The fetus ejection reflex revisited

Not Just Mechanical Birthing Bodies: Birthing Consciousness and Birth Reflexes

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.

Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth?

The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.

Influence of dog-appeasing pheromone on canine maternal behaviour during the peripartum and neonatal periods

Background

Parturition and the initial postpartum period are important moments in the reproductive cycle of dogs.

Methods

A study assessed the effect of ADAPTIL, a dog-appeasing pheromone, on maternal behaviour during peripartum. Bitches were continuously exposed to ADAPTIL (n=20) or placebo (n=21) in double-blinded conditions from an average of about seven days before parturition up to 21 days postpartum. Differences in maternal behaviour in relation to the treatment were evaluated by the observation of specific activities through video recordings, such as the time spent by the bitch in close contact with the puppies, oronasal interaction and nursing duration and position. Videos were recorded at four time points (W0: within the first 48 hours of whelping; W1: one week after parturition; W2: two weeks after parturition; and W3: three weeks after parturition). In addition, the perception of breeders in relation to the quality of maternal care, puppies’ wellbeing and overall relationship between the bitches and the puppies was evaluated using Visual Analogue Scale at the same time points. Moreover, the daily activity of the bitches was measured by using an electronic device (FitBark dog activity trackers, Kansas City, Missouri).

Results

For all observed maternal behaviours, there was a steady decrease in levels as the puppies developed, independently of treatment. However, bitches exposed to ADAPTIL tended to nurse significantly more in lying position, while those exposed to the placebo nursed more in a seated position, especially at W1 (P=0.06) and W3 (P=0.005). According to the breeders, the attention scores of bitches towards puppies were significantly higher in ADAPTIL than in the placebo group at each time point (P=0.01). Moreover, a difference according to parity was observed (P=0.004), with greater attention score displayed by primiparous bitches exposed to ADAPTIL compared with placebo on W0 (P=0.02), W1 and W3 (P<0.001). The global mother–puppies relationship was also perceived as significantly better (P=0.0002) by breeders of bitches exposed to ADAPTIL, with significant differences at W2 (P=0.01) and W3 (P=0.001). The bitches’ daily activity increased starting two days before the whelp, peaked during parturition and then gradually declined up until four days postpartum. There was a trend towards a difference in the activity level according to the treatment during the full study period (P=0.09) and at two days before parturition (P=0.07). Bitches exposed to ADAPTIL were more active compared with placebo in relation to the FitBark data.

Conclusion

The use of ADAPTIL in maternity modulated maternal behaviours. Concerning the caregiver’s view, bitches under the influence of ADAPTIL had greater and extended attention towards the puppies and they were eager to stay with the puppies for a longer time.

Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

BACKGROUND

Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care.

AIM

To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds.

METHODS

Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively.

RESULTS

Item-level content validity was achieved on 37 items for birth unit midwives (n=10); 35 items for Aboriginal or Torres Strait Islander women (n=6); 33 items for women who had anticipated a vaginal birth after a caesarean (n=6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n=20). Survey-level content validity was not demonstrated in any group.

CONCLUSION

Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors.

‘Birthgasm’

Childbirth is a fundamental component of a woman’s sexual cycle. The sexuality of childbirth is not well recognized in Western society despite research showing that some women experience orgasm(s) during labor and childbirth. Current thinking supports the view that labor and childbirth are perceived to be physically painful events, and more women are relying on medical interventions for pain relief in labor. This review explores the potential of orgasm as a mode of pain relief in childbirth and outlines the physiological explanations for its occurrence. Potential barriers to sexual expression during childbirth and labor, including the influence of deeply held cultural beliefs about sexuality, the importance of privacy and intimacy in facilitating orgasmic birth experiences, and the value of including prospective fathers in the birthing experience, are discussed. The role of midwives and their perceptions of the use of complementary and alternative therapies for pain relief in labor are examined. While there are indications of widespread use of complementary and alternative therapies such as hydrotherapy, herbal remedies, and breathing techniques for pain relief in childbirth, orgasm was not among those mentioned. Lack of recognition of the sexuality of childbirth, despite findings that orgasm can attenuate the effects of labor pain, suggests the need for greater awareness among expectant parents, educators, and health professionals of the potential of orgasm as a means of pain relief in childbirth.

Do not disturb: the importance of privacy in labor

In nature, when a laboring animal feels threatened or disturbed, the stress hormone catecholamine shuts down labor. Similarly, when a laboring woman does not feel safe or protected or when the progress of her normal labor is altered, catecholamine levels rise and labor slows down or stops. This column discusses the importance of providing labor support that respects the woman's privacy, protects her from unnecessary interventions, insures her safety, and allows her to trust her inherent ability to give birth normally.

"The instincts of motherhood: bringing joy back into newborn care"

Although homo sapiens is equipped with subneocortical neuro-endocrine structures comparable to those of all mammals, there is no scientific curiosity about basic behaviours such as the maternal protective aggressive instinct or basic emotional states such as joy. A study of the fetus ejection reflex is an opportunity to present the rational control of the procreative drives as a by-product of human brain evolution, and to clarify the concepts of neocortical inhibitions and cultural conditioning. After referring to recent spectacular advances, we anticipate that in the near future several developing scientific disciplines will have the power to overcome the effects of thousands of years of socialisation of childbirth.

Criteria-based audit to improve women-friendly care in maternity units in Malawi

AIM

To assess and improve women-friendly care in maternity units in Malawi.

METHODS

We interviewed 280 women about the care they received during childbirth at 29 different health centers. Results were compared with standards for women-friendly care, developed locally and based on evidence from World Health Organization manuals. The audit results were presented, and recommendations were made and implemented. A re-audit (involving 367 women) was conducted 3 months later.

RESULTS

Significant improvements were recorded on greeting clients (74.6 vs 87.7%; P < 0.001), respect for clients (91.1 vs 98.6%; P < 0.001), support by a companion during labor (58.9 vs 75.6%; P < 0.001), informing clients about different birthing positions (68.6 vs 79.3%; P = 0.002), allowing clients to adopt different birthing positions (67.9 vs 83.4%; P < 0.001), cleanliness of maternity wards (89.6 vs 97.0%; P < 0.001), speaking to clients using simple language (92.1 vs 98.6%; P < 0.001), ensuring privacy with curtains or screens (86.1 vs 92.1%; P < 0.012), and client willing to recommend the health facility to a friend (94.6 vs 98.6%; P = 0.004). However, there were no significant changes in the level of self-introduction by providers (62.5 vs 68.7%; P = 0.103) and provision of a clean bathroom and toilet (83.6 vs 80.4%; P = 0.282). Surprisingly, there was a significant deterioration in the use of linen to ensure privacy (86.4% vs 74.9%; P < 0.001). Overall, satisfaction of women increased by 9%.

CONCLUSION

The criteria-based audit was associated with an improvement in the quality of women-friendly care services in maternity units in Malawi.

Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events

OBJECTIVE

this study investigated the phenomenon of spontaneous labour contractions becoming less frequent on admission to hospital, which is observed anecdotally but is not evident in the literature. Anxiety in response to hospitalisation has been proposed to be responsible by initiating the biochemical response termed 'fight or flight'.

DESIGN

A non-experimental prospective design and a combination of quantitative and qualitative analysis. Data were collected using self-report labour diaries, postnatal questionnaires and hospital records of labour. Univariate analysis using t-test and chi(2)-test was performed to examine relationships between variables, and content analysis was undertaken on qualitative data regarding reactions to hospitalisation.

SETTING

hospital and community maternity services provided by a National Health Service hospital in Southern England in 1997.

PARTICIPANTS

about 87 women at least 37-week gestation, uncomplicated singleton pregnancy anticipating spontaneous labour with a live fetus.

MEASUREMENTS AND FINDINGS

labour diaries were analysed from 26 births. In three home births and 11 hospital births, labour contractions became more frequent, but in the remaining 12 labours, contractions decreased after admission to hospital. Women whose contractions slowed were not more anxious, but they rarely had cervical dilatation over 5cm and usually assumed a recumbent position in hospital. Artificial rupture of membranes was performed more frequently in these women, they used more pain relief and had a higher incidence of complicated childbirth; however, these differences were not statistically significant.

KEY CONCLUSIONS

labour contractions can increase or decrease in frequency following admission to hospital, and the change of frequency may be associated with stage of cervical dilatation and posture rather than anxiety.

IMPLICATIONS FOR PRACTICE

routine intervention to speed up labour on the basis of admission observations is called into question, and women should be made aware that slowing of contractions can occur as a normal part of changing the labour environment. Further research is needed to determine the physiological parameters of spontaneous labour and the role of posture in labour progress is needed.

The birth of a breastfeeding baby and mother

In this column, the author describes the way in which the normal, natural process of labor and birth prepares both mother and baby for breastfeeding. Birth practices including induced labor, routine interventions, epidural analgesia, and separation of mother and baby disrupt the process of early breastfeeding for mother and baby. Normal, natural birth sets the stage for uncomplicated breastfeeding.

The unknown human infant

What is physiological? It is often difficult to answer this kind of question in the field of human reproduction. That is why we propose to take, as a reference, a population of one hundred infants whose lifestyle is, in many respects, different from the standard Western norm. They were born at home without any drugs, share the mother's bed, were breastfed for more than a year, and so on. This study raises questions such as: --Is the neonatal loss of weight physiological? --What are the physiological sleep-wake patterns of the human infant? --Are the transitional phenomena normal stages of human development? --Why are some infants ill when their mother loses weight?