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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. (1-2)
I am often asked to clarify the difference between the fetus ejection reflex and the well, known Ferguson s reflex. (3) 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 …