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The Journal of Perinatal Education logoLink to The Journal of Perinatal Education
. 2023 Jul 1;32(3):149–161. doi: 10.1891/JPE-2022-0007

Not Just Mechanical Birthing Bodies: Birthing Consciousness and Birth Reflexes

Orli Dahan ✉, Michel Odent
PMCID: PMC10386783  PMID: 37520790

Abstract

There are two concepts of neuroendocrine reflexes associated with the expulsion of the fetus through the birth canal during the second stage of birth: the Ferguson reflex and the fetus ejection reflex. These concepts are often confused with one another and treated synonymously, thus interchangeable. However, the two not only refer to different phenomena, but they also represent the birthing woman differently. The Ferguson reflex treats the birthing woman as simply a biomechanical body. In contrast, the fetus ejection reflex does not ignore women’s conscious states during birth and recognizes what is currently a well-known empirical fact: The event of birth is a complex biophysical process affected by many mental, social, and environmental factors. In that, it has a connection to the phenomenon of birthing consciousness, which is the positive altered state sometimes experienced during a physiological and undisturbed childbirth. We argue that birthing consciousness and the fetus ejection reflex, made possible by reduced cortical control, are extremely helpful in promoting physiological human childbirth. Therefore, treating a woman giving birth as a biomechanical body is not only erroneous but can also lead to medical mismanagement of the second stage of physiological childbirth with associated mental and physiological consequences.

Keywords: Ferguson reflex, fetus ejection reflex, birthing consciousness, birth management, physiological childbirth

INTRODUCTION: THE CURRENT MISUNDERSTANDING CONCERNING THE TWO SECOND STAGE OF BIRTH REFLEXES

In obstetrics literature concerning the second stage of birth, which spans from full dilatation of the cervix to expulsion of the fetus, two different reflex concepts are often used synonymously. However, the two are not identical and refer to different phenomena (Odent, 2003). The first defined and more familiar concept is the Ferguson reflex (Ferguson, 1941). This reflex represents the most powerful rhythmic uterine contractions initiated by high levels of oxytocin during the second stage of birth (Baker, 2010), which help the birthing woman respond to her own instinctive urge to push the baby out (Hamilton, 2016). The second reflex, presented and defined nearly 30 years later, is the fetus ejection reflex (Newton et al., 1968). While the fetus ejection reflex also requires powerful rhythmic uterine contractions initiated by high levels of oxytocin, it does not involve the voluntary pushing of the birthing woman. When the fetus ejection reflex is triggered, the fetus is spontaneously ejected out of the birth canal, and no pushing efforts are needed (Odent, 2009). However, the fetus ejection reflex is less used and less prevailing (Odent, 2019).

A brief overview of the literature demonstrates the treatment of the two reflexes as both synonymous and different, emphasizing the significant confusion and misunderstanding between the two. The Wikipedia entry on the Ferguson reflex refers to the terms as synonymous: “The Ferguson reflex (also called the fetal ejection reflex) is the neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls. It is an example of positive feedback in biology.”1 This confusion is important since up to 94% of medical students have reported using Wikipedia to supplement curricular learning (Allahwala et al., 2013), and Scaffidi et al. (2017) demonstrated empirically that Wikipedia can be used effectively as a resource for short-term knowledge acquisition by medical students. Furthermore, 70% of junior physicians have reported using Wikipedia in clinical practice (Kritz et al., 2013; Scaffidi et al., 2017). In 2011, members of WikiProject Medicine (Heilman et al., 2011) maintained that since the internet has become a valuable health information resource for the public, it can be used to promote worldwide health. However, Swire-Thompson and Lazer (2020) concluded that online misinformation concerning health has severe consequences for the general public’s health due to the way in which most people use the resource.

In academic literature, Abbas et al. (2011) discuss uterine physiology, briefly referring only to the Ferguson reflex, and Hotelling (2009) refers only to the fetus ejection reflex in relation to oxytocin and endorphin release during birth. According to Hotelling (2009), at the end of labor, the pressure of the baby’s head stimulates stretch receptors in the lower vagina, stimulating the fetal ejection reflex that brings forth the baby more easily and quickly. However, this biomechanical description is more suited to the Ferguson reflex than the fetus ejection reflex. 2 Mayberry and Daniel (2016) literally state that these two concepts are synonymous: “Toward the end of labor, pressure from the baby’s head that stimulates stretch receptors in the lower vagina of the mother triggers a surge in hormones, which not only makes the mother more alert but also stimulates the fetal ejection reflex (FER) resulting in a quick delivery … Also referred to as the ‘Ferguson reflex’, the FER is consistent with evolutionary thinking, where a quick delivery favors safety of mother and newborn.” (Mayberry & Daniel, 2016, p. 335).

Referring to the two concepts of reflexes as denoting the same phenomenon in the world is a mistake because there is a crucial difference between the two reflexes. Amis (2015) notes that the Ferguson reflex helps the birthing woman complete the second stage of birth because it promotes her pushing efforts. According to Hamilton (2016), this reflex creates an instinctive urge to push the baby out. In contrast, the fetus ejection reflex does not involve voluntary pushing. In fact, when the fetus ejection reflex is triggered, the fetus is ejected out of the birth canal, much like the cork of a champagne bottle (Odent, 2003). It is comparable with other involuntary ejection reflexes, such as sperm ejection and milk ejection reflexes (Newton, 1987; Odent, 2009). No pushing is needed or even possible in a spontaneous fetus ejection reflex.

The question of whether the birthing woman needs to voluntarily push the fetus (as in the case of the Ferguson reflex), or the fetus is involuntarily ejected throughout the birth canal (as in the case of the fetus ejection reflex)—represents not only an apparent difference between the two reflexes but also a crucial issue of physiological health. This is because pushing during the second stage of birth negatively impacts pelvic floor structure and function (Schaffer et al., 2005; de Tayrac & Letouzey, 2016). Hence, it is reasonable to hypothesize that triggering the fetus ejection reflex by refraining from all voluntary pushing will, in most cases, best serve the birthing woman’s health in the postpartum and succeeding periods of her life.

The matter of pushing is essential for discussing the second stage of birth. A series of descriptive studies in the 1980s reported that labor progresses well and that fetal outcome is good when at the second stage of labor the birthing woman’s pushing is paired with the involuntary reflex rather than coached pushing (Roberts et al., 1987). Indeed, a more recent review (Kopas, 2014) concluded that current evidence for the second stage of labor management supports the practice of spontaneous (nondirected and uncoached) pushing, and Low et al. (2013) have shown that spontaneous pushing can help avoid postpartum urinary incontinence. Simkin (2017) suggested that childbirth educators and parents who want to improve birth outcomes be made aware of the growing evidence that coached pushing according to specific methods is not recommended.

Unfortunately, management of the second stage often follows traditional obstetric protocols rather than evidence‐based practices (Kopas, 2014). In fact, it appears that the belief that all babies must be pushed out is deeply rooted when it is a consequence of misunderstanding the physiology of birth positions in the second stage of birth. In natural unanesthetized birth, when the woman is not in a lying down position, the head of the fetus contacts a nerve plexus at the front of the pelvis, which triggers the backward movement of the rhombus of Michaelis, creating more space in the pelvis. This sequence triggers the involuntary fetus ejection reflex (Sutton, 2000).

Thus, it is noticeable that the fetus’s ejection reflex is preferable from a purely physiological point of view. The following question is what we can say more about the fetus ejection reflex, for example, from biological, behavioral, and brain mechanism perspectives.

THE CONNECTION BETWEEN BIRTHING CONSCIOUSNESS AND THE FETUS EJECTION REFLEX: DOWNREGULATION OF PREFRONTAL CORTEX FUNCTION

“Birthing Consciousness” and the Brain Mechanism of Physiological Childbirth

In recent articles, Dahan (2019; 2020; 2021a; 2021b; 2021c; 2021d) has developed the concept of ‘birthing consciousness,’ a unique psycho-physical altered state of women’ consciousness that often occurs during physiological birth, similar to other altered states of consciousness triggered by reduced prefrontal cortex function. Empirical findings support the similarity between the phenomenological, cognitive, and biochemical characteristics of birthing consciousness and of the transient hypofrontality brain mechanism.

Birthing consciousness is a highly positive altered state that women can experience during natural birth. Prior studies have documented the experience of an altered state of consciousness during birth, yet the psychophysiological study of birthing consciousness is only just beginning (Dahan, 2020). The phenomenological features of experiences of birthing consciousness include feelings of peacefulness, calm, and reduced pain and anxiety sensations (Dahan, 2020; Dixon et al., 2014; Stenglin & Foureur, 2013). Cognitive features that downregulation of prefrontal cortex activity produce in women during a natural birth - most commonly occur as labor intensifies. For example, birthing consciousness involves shifting into a less verbal state during which the birthing woman does not want or cannot talk and communicate (Odent, 2019). The birthing woman often experiences a healthy dissociative state characterized by removal from surroundings to varying degrees, distorted sense of time, disorientation, shifted awareness, relinquishing of social constraints in various forms, and focused attention (Olza et al., 2018; Zambaldi et al., 2011). Women have described a sensation of withdrawal and have used phrases such as “in the zone,” “in a faraway place,” and “on another planet” (Olza et al., 2018, p. 6). Kurz et al. (2019) refer to this phenomenon as a transcendent birth experience. Women who experienced this focused attention experienced less affective pain. Thus, it appears that as labor intensifies, women can modify their pain experience during natural and undisturbed birth by focusing and retreating to a private inner world (Dixon et al., 2014; Stenglin & Foureur, 2013).

The specific biochemical features of birthing consciousness are related to the mental and behavioral characterizations of physiological birth (Dahan, 2020). During a spontaneous birth process, the hormones that start and maintain labor also sustain the instinctive emotions and behaviors of the birthing woman (Dixon et al., 2014). The biochemical processes of normal birth promote pain reduction as birth progresses (Lothian, 2004). The simultaneous increase of brain levels of oxytocin, prolactin, and endorphins contributes to modifying the pain experience of women during physiological birth and enables the birthing woman to focus and retreat (Dahan, 2020; Dixon et al., 2014). According to Roos et al. (2011), prefrontal cortex function appears to be altered during the processing of fear-relevant stimuli in pregnancy. Changes in hormone levels may lead to changes in prefrontal cortex function and, in turn, to changes in cognitive-affective processing and anxiety (Roos et al., 2011).

Natural birth is an experience of extreme pain—and anxiety, fear, and nervousness during birth correlate with longer and more complicated birthing, often necessitating medical intervention (Hishikawa et al., 2019). The transient hypofrontality brain mechanism correlates with pain reduction, among other phenomenological and cognitive features that promote birthing. Thus, Dahan (2020) hypothesizes that hypofrontality is crucial to physiological birth because this brain mechanism makes it easier for a woman to focus her attention and retreat to an inner world. In other words, birthing consciousness increases the probability of optimal birth outcomes (Dahan, 2020).

Figure 1 shows the biochemical, mental, and brain mechanisms that constitute birthing consciousness and promote physiological childbirth.

Figure 1. The factors that constitute birthing consciousness and promote physiological childbirth.

Figure 1.

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The Discoveries of the Ferguson Reflex and the Fetus Ejection Reflex

When thinking about the brain mechanisms of the fetus ejection reflex, it is vital to keep in mind the way the two reflexes were discovered. Ferguson (1941) studied anesthetized rabbits and found that their uterine contractions were induced by vaginal dilatation. Ferguson’s research was limited to the effect of local vaginal stimulations in nonhuman mammals (Odent, 2009, p. 18). Niles Newton (1987), who coined the term fetus ejection reflex, examined the effects of environmental factors on the parturition of mice, focusing on the crucial factor of cortical inhibition in nonhuman mammals. Odent (1987) suggested that a fetus ejection reflex is also possible in humans if not repressed by neocortical activity—which usually occurs in a typical modern birthing environment (see also Dahan, 2021a, 2021b, 2021c, 2021d).

Odent (2019) observed that in some extraordinary situations, women can experience the fetus ejection reflex, characterized by birth after a short series of involuntary and powerful contractions. When the reflex occurs, the birthing woman appears to be in an altered state of consciousness. Women experiencing the fetus ejection reflex find themselves in an unexpected posture, often bending forward or in a quadrupedal position. Furthermore, this reflex does not always start at the end of the second stage of birth, in full dilatation, with the fetus descending (unlike in the Ferguson reflex case). Birth with an authentic fetus ejection reflex can occur unexpectedly. However, any intrusion, such as loud voices, bright lights, stress, or feelings of being unsafe or being observed, tends to activate neocortex activity, interfering with the birthing woman’s special state of mind. The result is a failure to trigger the fetus ejection reflex and movement into the second stage of birth, necessitating voluntary pushing (Odent, 2019, pp. 169–175).

A Hypothesis Concerning the Brain Mechanism of the Fetus Ejection Reflex

What follows is the essential posits regarding the brain processes of the two different reflexes:

  1. Ferguson studied the so-called Ferguson reflex in anesthetized, unconscious rabbits (Ferguson, 1941).

  2. Newton et al. (1968) demonstrated the effect of cortical inhibition on reflexes in the second stage of birth, even among mice that were not anesthetized. In their research, when the mice were disturbed during early labor, especially by a lack of privacy, catecholamine surges completely stopped the birth process. When the mice were disturbed later in childbirth—the fetus ejection reflex did not occur (see also Newton, 1987). This is probably because stress, fear, and lack of privacy inhibited hormone release (Lothian, 2004).

  3. Human birth is much more difficult than the birth of other mammals. This is because of the human obstetrical dilemma, which is the widely accepted hypothesis (Wittman & Wall, 2007).

  4. Odent (1987) introduced the concept of the fetus ejection reflex among humans and claimed that the effect of cortical inhibition is essential. This is because many researchers maintain that during childbirth and sexual activity, potential inhibitions might originate in the neocortex (Cunningham, 2016; Neerland, 2013; Newton, 1992; Odent, 2019). Since birthing is instinctive, intimate, and private, blocking some socialized inhibitions is likely a necessary condition for a natural birth. Inhibition blocking enables the relevant parts of the brain to release the different hormones needed for reducing pain, fear, nervousness, and stress, thus enabling the birth process to proceed optimally (Gavin-Jones & Handford, 2016, pp. 30–39). Dixon et al. (2014) have suggested that the need for internal focus without being disturbed might reflect a physiological, universal, and crucial need for women during physiological labor.

  5. Conclusion: We assume that for rabbits, the Ferguson reflex is essential. However, we assume that among humans, the priority is to reduce neocortical activity in order to trigger the fetus ejection reflex. And while the Ferguson reflex may occur during human birthing—the Ferguson reflex still requires voluntarily pushing the fetus and can take time. Nevertheless, because human birth is much more difficult than the birth of other mammals, and the fetus ejection reflex happens spontaneously and fast, without investing pushing efforts—the fetus ejection reflex, in cases in which it occurs, plays a much more important role in human childbirth.

We understand the Ferguson reflex as solely mechanical and biophysical. It is a reflex based on the features of uterine physiology and its mechanics. In contrast, the fetus ejection reflex is a psychophysical phenomenon highly correlated with a woman’s state of mind during the birthing process: the so-called birthing consciousness. Thus, there is a crucial difference between the two reflexes: one ignores consciousness, and the other does not. By ignoring consciousness, the Ferguson reflex is oblivious to the complexity of the process of birth: a process that is affected not only by biochemical and physiological factors but by mental, behavioral, social, and environmental factors as well. Thus, it is evident that the fetus ejection reflex—in recognizing the vitalness of all of these factors to the second stage of labor—is the much more accurate and appropriate reflex to examine in the birth process of women.

Figure 2 shows the difference between the two reflexes in terms of acknowledging or ignoring birthing women’s consciousness during birth: The Ferguson reflex is a biomechanical process of the womb and cervix, whereas the fetal ejection reflex is a biophysiological, social, behavioral, and mental event significantly affected by the birth environment.

Figure 2. The difference between the reflexes in terms of acknowledging or ignoring birthing women’s consciousness.

Figure 2.

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WHAT USUALLY HAPPENS IN CONTEMPORARY BIRTH ROOMS?

After understanding that the fetus ejection reflex best serves the birthing woman’s physiological health, an important question is what happens today during the second stage of birth in terms of the fetus ejection reflex and birthing consciousness. It appears that the picture is far from optimal. In fact, in most cases, the fetus ejection reflex will not be triggered given that the crucial mental, social, and environmental conditions are not given specific attention nor attained in a typical contemporary hospital birthing setting.

Here we claim that in a typical modern birthing room, the birthing woman is usually described only in terms of her uterine contractions and vaginal dilatation. The process of birth is measured only by physiological terms while ignoring psychological and environmental factors that can promote physiological childbirth.

Many studies have empirically shown the importance of one-on-one social support during childbirth. It has been proven to improve birth outcomes, both physiologically and psychologically (Bohren et al., 2017). Recently, Dahlen (2020) argued that continuous support during childbirth should be considered a fundamental human right. However, modern hospitals do not provide continuous support (see also Dahan, 2021a).

Likewise, many studies refer to environmental and psychological factors that promote physiological birth: the freedom to move in the birth space according to will (Hodnett et al., 2009), being free to choose the birth position during the second stage (Odent, 2019), low lighting in the birth room (Wrønding et al., 2019), pleasant temperature (Odent, 2019), and an environment without loud noises and strangers (Lothian, 2004). However, in a typical modern birth room, these conditions are rarely met (Dahan, 2021a).

Here are a few relevant quotes from qualitative studies describing women’s experiences during highly medicated birth. These stories indicate the clash between what the birthing woman needs and what happens in practice. We can interpret these episodes as overlooking birthing women’s subjectivity:

“I was steamrolled with unnecessary intervention and didn’t get to speak with a doctor about my options, risks vs benefits … I feel like the nurses, doctors and hospital only did what was in their best interest, not mine… It was a nightmare.” (Read et al., 2017, p. 4)

“…an OB coming in and telling me that she would like me to deliver by 5 pm because she wanted to go home …” (Read et al., 2017, p. 3)

“…All in all, I felt very bullied, and even violated … It was the feeling of disempowerment and not having the right to do with my body what I wished and that someone else could force me to do something against my will.” (Read et al., 2017, p. 5)

“That [epidural] was something I really didn’t want … because I’d had trouble with my back, anyway, so I didn’t really want to mess about with that but they talked me into it.” (Baker et al., 2005)

‘‘In my first birth experience, I felt bullied, robbed, cheated, and fearful in the hospital environment. I could not use my voice in the hospital and my doctor did not listen anyway. I was a passive patient, instead of an active participant.” (Boucher et al., 2009, p. 122)

In such conditions, it seems impossible to engage in a mental state of focusing. All the psychological and environmental factors described above are triggering cortical activity instead of reducing it (see Dahan, 2020, 2021a). Moreover, ignoring the birthing woman’s consciousness disrupts childbirth, as acute pain, stress, and anxiety during childbirth are factors that inhibit childbirth (Clesse et al., 2018).

The use of Pitocin is another typical example of considering a birthing woman as a biomechanical birthing body. In case of insufficient progress during childbirth, the standard practice is using Pitocin, which initiates muscular uterine contractions. Pitocin, however, is only the synthetic form of the hormone oxytocin, and there are functional differences between them. While the synthetic hormone affects uterine contractions, it cannot cross the blood–brain barrier. Thus, Pitocin lacks the significant additional effects that oxytocin has (see Uvnäs-Moberg et al., 2019), such as inducing feelings of calm and reducing pain, stress, and fear—all are essential for promoting physiological birth (Dahan, 2020).

Another example is the widespread use of epidural anesthesia, recommended to the birthing woman as a medicine that eliminates the pain of labor. However, empirical studies demonstrate that while epidural anesthesia is beneficial in blocking contractions pain, epidural has disadvantages that are overlooked in many birth rooms (Qiu et al., 2020).3

When a birthing woman receives epidural anesthesia, she cannot move freely. Studies show that the freedom to move during childbirth promotes childbirth while lying down during labor has been found to correlate with longer and more complicated births (Betrán et al., 2018). Also, due to the paralysis caused by the epidural, the birthing woman sometimes has difficulty pushing the baby out through the birth canal, which can lead to an instrumental birth or unplanned cesarean surgery (Jansen et al., 2013; Petersen et al., 2013). Instrumental births have been found to correlate with a traumatic birth experience, which endangers mental health in postpartum. Moreover, physically recovering from an instrumental birth and a cesarean surgery is more complicated (Dekel et al., 2019).

The epidural necessitates a recumbent position of the birthing woman. Still, sometimes even birthing women without epidurals are forced to give birth while lying on their backs (Dundes, 1987; Reed et al., 2017). However, studies show that the second stage of labor is faster in upright or kneeling positions. Vertical birth positions allow the pelvic bones to move. Hence, the birth is more rapid, less painful, and less prone to complications (Sutton, 2000). Reed et al. (2017) have many examples of how the medical staff often prioritizes their own desires and agendas over the desires and needs of birthing women. Here, too, we see that birthing women’s psychological facets are being overlooked.

From these examples, one can deduce how the birthing woman is referred to in a typical birth room: She is perceived as only a uterus. In other words, she is viewed as a mechanical birthing body, as if her consciousness can be dismissed as irrelevant to the process of childbirth.

In the fetus ejection reflex case, it is theorized that the birthing woman must be in a specific state of consciousness, perhaps induced by hypofrontality (Dahan, 2020; Odent, 2019). Thus, the fetus ejection reflex phenomenon accepts that birthing is a complex psychophysiological process. Birthing women are not only mechanical bodies but also subjects; they give birth with their minds and bodies.

In the standard birthing room, the birthing woman is usually lying in a passive state, anesthetized and paralyzed, waiting for her fetus to be birthed by the medical staff. She is encouraged to take an epidural to be quiet and not interfere with the process. There is a hidden premise here: The birthing woman’s consciousness might interfere with the birth process. Thus, it is better to be anesthetized. She is treated as a biomechanical body rather than a conscious subject.

However, failure to address environmental and psychological factors that promote physiological birth may delay the birth’s progress and lead to more medical interventions. Ignoring birthing women’s states of consciousness can have mental, physiological, and even ethical consequences. The feeling of loss of control itself, resulting from medical intervention during birth can generate anxiety and result in difficult childbirth (Clesse et al., 2018).

Figure 3 summarizes how ignoring the birthing women’s psychological and environmental needs in a typical birth arena disturbs birthing consciousness, prevents the fetal ejection reflex, and in turn, necessitates more medical interventions, thus causing more complicated childbirth.

Figure 3. The consequences of ignoring environmental and psychological factors in modern birth arena.

Figure 3.

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A NEW PERSPECTIVE ON THE TWO SECOND STAGE OF BIRTH REFLEXES: THE FETUS EJECTION REFLEX IS RIPE FOR MUCH ADDITIONAL INQUIRY

The Ferguson reflex not only plays a less essential role than the fetus ejection reflex in managing the second stage of human birth, but it also represents the birthing woman unjustly: In ignoring the birthing woman’s conscious states, the Ferguson reflex defines women as mere birthing objects. But a birthing woman is not an unconscious rabbit. The birthing woman is in a much more complex state that cannot be described only by her uterine contractions and vaginal dilatation. Thus, we should doubt whether the Ferguson reflex validly describes the birthing situations of women. This objectification contrasts with the fetus ejection reflex’s inherent treatment of birthing women as subjects in acknowledging the crucial effect of mental and social factors on the reflex.

However, after the fetus ejection reflex was identified in the ’60s (Newton et al., 1968), it immediately disappeared into the abyss of oblivion. It was brought to light 20 years later by Odent (1987). Still, it is currently broadly ignored in the mainstream literature or widely confused with the less essential concept of the Ferguson reflex. Now, with the acknowledged phenomenon of birthing consciousness and its connection to the fetus ejection reflex in terms of the psychological and environmental factors that promote physiological childbirth, we hope that the fetus ejection reflex is ripe for much additional inquiry.

Figure 4 indicates the timeline of the fetus ejection reflex from a historical point of view and the current understanding of its importance in promoting birthing women’s health.

Figure 4. Timeline of birth reflexes and birthing consciousness.

Figure 4.

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CONCLUSION AND DIRECTIONS FOR FUTURE RESEARCH

In a recent article, Kennedy et al. (2018) called for birth researchers to ask different questions to improve the quality of care for women and their newborns. Currently, research is focused on women at the most significant risk for complications. New research questions should focus on strengthening women’s capabilities to have a spontaneous physiological birth (Kennedy et al., 2018). The current article intends to ask precisely this kind of research question.

We have argued that ignoring the birthing woman’s consciousness is not insignificant. Only upon examining what we currently know of the birthing process and how mental, social, and environmental aspects affect the physiological birthing process and can promote or hinder birth, it becomes clear that the fetus ejection reflex more accurately describes an essential reflex in human birthing. Additionally, keeping in mind the disadvantages of active pushing in the second stage of birth vs. the advantages of spontaneous ejection of the fetus, we conclude that ignoring the fetus ejection reflex neglects important understandings concerning the human birthing process.

Women have conscious states, they birth with their minds and bodies; they are not merely mechanical birthing bodies. Therefore, it is worthy to begin an empirical investigation of the phenomenon of the human fetal ejection reflex. Empirical research on birthing women’s second-stage labor birthing reflexes can take a number of forms. For example, do women who birth in a domestic environment (homebirth/birth centers) experience more fetal ejaculation reflexes than those in a more hospitalized environment? Is there a correlation between each reflex and pelvic floor health postpartum or between severe perineum tears due to the birth process? These kinds of research questions will certainly help update medical practices to support natural birth processes, the current stated goal of many western obstetrics organizations.

Biographies

ORLI DAHAN, PhD, Faculty of Social Sciences & Humanities at Tel-Hai College, head of the consciousness studies program.

MICHEL ODENT, MD, Primal Health Research Centre, London, UK.

Funding Statement

FUNDING The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.

NOTES

2.

Hotelling (2009) is well aware that the psychological state and the environment can either promote the opening of the cervical sphincter enabling birth or promote the closing of the cervix, hindering the movement of the baby through the birth canal. However, Hotelling does not relate these factors to the fetus ejection reflex.

3.

Epidural analgesia is the most administered anesthesia during birth. For example, in the United States, more than 70% of women receive epidural analgesia in hospital childbirth (Qiu et al., 2020).

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

ACKNOWLEDGEMENTS

The authors thank Joram Feldon for reading a previous draft of this paper and for his helpful suggestions. We also thank the anonymous reviewers of this journal for their valuable comments.

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