? Squatting - Birth Positions - Giving Birth Naturally

Birth Positions:
Squatting

Of all the birth positions you could choose for the second stage of labour, squatting is probably your best bet! It does take some exercise, but as you'll see below, it's more than worth it! If you are hoping for a natural birth, learning how to squat is one of the ways to make that happen!

Birth position: Squatting

Description:

How do you describe the squat position? Imagine doing a poop in a long-drop (a pit latrine) and you'll have the idea.

Come to think of it, the squat is a very popular birth position in the non-Western where giving birth lying down, and water-borne sewerage, are almost unheard of.

squatting with support
Squatting with Support

You can squat unsupported, although this may require exercise beforehand, or you could squat with the support of a birthing chair, or holding onto a squat bar, sometimes available in hospitals. You can also do a supported squat where you place your arms over the thighs or arms of your support person. The illustration here doesn't really show how close you are to your birth partner in this position. Make sure you read the tips for some more important info!

Tips:

  • It is best to use this position in the second stage of labour i.e. the actual pushing phase, as it can be a tiring position. It helps to practice this one during pregnancy.
  • It may be possible to squat if you have had an epidural depending on the type of epidural. Just make sure your birth attendants are strong enough to catch you if you fall. One study stated that injuries from falling while trying to squat with an epidural were too prevalent to recommend it in their situation, although for the life of me I can't find the reference!
  • Squatting has been associated with higher rates of perineal tearing in some studies, although quite the opposite has been observed in other studies. I think this is not the squatting position itself, but the squatting technique used. For example, if you squat with your weight forward on your toes, your calves, thighs, and hence your perineum and vagina, are tightened, whereas if your weight is back on your heels (with a rolled towel under you heels for support if necessary), these muscles can relax, and you can thus prevent tearing.
  • Squatting lengthens your gluteus muscles, your hamstrings and quadriceps (thighs) and your calf muscles – all very helpful! The tension in these muscles can actually affect the tension in your pelvis (and hence the size of your pelvis) during delivery, so being flexible in these areas can also help you! Sitting in a chair for most of the day really decreases flexibility in these areas, so a little extra practice and effort is necessary to get that flexibility back.

Some other tips for a good squat position:
Alignment Matters: The Hunting and Gathering Mama
For some more great tips, and some intermediate exercises, check here: Alignment Matters: You don't know squat

Correct Squatting Technique Incorrect Squatting technique
Correct Technique to Practise Squatting Incorrect Technique to Practise Squatting

Technique Tips:

  • Practice squatting with a rolled towel under your heels until you can do it with your heels down.
  • Try holding onto a doorknob (one hand on either side of the door) for support until you get this right. If you are having a homebirth, you might like to use that very same doorknob for support when squatting in actual labor!
  • When holding onto the doorknob, make sure that the line between your ankles and knees is vertical. Your knees should not be far forward. The ideas is to eventually get your heels down.
  • Make sure your spine is not rounded and that your back, especially your lower back, is straight, if not slightly concave. To achieve this you may feel as though you are really sticking your bottom out.
  • If you check the links above, you'll find that walking 10km a day is also incredibly beneficial for pregnant women, and any women in fact. This does not mean you need to set aside specific time to walk, like you would to go to gym, but to increase the amount of walking you naturally do. I found that as a waitress and as a teacher (not at the same time) I walked at least this amount on a daily basis!

Advantages:

  • Squatting opens the pelvis by up to 30% compared to lying down (1). (Just that one on its own is good enough reason for me!)
  • Squatting is reportedly less painful than lying down. (2)
  • Squatting ‘straightens' the birth canal as it helps the pelvic bones to line up, rather than emphasizing the u-turn caused by the lithotomy position or the semi-sitting position.
  • Squatting to give birth makes use of gravity. If you think the effect of gravity is negligible, it isn't. Ever had that experience where you're lying down and the moment you stand up you desperately need to pee? That's gravity!
  • All of the above help to shorten the pushing phase of labour. (3, 4, 5, 6)
  • Which means that less oxytocin is required to speed things up. (2)
  • Squatting also decreases the need for the use of forceps when compared to the semi-sitting position. (5
  • The dangling squat also helps to lengthen the body which can give the baby space to get into a better position.
  • Some studies mention that squatting prevents tearing (3, 6), although some mention that tearing rates are the same (2) or higher (4, 7). As mentioned before I think that increased tearing is due to lack of support, as mentioned by the researchers themselves (4), as well as, in my hopefully well researched opinion, incorrect squatting technique (See above).
  • Squatting can decrease episiotomy rates. (2, 3, 6)
  • Another great advantage to the squatting position is that it doesn't have any real disadvantages in that it doesn't seem to cause any problems or complications! (2, 3, 8)

Disadvantages:

  • May be tiring, which is why it's generally a good idea to save it for the second stage (the pushing stage).

Other references on the benefits of squatting: 9 & 10.

References:

1. Ehrstrom, C qtd in McKay, S (ed.) ICEA review. 2(1978)1. Back.

2. Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, & Mayerhofer K. Women's position during labour: influence on maternal and neonatal outcome. Wiener Klinische Wochenschrift. 2003 Oct 31;115(19-20):720-3. Back.

3. Golay J, Vedam S, & Sorger L. The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being. Birth. 1993 Jun;20(2):73-8. Back.

4. Allahbadia G N, Vaidya P R. Squatting position for delivery. Journal of the Indian Medical Association. 1993 Jan;91(1):13-6. Back.

5. Gardosi J, Hutson N, B-Lynch C. Randomised, controlled trial of squatting in the second stage of labour. Lancet. 1989 Jul 8;2(8654):74-7. Back.

6. Bhardwaj N, Kukade J A, Patil S, & Bhardwaj S. Randomised controlled trial on modified squatting position of delivery. Indian Journal of Maternal and Child Health. 1995 6(2):33-39. Back.

7. Shorten A, Donsante J, & Shorten B. Birth position, accoucheur, and perineal outcomes: informing women about choices for vaginal birth. Birth. 2002 Mar;29(1):18-27. Back.

8. Kelly F W, Terry R, & Naglieri R. A review of alternative birthing positions. Journal of the American Osteopathic Association. 1999 Sep;99(9):470-4. Back.

9. Association of Women's Health, Obstetric, & Neonatal Nursing. 2008. Nursing care and management of the second stage of labor (2nd ed). Washington, DC: AWHONN. Back.

10. de Jong P R, Johanson R B, Baxen P, Adrians V D, van der Westhuisen S, & Jones P W. Randomised trial comparing the upright and supine positions for the second stage of labour. British Journal of Obstetrics and Gynaecology. 1997 104:567-571. Back.

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