The Fetal Ejection Reflex and Pushing

Stop telling women they don’t have to push! 

In the process of physiological birth, the birthing person will feel the urge to push on their own and it will be an uncontrollable reflex called the fetal ejection reflex. The body will bear down and start pushing when the baby has made the final movements and rotations necessary to move through the birth canal. This is different than a provider checking a mother’s cervix and saying, “okay, you’re 10cm dilated. Let’s push this baby out!” Waiting for that reflex helps ensure that your baby has made the movements necessary for birth. This allows your body to use the power of this reflex to push your baby out.  

Pausing for Birth Before the Fetal Ejection Reflex

It is very common for there to be a pause in time from the moment full dilation is reached and the time that the fetal ejection reflex occurs. The birth blueprint isn’t the same for every birthing person, but this is often the case. Many times, a mother simply needs time to rest and wait for that reflex to happen. And as long as everyone is safe and healthy, there is no reason that this process needs to be rushed. This is physiological birth, and it is a very normal process.  

Your birth doula can help you navigate the process of physiological birth.

Additionally, there is an increasing awareness of this process. I often hear childbirth educators, doulas, and midwives say, “did you know you don’t even have to push your baby out? You can just breathe your baby down and your body will do the work for you.”  

However, the lifestyles we live today are far from natural and our bodies feel the burden of these changes. Imbalances in the pelvis, scar tissue, lack of movement, interventions, early pushing and birth management, nutritional status, and many other factors lead women to a different place in the birthing process. For the majority of mothers, if left undisturbed, the physiological birthing process will take over.  

But what if it doesn’t? What if the fetal ejection reflex doesn’t lead to a quick pushing phase?

Let me speak from experience. For example, in my first birth I labored for nearly 20 hours. My labor started out with a posterior baby. I was one cm dilated after hours and hours of regular contractions that were 3 minutes apart. Through transition, my body started bearing down and I felt a lot of pressure. My midwife checked my cervix and I had a cervical lip and yet my body was bearing down and I could not control my pushing. As a result, my midwife tried for a very long time to pull back the cervical lip (and holy shit I think I still may be traumatized from how painful that was).

We tried every possible pushing position – birthing stool, in the water, on the bed, standing, etc and there was very little progress. I pushed for 6 hours. Surprisingly, my daughter was born with her arm wrapped around her neck, like a scarf, behind her head.  

I absolutely HAD to work hard at pushing my baby out. It was the only way she would have been born.  

After my first birth, when I told my birth story, I had friends tell me, “you shouldn’t have to push that long in birth. Didn’t you know you don’t even have to push?”  

Bullshit.  

Tell me one more time that I didn’t have to put all my strength into pushing my baby out. 

Your Body is Not Broken

For a long time, this made me feel like there was something wrong with me and my body. Why couldn’t I just breathe my baby out like all of these other women seem to be able to do? What was wrong with me that my birth was so hard? Maybe if I did the spinning babies tricks at 30 weeks instead of 35 weeks, my labor would have been easier. Maybe if I saw my chiropractor twice a week instead of once a week. It was a really negative thinking cycle.  

The fetal ejection reflex is real. We need to give birthing mothers the space to listen to their body and feel that reflex to harness the power of physiological birth. However, there are a ton of birthing situations in which that doesn’t or can’t happen. Sometimes, babies find themselves in challenging positions. In these situations, you really do need to work hard at pushing in combination with other techniques to move that baby. What if mom has an epidural? Is it really okay to tell her that she doesn’t have to push when she can’t even feel that reflex?  

I’m definitely not advocating for directed pushing, purple pushing, or any of those things.

But…

Birth can be really hard.  

You can have a long pushing phase of labor, even if you did ALL the things to promote a natural birth process. And let me tell you, I have been a doula at many births with some crazy long pushing phases. Unfortunately, it can be incredibly draining and scary for families as the risks of complications arise.  

When you tell a mother she doesn’t have to push, you’re not truly preparing her for birth. It ignores the possibility that she may need to work hard to push her baby out. You’re invalidating that struggle and all of the emotions and feelings of failure that come with it. 

We need to stop telling mothers that they don’t have to push, and instead prepare them for what they may need to do in a challenging situation. Therefore, we need to prepare them for endurance, physically and emotionally, and let them know that it absolutely can be a variation of normal.  

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