during labour. Dournal of reproductive and infant psychology 1551- 5% .$0.B. 030 2ewton 2, "oshee ,, 2ewton :. <xperimental inhibition of labor through environmental disturbance. ?bstetrics and Fynecology 15@B- $B10$BB. 0@0 2ewton 2. The fetus ejection reflex revisited. Airth 156B- 1.% 17@0176.