Fetal Ejection Reflex
Towards the end of labor, you may begin to spontaneously bear down or push during the peak of a contraction. This transition occurs as the baby descends into the pelvis and places pressure to initiate the fetal ejection reflex. This spontaneous pushing can be a signal that is now time to push and the baby is ready to be born!
Fetal Ejection Reflex occurs when the fundus, or the top of the uterus, has built-in strength and thickness during labor and begins to passively push the baby down and out. This reflex can range from feeling like you’re pooping to an overwhelming sensation that makes you feel completely out of control.
What to do if you begin to spontaneously bear down but you don’t want to actively push yet??
Allow it to happen without fighting it; focus on breathing with it. Surrender and release into it as much as possible. May be helpful to find a restful position to relax into.
Don’t add to it. Believe that your body is going to push the amount that it needs to help your baby be born, and you don’t necessarily need to add a lot of intentional effort to it.
But, it is also important to note that FER can occur even before you are completely 10 centimeters dilated! If your provider or nurse checks you, they may note that you have an anterior lip or are 9.5 cm dilated. This anterior lip is when the front of the cervix is still there, but the rest of the cervix has melted away. Usually, with a few more contractions, this lip will disappear as the baby’s head continues to descend downward. If there is still a lip, you may feel a pinching sensation towards the pubic bone (front of the pelvis).
If you have an anterior lip, should you stop pushing??
The answer is usually no. Likely with a few more contractions, the anterior lip will melt away, and if you didn’t get checked no one may have even known it was there. If it persists, there is an option for your provider to manually reduce it or push it over the baby’s head.
This may potentially be something you are told to do by well-meaning medical care team members. They may say, “you’re not 10cm, if you continue to push, your cervix will swell and you will need a c-section.”
It is important to reflect on how being told something like this may make you feel in the moment. It could cause you to doubt your ability to give birth; maybe make you feel like something is wrong with you or your body, that your body is betraying or failing you. It can cause you to stop coping well, and begin to panic. It can cause labor to feel more pain as you try to stop your uncontrollable urge to push!
We had several followers share that they were told to stop pushing with an anterior lip, and their baby started to experience decels for some that resulted in a cesarean birth and others instrument-assisted delivery. The question is, did trying to stop their spontaneous and uncontrollable urge to push cause them to go into a state of distress that affected their baby? We don’t have a concrete answer on this, but something to consider. We had wonderful conversations with so many of you about this topic!
From a midwife:
“So we know that adrenaline and fear/stress can cause a chain reaction in labor. It can stall it. It can divert its natural progress. But I am not sure if there is evidence to prove it can cause decelerations but anecdotally I 100% believe it can. Perhaps if by forcing yourself so much to not push, it affects your heart rate and blood pressure, and potentially uterine blood flow. Then I guess it could that way. But telling someone to not push because of an anterior lip is impatient and unnecessary. Some woman can and do push past a cervical lip. Especially if they are a multip.”
What about if you’re less than 9cm??
Now, there is a possibility that your cervix will swell from spontaneous bearing down. This is usually from the baby being in a less optimal position such as posterior (sunny side up, OP) or asynclitic (head is tilted sideways), and usually occurs at a lower dilation (4,5,6,7cm for example).
Thoughts from providers from our Instagram DMs:
One OB shared that if someone is spontaneously pushing, and they are 8 cm or more, there is usually no issue, especially if they are a multip (someone who has had a baby before). If they are dilated 7 or less & a first time mom, there is a possibility of swelling of the cervix.
A midwife and labor & delivery nurses (amongst others) shared that they see more swelling when babies are malpositioned (OP commonly), since spontaneous bearing down occurs at lower dilations. Baby’s head hits a pressure point just right to trigger FER.
What can you do if you’re bearing down but not over 8 cm?
If the baby’s position may influence early bearing down, hopefully, we can address it before you start bearing down.
Here are some signs during labor that the baby may be malpositioned:
Contraction pattern: Double Peaking, “Bumpy”, Back to Back/Doubling/Tripling. These would be contractions that are really strong in short periods with longer breaks in between. Your body is trying to help the baby rotate, but needs to also give the baby a break from all the stress of the contraction.
Back Labor: this is not ALWAYS a sign of malposition, but could be a clue. Some folks just labor like this based on their anatomy and postural tendencies. You may also not have any back labor at all and the baby could be in a weird position. So this is not a definite but can be a sign.
Monitoring Location: where the monitor is being placed can sometimes gauge where the baby is in the belly, but sometimes the placenta location can get in the way. When babies are anterior, they are easier to find and the heartbeat is the loudest.
External Palpations: belly mapping or feeling for where the baby is in the belly can be a clue as to their position. Feeling where a baby’s spine, head, arms, and legs can be a clue as to where the baby could be hanging out. Arms and legs feel cylindrical, like sausages. If there’s an anterior placenta, you may not be able to feel externally as easily.
Ultrasound: using ultrasound can be a fairly accurate way to see what position the baby is in, but may not be readily available and should be used as a confirmation.
Movement Tendencies: for my clients that had babies that were posterior, they tend to have a one-sided tucking tendency. They tend to rock forward and back while tucking one glute under to create more space to allow the baby to rotate out of a posterior position.
But what if you’re spontaneously bearing down??
Invert: get pressure off the cervix to help relieve the urge to push. This can also help the baby reposition themselves! This can be as upright as a forward-leaning inversion with the forearms and knees on two different levels, or as mild as a puppy dog pose with the chest and knees on the same level.
Breathe: slow, long inhales and exhales can help you relax with the sensation to bear down. It can also help you feel calmer in a potentially stressful situation!
And sometimes it’s what your baby needs to help it rotate into a better position.
What if you do swell??
Inversions to take pressure off the cervix, or lying on the other side (if the right side is swelling, try laying on the left to take pressure off for example)
Benedryl to help relieve the swelling
And we have also heard of using ice in a glove to help reduce swelling but have not tried this personally.
In conclusion, if you begin to spontaneously bear down it is likely completely normal and a part of your labor! It can feel very overwhelming, like an out-of-body experience or very primal in a way. You may find that you quite literally roar your baby out! Allow it to happen, but don’t add intentional effort to it if you don’t feel ready to actively push. If your provider finds that you are less than 8cm, it may be worth inverting for a few contractions to take pressure off the cervix and help the baby find a better position.