Fetal Ejection Reflex: Image

The Fetal Ejection Reflex

Published 12 February 2021, updated 12 February 2021

What is the Fetal Ejection Reflex (FER)?
Also known as the Ferguson Reflex, the fetal ejection reflex is a term believed to be coined in the 1960s by scientists studying birthing mice. It was brought into common usage for birthing women by obstetrician Michel Odent in the 1980s.

It describes what the name says; a reflex that expels the baby.
A rush of hormones, its effect on the uterine contractions, and the sudden, expulsive birth of the baby, caused by no conscious effort of the mother.

Why is FER important?
"We think in pictures and we should be painting accurate pictures. The cervix nor the vagina bloom. The cervix is not a zip lock bag. The purpose of labor is NOT the creation of an opening or a hole... The purpose of labor contractions and retractions is to BUILD the fundus, which will, when it is ready, EJECT the baby, like a piston. Without a nice thick fundus there is no power to get baby out....the cervix does not dilate out....it dilates UP as a result of the effort to pull muscles up into the uterus to push muscles up to the fundus. The cervical dilation is secondary to that. The cervix is pulled up as a result of the building of the fundus.

…..What is important is to keep (the mother) well supported for the purpose of the appropriate chemistry, to keep her well hydrated and nourished for muscle strength, and to believe in her. We should be supporting her so that her physiology and that of her baby are unhindered, so they can finish what they started.

We should not be measuring, poking, or interpreting her labor. THIS CHANGE in teaching about labor could make such a difference for women who are imagining what is happening in their bodies during labor. How much more strength might they have if they have an accurate picture?" -Carla Hartley, Trust Birth

It’s important to know about the Fetal Ejection Reflex because I believe that knowing that your body is capable will help you trust your body even more. Knowing that you’re designed this way, that you have all that you need built in - how could you not be in awe of yourself, and excited to be in tune with and support your natural functions to their fullest extent?

“In the wild, mother and young have a better chance of survival if the mother can regulate labor so that the young are born in safe, quiet surroundings.”

–Niles Newton, behavioral scientist and professor at Northwestern University circa 1987

So, how does FER work?

The first stage of labour was in a calm environment, and now moves to the next stage.
The transition hormones surge, the fundus builds, and the baby’s head presses on the internal os of the cervix as it dilates completely.
The contractions change from positioning, building contractions to pushing, top contractions (visual here https://www.youtube.com/watch?v=URyEZusnjBI)
This combination releases oxytocin and can trigger a reflex that causes spontaneous, expulsive uterine contractions.
The mother may feel a burst of energy, and often wants to be upright or grasping onto something for support.
The reflex ejects the baby after only 1-3 involuntary (uterine) pushes, (sometimes more)
The baby sometimes barely crowns but shoots straight out (depends on the mother's positioning, soft tissue flexibility, and baby's size)
You can also experience a more gentle but still strong version of this with your fundus pushing for you, but it taking a few minutes like a “normal” pushing stage (perhaps due to pelvic positioning)
FER can be painful or painless.
However, it is almost always surprising and intense.

What does FER feel like?

Freebirthing women have described their experience of FER as:

"Vomiting in reverse"

"The baby just slipped out suddenly"

"I felt my uterus tense up and push"

"Intense!"
“Like a sneeze!”

"Like my vagina threw up"

"The baby just came shooting out"
“I had a strong contraction and the head came out!”
“I did literally nothing, my body did it naturally!”
“It was overwhelming, the complete power of it”
“It was incredible to feel my body working for me after hours of labour”
“No conscious pushing on my part at all”
“It’s the same uncontrollable feeling of having to throw up”
“My body was on autopilot”

"I didn't have to do a thing. There was no doing. Only witnessing and receiving "

During the uncontrollable feeling they say things like:

" I didn't do that"

"I'm not pushing!"

"Ahhhhh!?"

"I can't stop it!"

They might have also screamed or gasped a little as they feel their body take over and push without them.

When does FER happen?

FER frequently happens in times of either high stress OR low stress.
How can it happen in such diametrically opposed situations?

This is because high stress scenarios produce catecholamines (like adrenaline), which tell the body that the baby needs to be born fast to be safe.

And in low stress situations, the mother produces lots of oxytocin, which can speed up and create efficient contractions - the body knows it is a safe time and place for the baby to be born and takes advantage of it.

Some examples would be birthing in the car (high stress) and birthing at home (low stress).

Presenting to hospital, having the midwife arrive, or being vaginally checked are some things that can all stall labour or inhibit FER when done at a crucial time in labour.

Being told what position to lay in (especially on your back), being uncomfortable, upset, or feeling observed, and having someone tell you when and how to push (coached pushing) will all stop or prevent FER.

If labour has been long, and the mother is exhausted, the uterus is most likely tired too, and the mother may need a rest and some high energy food and drink to restore her, in order to allow the uterus to function efficiently.

FER rarely happens during induction (Pitocin augmented) labours, and under the influence of epidural anaesthesia, as these block the physical and neural feedback required.

However, there was a woman who gave birth in a vegetative state. Her body birthed the baby for her, and even without many details, we can know it was the FER!

Many multiparous women experience FER in subsequent births. This is partly because the body has a memory and labours quicker, and partly because the woman is more confident in her body and educated about the natural processes.

Note: During a breech birth, where FER has already pushed the baby halfway out, you may need to continue to push the rest of the baby out yourself, as the baby will not be engaged the same way as a cephalic-presenting baby, and the reflex will cease to be triggered.

What if I feel like pushing, is that FER?

You may experience involuntary pushing or a strong urge that you can breathe through in an undisturbed birth.

The natural urge to push is normal, and common at the end of labour. It is instinct led. It is also part of the body’s design to help you birth the baby. But it is not the FER.

FER is not like just “feeling pushy”. It’s not “I worked with my body and pushed during contractions”
It’s when you cannot stop your body's process, anymore than you can stop yourself vomiting once it starts.

"Finally, a true fetus ejection reflex will eliminate the need for a second stage of labor altogether. Meaning, pushing is not a necessity and all that is required is positioning and relaxation of the pelvic floor muscles."

- Katie Hunter, Pelvic Pain Rehab

Can I make FER happen in my birth?

The short answer is no, you can’t make it happen.

You can create the ideal environment. You can wait and relax and let your body start pushing for you.

But it's a teamwork of a whole bunch of things, and it may not happen to you.

You can definitely increase your chances of success though with an unhindered home birth!

Whether you push instinctively or baby gets pushed out for you, whether baby comes out noisily and expulsively, or comes out gently while you breathe through the contractions - your birth is yours. Neither is wrong or right.
It is a unique and unreplicable combination of hormones, environment, uterine strength and shape, pelvic alignment, and your emotions.

Please don’t compare your births to other women’s when it comes to FER. It is so situational and not something that can be “achieved”.
Or something that makes you a failure in any way if it didn’t happen.

The important thing to aim for is supported, mother-led, instinctive birthing, wherever and however that takes YOU!

Final quote on the foetus ejection reflex:

“As we can see, not only are the same hormones involved in these different episodes of sexual life, but the same patterns, the same sort of scenarios are reproduced. The final phase of each sexual event is always an ‘ejection reflex’ and terms such as ‘sperm ejection reflex’, ‘foetus ejection reflex’, ‘milk ejection reflex’ are highly suggestive of this likeness. I adopted the term ‘foetus ejection reflex’ (which had been proposed previously by the American scientist Niles Newton in the context of non-human mammals) to refer to the very last contractions before birth among humans, when the whole process has been undisturbed and unguided. This is a very short phase when, paradoxically, strong and effective contractions are associated with a rush of adrenaline so that the mother had a tendency to be alert when the baby is born. The reflex is almost unknown in hospital delivery rooms, and even at home births it is inhibited if another person takes on the role of ‘coach’, ‘guide’, ‘helper’, ‘support person’, or ‘observer’.”

-“The Scientification of Love” by Michel Odent, 1999.

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Fetal Ejection Reflex: Text