Whenever womben “should” one another, I internally cringe. There is so much anti-ideological ideology in the world… its’ dizzying. There is the die-hard “hospital birth is the only safe option” crowd… but then on the other end of the spectrum, there is just as much ideology, some of which actually may be just as harmful, and certainly can give some false security.

Women have been speaking a lot on social media, etc about Fetal Ejection Reflex (FER), and what some call “breathing your baby down”. It’s become a hot topic, and there are inevitably many opinions on the subject, some who say it is the luck of the draw, others who say that every woman “should” wait until they experience this. What the heck is real?

Well, as a long time pelvic floor care bodyworker turned doula /birth tender, I can honestly say there is a lot more to the picture than meets the eye. 

I myself experienced FER with all four of my babies’ births. To me, it was in most of those births, a freight train that if anything, I had to breathe and focus to slow it down to allow my tissues to stretch and not tear. I never needed to push, and aside from my one birth with a midwife, who told me to try pushing when I really didn’t need to, I didn’t. Even then, once the baby truly reached my pelvic floor, there was no stopping it, and no need for focused pushing. My body essentially does it on its own.

But I am certainly aware this is not the experience of every woman. For some, however, the “pushing” stage (second stage of labor) is excruciatingly long, and for that, I have to question, are we having her push too soon? 

The answer in most hospital settings, and even some home birth settings as I saw even with my own “extremely experienced” midwife, is that we typically are not waiting long enough. Michel Odent, and before him, Constance Benyon, did extensive experimentation with stepping back from the role of “coach” in labor, instead waiting to see how often women would have the spontaneous urge to push, or better yet, Fetal Ejection Reflex. 

I place these two in slightly separate categories, though the line is truly blurred, only to highlight the fact that for some women this FER sensation will be felt as the need to push, a deep, bodily sensation accompanied by an almost involuntary but wholly satisfying bearing down. For other women, and I would say I generally fall into this category, the body does the bearing down entirely on its own without even having a sense of desire to push… perhaps it is only a matter of timing in these cases, that the urge and actual bearing down impulse are so instantaneous and so strong, that there is absolutely no conscious sense of pushing on the womban’s part. Or, perhaps there is a bit more nuance there between the woman who feels the FER but still has a need to consciously push with the urge, versus the woman who’s body does the pushing for her entirely involuntarily. 

Either way, it seems that once this happens, there is almost no stopping. The body takes over, the urge and even satisfaction of bearing down far outweighs any desire not to. 

We have to understand, and I speak about this in great depth in my online and local classes, that many doctors and even midwives will coach a womban to push immediately when she reaches 10 cm dilated. Some even tell a womban to push before she is fully dilated! 

This is, in my humble but educated opinion, extremely dangerous and detrimental to the natural and healthy, safe physiologic unfolding of the birth process. The baby is still at the ischial spines when dilation is occurring or has just occurred, and the baby’s head must make an internal rotation to clear the ischial spines properly, and for the head to emerge in a different angle than the rest of the body. If we push too early, the head may get stuck at this stage, and I believe fully that this is what we are seeing in the vast majority of cases of long, difficult second stage. 

So, what happens if we wait, and the baby makes the internal rotation? 

Well, in the majority of cases, unless the woman’s midpelvis and/or pelvic outlet (the space between her ischial spines, and the space between the pubic bone and coccyx and ischial tuberosities) is truly too tight a fit, the baby will naturally slip down that next level, past the spines, and fully drop onto the pelvic floor musculature. This sling of muscle, mind you, also contains both sympathetic and parasympathetic nerves, as well as pressure and stretch receptors, all of which do a wonderful dance, causing signals to the brain which cause a cascade of hormonal response. 

The sympathetic nerves and hormonal response causes a sudden rush of adrenaline to the womban (and her baby gets one also), meanwhile the parasympathetic induces another rush of oxytocin (the hormone of uterine contractions and of loving bonding). All these nerves and subsequent responses in the brain and body are responsible for a profound physiologic shift, which causes the FER. Big waves of contractions begin again after likely having paused for a bit prior, the uterus but also entire body bears down in a powerful way, and the woman works to hold this freight train of energy with gentleness through her breath, breathing that baby out.

What I think we need to understand, however, and what has somehow become my mission, is the understanding of what makes this mechanism sometimes go a little less than full force and instantaneously. 

The biggest factor in this nuance of experience is in the particularities of an individual’s pelvic floor musculature and the nerve force in those nerves. In other words, is the baby’s head able to truly rest evenly on the sling of muscles and nerves, thus sending a healthy nerve response to the brain? And, in turn, is that nerve tissue able to carry a strong signal, not impinged by imbalance, adhesions or tension in the muscles? 

This is a complex subject to delve into, with more nuances that will require a deep dive in my courses, but the foundation of understanding is crucial here: womben are going to need tailored care to address pelvic floor issues and neurological function if they have any issues that may be in the way of this healthy response. Not every womban will have issues, obviously, but for those who do, a combination of bodywork or self-care massage, and exercises, as taught in my online education portal, is essential.