 So, I wish to introduce the speaker of today and our speaker is called Mangret Jawit. Mangret Jawit gained midwifery knowledge mainly through 20 years of editing, midwifery matters. The magazine of association of radical midwifes which co-hosts VIDM that we are doing today. She is a psychologist and have spent many years trying to discover how uterus works. Notably the interaction between stress hormones and the hormones of labor which she spoke about last year on VIDM. More recently she has been looking at anatomy and physiology of second stage of labor. Welcome Mangret Jawit. Thank you Eunice, that's lovely. Well, thank you for inviting me to speak today. As Eunice said, I'm a psychologist and I'm interested in human behaviour and interested in how women behave during birth. A large part of that behaviour is to do with how their bodies work, how their bodies behave. It seems to me that birth is such a whole body activity that how women move about and behave in labour is of supreme importance. I want to talk a bit about the biology. Earlier this week I was listening to a programme on the radio by Professor Peter Goadsby, he was talking about, he's just received a brain prize for discovering how to treat migraine. And he said that once we understand the biology of something, the treatment becomes obvious. And I think there's tons more about the biology of labour and birth that we need to know. So that the treatment does become obvious and this presentation really is thinking about the role of the clitoris in birth. Can't get anything much more concrete than that little organ. Okay, right, I'm muted again. Right, so I started, I haven't been given the presentation. I can't click the slides on Eunice. But that's alright. I'll tell you to click them on when I need to. I came across, I started to look at the physiology of second stage because somebody wanted me to write a book about it. And I thought, well, I better know what I'm talking about. Now, I, right, there's a lot of background noise from somewhere. Right, my interest was, was piqued by an article called Birth Without Active Pushing by Jean Sutton, who's a New Zealand midwife. Quite well known for her role in optimal fetal positioning. She was also passionate about the relationship between the mother's position and the position of her baby. She also thought in terms of two bodies moving in relationship to each other. And I think that it was this paper of genes when I first realized that there might be a link between birth and orgasm. In fact, this is the only midwifery paper I've ever found that mentions the G spot, which was quite famous when I was younger in my younger days. Which is supposed to be a particularly sensitive area on the anterior wall of the vagina that could perhaps be simulated during sex, and might be responsible for vaginal orgasm, which I must say is incredibly rare. I think I was going to do a poll, but I won't embarrass you all. But I don't know that I ever had one in my life, not that way. Anyway, Jean suggested a link between G spot stimulation and birth. But what is the relationship between the G spot and the clitoris? In 2000, when Jean published her paper, we hadn't a clue. But in 2005, all that changed. So now I need the next slide. I've got the slides. Good, lovely. Right. All that changed because Dr. Helen O'Connell, well, I don't know whether she might be a Mrs. She was an Australian surgeon, is an Australian surgeon, a urologist. So she's messing around doing surgical surgery on that part of women's anatomy, which is very sensitive. While she was preparing for her exams, she looked at the various anatomy books and they all contradicted each other. She kept getting questions wrong in her exam and she thought, well, she'll go and have a look and see where it really is. As a surgeon, it was really important for her to know the anatomy of the area where she would be performing surgery. So she dissected it and she looked at MRI images. And she came to the conclusion that, like an iceberg, most of the clitoris is hidden from sight. Right. Last year on Halloween, witching hour, this is how much respect is given to the female clitoris, that it's a bit of a joke. The Guardian, our left-wing newspaper in the UK, had this headline. It said that the sole function of the clitoris is female orgasm. And it asked whether is this why it's ignored by medical science? Is this why it's treated as a joke? Well, I looked up the clitoris on Wikipedia just an hour ago just to check that I'm still up to date with. And I'm just going to read you a couple of quotes from the Wikipedia article on the clitoris. And it says, the clitoris usually lacks a reproductive function. The only function that is mentioned is that hyenas give birth through the clitoris, but the humans don't. So that's irrelevant. And the other quote is that the only known purpose of the clitoris is to provide sexual pleasure. Well, I don't think so. Back to my notes. Right. The only bit of the clitoris that we're aware of is just this little bit here. Most of it's hidden inside. Right. I can agree that the main function of the clitoris is to provide females with orgasm. But the million-dollar question for me is what is the purpose of that orgasm? Now, we know that the male orgasm serves to get the sperm into the right place in the woman. But why in earth do women need an orgasm to give birth? They don't. They don't need an orgasm to conceive. Many, many women have conceived without ever having an orgasm in their lives. Jean Sutton, back to Jean Sutton, she thought that orgasm was part of physiological birth. Some women certainly do report birth as orgasmic. In fact, the French call orgasm pretty more little death. But I think that it might be a good thing to consider orgasm as little birth. So that's a sensation that women have, a huge sensation that women can have during birth. Some of them, not all of them perhaps. Some of them can also have when stimulating their clitoris during sex, either externally or internally. So, where is it? Let's have a look and see where this wonderful organ is situated. We have, if you want this picture bigger, if you press on the little grey box on the right, it'll make it fill your whole screen and you might have to see better. I don't think I can do that. Now, here's the tip that we'd all know about, the external bit that we can all simulate. And there's huge nerves going back to here. It's attached to the bones of the pubic ramai down here. Men's penis is also attached in this place. It's a good solid connection. But also Helen O'Connell considers that the vestibular bulbs here are part of the clitoris. On this side, they're uncovered. And on this side, they're covered, they're shown covered up with bulbo avionosis. I probably said that wrong, sorry. And here we have the vagina, of course, so that we've got a whole lot of connection very near to where that baby is going to be coming out. Right. The nerves are huge nerves. They're so large you can see them with the naked eye, one or two millimeters even. There's a huge amount of nerve endings, 8000 or something, I think. Certainly more than it just needed for women's sexual pleasure. Perhaps not. Well, I don't mind. Now, let's come to the G spot. Right. A little later on, about four years ago, Helen wanted to investigate. Helen O'Connell wanted to investigate the location of the G spot. Various people have said that it actually exists as a place. But she dissected it again with much detail. The vaginal wall, the anterior vaginal wall, which is this bit here, to see whether there was an anatomical change in the tissue type. And she discovered that there wasn't. But the G spot does seem to be to lie in front of the clitoris here. Do you see we've got a different angle of it now? Here are the bits going down the pubic bones. And here's the bit that we can feel. So the woman is on all fours or something, probably. So the G spot does sort of exist in that if you stimulate it, you will get at the internal clitoris back here. How are we doing for time? Where are we? Are we okay? Right. So this is what some people think happens during birth. Now, I never did experience birth as orgasmic. It was pretty amazing, but I didn't have one of those. But women do. It's quite often reported that birth is orgasmic. And I think we need to have birth in a sort of place where you can facilitate an orgasm. And an orgasm is a reflex, really. A reflex is a bodily behavior that happens after our body parts are stimulated. A reflex action of the body is something your body does by itself without you putting your mind to it, once a specific stimulus has been given. So during sex, two parts rub together. Or it can be self-administered. Right. If we think about birth, during the late stage of second stage, the back of the baby's head is impinging on the internal aspect of the clitoris. We'll just go back a slide. No, two slides. And we've got the back of the baby's head. The baby's head is coming down here. And the back of the baby's head is towards the simpsons. And the face is in the sacrum, is it not? So we've got the baby's head stimulating the G-spot. Okay, slip forward again. And this is what Jean Sutton says, calls the birth orgasm. She says that the mother reaches upwards to find a firm object for grass. Her pelvis is going to become destabilized, you'll see. She allows her body to sag forward and her knees to roll out. Her back arches and she begins to wriggle her lower body. I think Jean must mean a reverse arch with the woman with her bottom in the air, which is lordosis rather than kyphosis. The male does arches his body in kyphosis when he's penetrating the female, but the female puts her behind in the air for him to get access. And the uterus contracts down and forces the baby's body down. So this is Jean Sutton talking about birth orgasm before we knew about the interocuterus. And here we've got some obligatory cat videos. And you can see that there's a little hump in the back there. Both of them prepared to be penetrated by male cats. There's a little bump here. The tail flicks to the side so that the male can enter. And there is a corollary in human birth. Here we've got a woman, she's on all fours. I don't know if you can see it. Again, click on this arrow here, this box here if you want to make it bigger, but she's got a beautiful lump in the back of her sacrum around her sacral area, which is moving to her pelvis, because we do have a tight pelvis of humans together to allow our babies to get out. Oh, now I've lost my page. Right. Okay. And this bump is caused by movements of the rhombus of mykylus. And again, Jean Sutton was a great believer. She saw so many rhombuses move during birth that she realized that something huge was happening. So the orgasm lifts the sacrum upwards and backwards. And the levitate ani muscles, which are the tail wagging muscles, also move. And I'm wondering whether these actually move the pelvic floor itself backwards, making the exit more accessible for the fetal head. We are very peculiar species standing on two-legged legs with our baby's exit straight down, that our body had to change hugely in order to be able to keep our babies in when we were walking on the two legs. Right. I just want to... There are a couple of videos on YouTube that I looked at when looking at birth and orgasm. One of them was an MRI. You could look it up. MRI birth will show you a baby's head bobbing up and down in the mother's birth canal. And it is stimulating the G-spot or the internal glissarist. It's absolutely obvious to me. Perhaps it's not obvious to everyone, but anyway, that's what it's doing. And there's a lovely other video of a chimpanzee mother giving birth. And she's doing somersaults and all sorts to... She knows something's going on and is trying to relieve pain, but she self-stimulates by touching her clitoris from the front. And so I think that, again, enough for me to realize it. Yes, it's not just sexual pleasure. It's really important in birth. Right. I've seen just skipped loads. What else have I said? Right. Let's go on to the next slide. So Jean Sutton says that the similarities between the mother's actions at the end of second stage labor and the involuntary actions which occurred during both male and female are striking. And the two similarities really are movement and oxytocin. And now I'm going to come to another paper, the third paper that was instrumental in me deciding I'd come out and start talking about this, which was a paper in midwifery today about the pulsatile nature of birth by a doula called Ruthie Karniorewicz. And in it she mentioned the short effective pressure impulses accompanied by a slight forward pelvic thrust. She quoted, this is a quote from Michel Rodin, and Michel Rodin called this the fetal ejection reflex. Well, for me, this felt so exactly like the vaginal contractions of orgasm that the penny finally dropped, that orgasm was actually to do with birth. And I started to wonder what these vaginal contractions are doing during birth, why they're there. And I think they might serve to hold the back of the baby's head while the face appears under the perineum. We have to keep asking these questions until we can understand the physiology well enough to know how to support the physiology instead of undermining it. So I love midwifery today actually. There's so much to talk about what women and midwives observe and see. It's absolutely stuffed full of physiology. Not textbook physiology, but both videos are great for watching as well. That's how you learn physiology. I mean, I'm not a midwife. I've learned my physiology through reading other people's work. But midwifery today is certainly wonderful. Right, so now I'm going to go through five reasons why I think that orgasm is really birth. What happens during orgasm? We get engorgement of the body, the bulbs and the crura of the clitoris. This will have the effect of cushioning the emerging fetal head. We've got the back of the fetal head, remember, against a really hard arch, archy bone and the baby's head needs protecting. It is the hardest bit of the baby's head, but it still needs protecting. It closes the urethra. Orgasm does, so that would be quite useful. We don't really want to be spraying the baby as it's coming out. Right, the second one. Stimulating the internal clitoris sends a nervous signal to the hypothalamus leading to a huge surge of oxytocin from the pituitary gland. This is what makes the bulbous cavernosis muscle vibrate and contract, giving these little contractions of the vagina. There's also a huge contraction of the uterus for one large downward push and the brain is flooded with oxytocin because it's a bonding hormone. The brain is flooded with oxytocin to prepare for feeding. Oxytocin is so implicated in birth and orgasm and sex and babies. I don't know why I never noticed it when I first started looking at hormones. Right, number three. This is Trunjean susan, really, that she thinks that the nervous signal initiates laudosis and the movement of the rhombus of the chylis, which increases the bony space in the pelvic outlet and, perhaps, as I say, moves the posterior pelvic floor muscles. I don't know how we're going to research this lot. Again, look at the biology and the biology will tell you what's happening. Right, number four. Sorry, I've got this out of order. I haven't died. The involuntary vaginal contractions, the little fluttering contractions that might be holding the back of the baby's head because, at this stage, the baby's head is coming round to be born and I'm going to go into that a little bit later. The physical effects of the orgasm, number five. Vaginal secretions for lubrication, I should imagine. I, myself, haven't been aware of enduring birth, but certainly I'm enduring sex and orgasm and it seems to be a very sensible function. I don't think, in England, we tend to use anything for lubrication, but I wonder how many women tear and have bad tears because they don't have enough lubrication because there's no chance of orgasm and whatever. I'm just throwing that one out there for you to think about. I think if we do have orgasmic birth with the fetal ejection reflex, there's no need to push and there's no need to tear. The baby's going to be born himself. It's the pushing, the vial cell of pushing that causes tears and position as well, the maternal position. So let's zip through because I'm keeping an eye on the time and I wanted time for questions, but I've just shown these two pictures of the pelvis. This one here is a chimpanzee pelvis. You can see it's long and thin, long and thin, and this is where the chimp's clitoris will be and this is where she'll grab to help her baby come up, but her baby just comes out straight down. Our baby, this is a human pelvis, has to come round his bend. That is why we have this arch in our pubic bones because the baby actually bursts himself by pivoting his face. The face slowly uncovers as he comes out. It has taken me a long time to get my head around all this. Sorry, it's not a frightfully good picture, but we've got the pubic bone here and the baby is bending backwards. I have to turn all these pictures upside down because the pictures in textbooks are always the wrong way up with the woman on her back. But here we've got the woman with her chimpanzee's pubis here and she's on all fours and the baby's head is falling out due to gravity. Right, this is a position all too many women have to give birth in hospital and there's no prospect of gravity being able to help this baby get out. And the other thing that the baby might have fallen deep into the pelvis and might have to be extracted with forceps. Now I always think if you can get forceps in as well as a baby's head, the baby's head should be able to get out without the forceps around the side. So I hate that position. I loathe it. It doesn't agree with the biology at all. I just wish they would get rid of those lithotomy poles. So we've got some better positions here. Here the woman's on her side and in fact her pelvic bones are being squashed together. This one is a bit flattened by being on the bed and this one, the weight of her bone is opening her pelvis up at the back and here we have a woman leaning forward. Not quite on all force because the picture didn't really work that way but the baby's face is coming out from the back. The baby's head is pivoting here. The baby births himself. We can think about, we don't have given enough agency to mothers and babies. We think we have to do things to them but actually we have to let them work it out for themselves. We have to understand the biology, their physiology, the biomechanics and we have to let mothers and babies do it themselves because they don't get any practice but bodies know how to give birth. Right, I invented a chair that I hoped the obstetric units would use to nudge women off the bed but so far I've sold a few but not very many. And that's the end really. So it's another picture I had. It came from Midwifery Matters which is the magazine of the Association of Radical Midwives of Babies Raising a Lotus Flower with the baby unfolding and presumably I'll show you the clitoris is just behind this petal here a little bit further in. And that's it really. I think that's the end. Is that the end? It is, it is. I'll go back so you can see that one still. Right, well that's all I have to say. I use most of my notes and some I missed out but please do ask anything you want. Thank you so much Madrex. I think the presentation has unpacked a lot of myths about orgasmic birth. For me actually the physiology is now more clearer than what I knew. So there are few comments here that are quite interesting. I have seen someone early Anderson, Susan, Catherine is saying, I've heard you talk about this before and it makes so much sense. We need to spread the word. And I think that has been echoed by someone else that midwives are supposed to hear this more often. And then someone is saying, Margaret we need more women like you in the world. That's quite true. Thank you so much. Iska is just commenting that she learned something about this in class. Someone is laughing out loud Red Miller, quite interesting. And then Aisha is talking about describing this physiology sounds so interesting and for sure we've really enjoyed. I commend the effort of the researcher well done. And Mary Buckley has some questions. I've often wondered about if we could remove the taboo of utilising private external clitoral stimulation during labor. Could we use a day, could we see a day when an external stimulator could be seen as normal as a taste machine? No, no, no, there's a chip in here. Please, no, we don't want... Oh, well, I don't know what to say, Mary. I just realised what you're talking about. You're talking about a vibrator, aren't you? Look, we have to be, I'll tell you what, we need to be in the sort of circumstances where we could have sex in order to... If we want to stimulate, I suggest that we stimulate our own fiturities or get our partners to do it for us if we want to do that. But we have to be in the sort of environment that allows such a thing to happen because the other thing is about having orgasms is you have to be in the right frame of mind. You can't have an orgasm to order. We have to be... So what I'm saying is we've got to get the birth environment right. If birth needs orgasms, we need to give birth in places where orgasms are possible. The other thing I wanted to add about the physiology, about the Wikipedia page, it came to me, I've got notes written all over that, the front page of my... Look, we have to change Wikipedia. It is, to me, it's absolutely blindingly obvious that orgasm has a huge function in birth, probably for all mammals. And we have to get Wikipedia changed. So if anyone knows how to change Wikipedia, please... I mean, I've published this in a couple of places, but not peer-reviewed journals. So I don't know how much of a peer-review one needs to get into Wikipedia, but if somebody could change Wikipedia to include this, it would help enormously because I get sick of seeing, oh, yes, it's just for sexual pleasure. Well, it isn't. But the birth environment is the most important thing, I do think. Thank you, Marie. Thank you so much. Marie has just commented down there and is saying, I have no women to use them when I'm not there, like an external stakeholder. Then there's an interesting question about what if a woman has had genital mutilation? Maybe we have to answer that? Well, you see, for female genital mutilation, usually it's the external clitoris that has been excised. I don't think they can't excise the stalk of it. I don't know how far back they go, but can I possibly get back to a picture of it? Right. They're excising this bit and they might... I don't think they can excise that much of it, but we've still got here, we've got the back. This is where the baby's head is impinging and they can't possibly excise that. And I don't think, I don't know whether they excise. I think possibly sometimes they do excise the bulbs as well, and in which case I don't know what to say almost. But most of it should still be there. The bit that the baby touches should be there, but I'm sorry, I'm so sorry. I don't know what to say really about that. And people are just commenting about how interesting it is, your presentation. Nice presentation from your perspective. What is the best position for mukbang thing? Maybe you could touch on that a bit. I think, right, I think the best position is probably all fours, forward leaning. Anywhere where the gravity, the weight of the baby's head is going to impinge on the closerers. The weight of the baby's head is going to be in the front of the pelvis, not the rear of the pelvis. I know some women do decide they want to give birth, flat on the back of the bed, but I think it's very, very rare. And most women, if they were to choose their own position, they do choose forward leaning or all fours, or perhaps with one leg stuck behind, all sorts. But we're not seeing it because, certainly in England, most birth takes place in hospitals, and it's a question of what mothers expect, where mothers expect to give birth on a bed, and they expect to have their legs in the thotopy, and that's how people are taught. So you don't need legs in the thotopy until you need intervention, and even then, most interventions can be done with the mother the other way up. So, yeah, that's what I feel about that. There is a question about, okay, people are commenting they're going to buy you a book and well done for that book. Oh, yes, that's right. That's my book. Yes, Michelle Holtzman is asking, how can they purchase your kneeling chair? How can we purchase your kneeling chair? Oh! Right, you can go to my website, which is birthupright.co.uk. That's my book. Can you see my book? It's rather the wrong way. Oh, no, it's not the wrong way. And the chair, yes, birthupright.co.uk, all one word. Or there's a Facebook page for it. It's actually called the Osborne kneeling chair because the seed corn money was provided by a legacy from a friend of mine. She left me some money and I used it to start developing the chair. It's moved on a lot since then, but thank you, Eloise. Oh, yes. And it costs a thousand pounds, but it's very sturdy and it should last for years. And it would save itself with one caesarean section saved you'd pay for it. That's not usually the way that people do their budgets, but anyway, yeah. Questions from the attendees? Do you be having any questions? I'm just having a look through to see. Oh, good. I am so passionate about birth position. I think the bed's all wrong. We've just got to get rid of that bed somehow. We have to stop thinking of the bed. We have to start making women active. We have to start allowing women to be agents of their own birth. So, there. Okay. Thank you. Thank you. Everyone is really appreciating for the good job. And I think it's a worthy presentation for midwives. And I would recommend midwives to also join your website to just visit your website and also your Facebook page. I really, really would recommend that. Thank you from a little group of lecturers and students from Bournemouth University. They appreciate you. Catherine Koopa is saying, thank you, great presentation. We really appreciate that. Rachel is saying thank you, and wonderful presentation. I think, yeah. And people are continuing to really appreciate your presentation, Margaret. And I can say I've also enjoyed as a listener to you. I want to attend more of your classes at Bournemouth. Thank you. Well, thank you for your hosting.