Birthowl’s natural childbirth


Posterior Position and the Fetus Ejection Reflex


Two facts regarding posterior  position have been authoritatively confirmed by published prospective studies.

The first fact is that worrying pregnant women about the position of their baby in the womb is useless. A large Australian randomized controlled trial involving 2547 pregnant women has eloquently demonstrated that hands and knees exercise with pelvic rocking from 37 weeks’ gestation until the onset of labor does not reduce the incidence of persistent occiput posterior position at birth.

The second fact is that fetal position changes are common during labor, with the final position established close to birth. This is the conclusion of a prospective study of 1562 women to evaluate changes in fetal position during labor by using serial ultrasound examination. Among babies who were posterior late in labor, only 20.7% appeared to be posterior at birth.
Finally, when the mother had no epidural, the overall rate of posterior position at birth was only 3.3%, although this study was conducted in conventional departments of obstetrics, where the basic needs of birthing women could not easily be met. The rate was 12.9% in the epidural group.

When taking into account these two well-documented facts, focusing on the right question becomes easy: what factors can influence the rotation process during labor?

The answer is simple: The factors that can facilitate the rotation process are those that make a typical fetus ejection reflex possible.The passage toward the fetus ejection reflex is inhibited by any interference with the state of privacy. The ejection reflex does not occur in the presence of a birth attendant who behaves like a “coach,” an observer, a helper, a guide or a “support person.”

The fetus ejection reflex can be inhibited by a vaginal exam, by an eye-to-eye contact or by the imposition of a change of environment. It does not occur if the intellect of the laboring woman is stimulated by rational language (e.g., “Now you are at complete dilation; you must push”). It does not occur if the room is not warm enough or if the lights are bright. The best situation I know for a typical fetus ejection reflex is when no one is around but an experienced, low profile, silent, motherly midwife sitting in a corner and knitting.

The image of the “knitting midwife” should not be understood in a literal sense. Instead, it symbolizes the authentic midwife as a protective mother figure whose own level of adrenaline is maintained as low as possible.
Noticeably, when the conditions for an ejection reflex are met, most birthing women find spontaneously complex and asymmetrical bending-forward postures that probably play an important part in facilitating the rotation of the baby’s head.

Persistent posterior position at birth will become exceptionally rare on the day when the meaning of privacy is understood and authentic midwifery has been rediscovered.

– Michel Odent, MD, excerpted from “Occiput Posterior Position Should Be Exceptionally Rare at Birth”

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