October 9, 2013
Volume 15, Issue 21
Midwifery Today E-News
“Tear Prevention”
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In This Week’s Issue

Learn about waterbirth with Cornelia Enning

Belgium conferenceWaterbirth is a way for a woman to give birth undisturbed and in dignity. It also has medical advantages for mother and child and can be helpful in the case of breech, OP or twin births. In this class, Cornelia will explore the many benefits and ways of using water in birth and will discuss its unique psychological and physical properties. Part of our conference in Belgium 30 October – 3 November.

Learn more about the Belgium conference.

Share your passion and joy for midwifery!

Harrisburg conferenceCome to our conference in Harrisburg, Pennsylvania, next April. You’ll meet midwives from around the world while attending classes with teachers such as Gail Tully, Sister MorningStar, Elaine Stillerman, Jeanne Ohm and Carol Gautschi. [Photo by Caroline Brown]

Learn more about the Harrisburg conference.

Quote of the Week

The best way to get rid of the pain is to feel the pain. And when you feel the pain and go beyond it, you’ll see there’s a very intense love that is wanting to awaken itself.

Deepak Chopra, an Indian-American physician

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The Art of Midwifery

The single most important factor I saw in tear prevention during my 12-year practice as a midwife was the s-l-o-w delivery of the presenting part. This seemed to give the tissues enough time to stretch. So when the head would crown, I’d ask the mother not to add to the push, but pant if she had to, and let her body ease the baby out. This seemed to be more effective than anything else I did (warm compresses, oil, perineal massage, positioning, etc.).

Patricia Kay, CPM
Excerpted from “Question of the Quarter,” Midwifery Today, Issue 65
View table of contents / Order the back issue

ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

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Jan’s Corner

Hemorrhage Control

The wisest plan a midwife can make for hemorrhage control is to prevent it. In our practices, let us align with the maternal process that is designed by its creator to prevent hemorrhage and promote bonding. All around the world Western medical practices have taken over birth. These practices are not in line with God’s plan to prevent it. Let’s remake our practices so we seldom see a hemorrhage. I have heard several experienced midwives say they seldom encounter a hemorrhage, because they keep their practices in line with the natural plan.

A calm reassuring attitude of the midwife in both pregnancy and birth are very important. Kindness doesn’t take long even if your practice is very busy. Keep mom from worry as much as possible. I love Michel Odent’s advice: “Do not disturb the mother!”

Let mom’s body tell her when to push. Honor the rest-and-be-thankful stage. Let her assume the best position. No lithotomy.

Banish fear.

No dilation checks without a *really* good reason. The whole body is saying down and out, not in and up. Make sure you really need the information and have her permission before you do one.

Put baby directly in mom’s arms, skin to skin.

Leave the cord intact until after the placenta comes, or longer.

Keep it calm. Mom’s own oxytocin is highest just after her baby is born if she has not been given drugs of any kind. Use this resource to her benefit and yours.

Don’t pull the placenta out. Give it time to detach. Be aware of any excess bleeding.

Do not disturb the bonding process. Talk as little as possible at this time.

Consider using the placenta for hemorrhage control if it is out. The cord and membranes can be used as well if the placenta hasn’t detached. Be ready to treat hemorrhage if it occurs, but don’t cause it.

I believe if we had instituted these practices 50 years ago, we would have saved millions of mother’s lives.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Featured Article

Champagne and the Fetus Ejection Reflex

The more I try to combine what I have learned from my experience of hospital birth and homebirth, the more I am convinced that the best way to protect the perineum, to avoid a serious tear and to eliminate the reasons for episiotomy is to deviate as little as possible from the physiological model. In other words, the best way is to create the conditions for an authentic fetus ejection reflex (Odent 1987; Odent 2002).

I am often asked to clarify the difference between the fetus ejection reflex and the well-known Ferguson’s reflex (Ferguson 1941). The Ferguson’s reflex is related to mechanical conditions: the pressure of the presenting part on the perineal muscles. A real fetus ejection reflex can occur long before the descent of the presenting part, or long after. It can start before complete dilation, or after. Usually it does not occur at all because the prerequisite is complete privacy. In the context of homebirth, I am familiar with this reflex when I follow the progress of labor from another room through the sound the woman is making, while her husband or partner goes shopping and there is nobody else around other than an experienced, motherly, silent and low-profile doula. I cannot remember one case of an authentic reflex in the presence of the baby’s father. During the reflex, there is a short series of irresistible, uncontrollable contractions, with no room for voluntary movements; the laboring woman can be in the most unexpected postures (often complex, asymmetrical, bending forward postures).

I have interpreted this reflex as the effect of a sudden spectacular reduction in neocortical activity, making possible the release of a complex hormonal cocktail. The release of high levels of hormones of the adrenaline family is suggested by the sudden expression of fear (often a very short episode of fear of death) that precedes the irresistible contractions (Odent 1991), and by a sudden tendency to grasp something and to be upright. The most helpful thing to do in terms of facilitating the fetus ejection reflex is just to accept this sudden expression of fear (e.g. “Kill me,” “Let me die”) without interfering: Reassuring rational words—a stimulation of the neocortex—would inhibit the reflex. The release of a high peak of oxytocin is of course suggested by the sudden power and efficiency of the uterine contractions. As for the ecstatic state of the mother, it suggests that the hormonal cocktail includes morphine-like hormones.

We must keep in mind that the term fetus ejection reflex was originally used by Niles Newton, when she was studying the factors influencing the birth of mice (Newton, Foshee and Newton 1966)—mammals who do not have a neocortex as powerful as ours. The reflex can occur among humans, provided that the activity of the neocortex is dramatically reduced so that the human handicap is overcome.


  • Ferguson, JKW. 1941. “A Study of the Motility of the Intact Uterus at Term.” Surg Gynecol Obstet 73:359–66.
  • Newton, N, D Foshee and M Newton. 1966. “Experimental Inhibition of Labor through Environmental Disturbance.” Obstet Gynecol 67:371–77.
  • Odent, M. 1987. “The Fetus Ejection Reflex.” Birth 14:104–05.
  • Odent, M. 1991. “Fear of Death during Labour.” J Reprod Infant Psyc 9:43–47.
  • Odent, M. 2002. “The Second Stage as a Disruption of the Fetus Ejection Reflex.” Midwifery Today 55:12.

Michel Odent
Excerpted from “Champagne and the Fetus Ejection Reflex,” Midwifery Today, Issue 65
View table of contents / Order the back issue

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Learn from the Eugene 2011 conference teachers!

Order this selection of classes on a portable USB drive, then load them onto your computer or into your MP3 player to have them handy whenever you have time to listen. Classes include First and Second Stage Difficulties with Gail Hart and Vicki Penwell, Shoulder Dystocia with Ina May Gaskin and Elizabeth Davis, Third Stage Difficulties with Marion Toepke McLean and Supporting Trauma and Abuse Survivors through Pregnancy and Postpartum with Maryl Smith. To order


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Midwifery Today Magazine Issue 107

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Birth Q&A

Q: Midwives: What are your best tear prevention tricks?

— Midwifery Today

A: Do lots of perineal massage in the third trimester to increase blood flow and tissue elasticity, as well as to familiarize yourself with the sensation of the muscles moving. Don’t push actively in the second stage (no valsalva) and allow baby to come at a sensible pace!

— Jessica Smart

A: Prenatal preparation in terms of diet, exercise and work to resolve body image issues and any history of sexual or pelvic floor trauma. Prepare the mom for what to expect in labor and second stage, including possible midwifery interventions, such as flexing the head or helping thin maternal tissues. Avoid pushing too early to help avoid perineal swelling. Use trigger points to release the perineal floor. Know how to support mom to crowning and after. Don’t rush the birth of the head without clear indication of fetal stress, and do allow baby to recover between contractions!

— Mary Littlefield

A: Waterbirth!

— Samantha McCormick

A: We use ginger compresses at Gentle Birth Midwifery Services in Bisbee, Arizona.

— Karen Michelle

A: Upright positioning, mama’s hands on her baby’s head as it emerges (if she can…) so she can feel how fast the baby is coming and control the birth herself. Good sex during pregnancy and a good relationship. Feeling relaxed in her choice of birth place and birth attendants. Being in water, and a whole-food diet!

— Lily Bhavani Aquarian

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Conference Chatter

Greetings everyone,

In only three weeks I’ll be seeing many of your lovely faces at our conference in Blankenberge, Belgium. How exciting! It’s such a lovely feeling when months of hard work and preparation finally come to fruition. I’m sure you all feel the same way after your own preparation of pouring over the program, highlighting your favorite classes, agonizing over whether you’re going to go to one or another amazing class that is scheduled at the same time, sending in your registration forms and perhaps booking travel and finding all the neat little local places you might pop out to go visit when you’re not in class.

I’m going to add one more thing to your exciting to-do list for the conference. We have a wonderful last minute addition to the program!

Tlalie Vered Shir will be teaching in the early morning before classes. She is a doula who accompanies homebirths, mainly in water. She developed Heartsong, a program that uses song/sound vibration with theta healing imagery, especially for women, pregnancy and birth.

Here is the summary of her class:

“As birth is an accelerated sacred process of trance-forming, creating a safe sounding space relaxes the nervous system and promotes a healing vortex. While allowing this space, we can be in a deeper connection with the source and attune to the moment. In the morning gatherings we will create sound together, learning new skills and ways to be in touch with our inner well.”

So come join us in Meeting Room 8 every morning before class for this delightful offering.

To learn more about the other classes that will be at our upcoming conferences, please visit our website: Belgium 2013 / Harrisburg 2014

— Andrea Goldman, conference coordinator

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Learn about midwifery education!

Are you an aspiring midwife who’s looking for the right school? Are you a practicing midwife who would like to learn more? Visit our Education Opportunities page to discover ways to start or continue your education.


My grandchild was born about one minute after the midwife walked into the bedroom. His cord was wrapped tightly around his neck and after she untangled him, she noticed how blue he was and, forgetting that she was chewing gum, felt that she needed to breathe a couple of breaths into him. Her gum went into his mouth and she had to do a quick sweep to remove it!

— Phyllis Leachman-Bacon

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