The ins and outs of squatting births

Squatting allows gravity to aid labour, and opens the pelvis for baby to move into the birth canal. Here’s what you need to know. By Francoise Gallet

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*Originally published in September 2014

Modern-day childbirth is commonly done semi-reclining, or lying flat, on a hospital bed. Squatting, on the other hand, is usually reserved for the gym, or it’s done, rather self-consciously, at the side of the road when we can’t get to a loo in time. But it’s a position that has substantial merit in childbirth, as it can both speed up the progress of labour and create a larger space in the pelvis for the baby’s descent.

Flat mom, flat baby

The lithotomy position – on your back, knees up and feet in stirrups – is a position that caters much more for the medical practitioner’s monitoring needs, than to facilitate the progress of a mother’s labour or her comfort, explains midwife, Susan Lees.

Also, lying for extended periods on your back during labour increases the risk of supine hypotension – a drop in the mother’s blood pressure due to the uterus compressing the blood vessel that goes to her heart. This in turn reduces the blood flow to the placenta and can compromise the foetus, Susan explains.

Therefore, she encourages women to try a number of different positions, and squatting is one of them.

Go with gravity

Being upright – as opposed to reclined on a bed – puts gravity on your side.

Midwife Angela Wakeford explains why you want gravity on your side: The first stage of labour is where your cervix dilates so that the baby can move past the opening of the pelvis and into the birth canal. The more the baby presses down on the cervix, which is where the aid of gravity is useful, the more the hormone oxytocin, also known as the ‘contraction’ hormone, is released. The more oxytocin, the greater the rate at which your labour progresses.

But squatting is hard work for the legs and may not be a position that you are able, or need, to sustain – especially during your first stage of labour. Any upright position, such as standing, leaning over slightly with your hands on the back of a chair, or even on all fours with your arms on the edge of a bed or birthing ball, helps your body to work with gravity.

Another alternative is to get your birth partner to sit and support you in your squat, suggests Angela.

Give your pelvis room to move

The other benefit to squatting is that it opens the pelvis to its maximum, because of the way in which the legs abduct – move outwards away from the midline of the body – when you’re in this position. As the legs move out, so the outlet of the pelvis opens up – even more so than if a woman is standing upright, explains Susan.

Susan therefore suggests this position for a woman who has fully dilated and is now pushing her baby through the birth canal to the point where it is crowning (when the baby’s head reaches the perineum).

Using a squat to help the pelvis open to its maximum, gives your baby room to manoeuvre itself through the outlet of the pelvis and into the birth canal; whereas lying flat on your back with the sacrum and coccyx pushing against the surface of the bed, makes it more difficult for the joints to be flexible.

Lie and deliver

But once the baby has descended down the birth canal to the point of crowning, gravity ceases to be useful. At this stage, what is optimal is for the perineum to stretch and yield slowly, so as to avoid tearing, explains Susan. Taking advantage of a reclined position, such as lying on your side with your top leg being supported by your birth partner or caregiver, still allows for some movement of the pelvis without using gravity to speed up the descent of the baby at the moment of delivery.

And although squatting can help speed up the progress of labour and allow for greater mobility of the pelvis, it’s important to avoid being set on one birthing position, counsels Susan.

“For some women, reclining almost flat with their knee up and foot on the hip of their birth partner or caregiver, can help labour progress. With each contraction, she can push her foot into the caregiver, thereby lifting the sacrum off the bed and still allowing for some movement of the pelvis.”

Plan your moves

It’s possible to use different positions during childbirth while also using various forms of foetal monitoring, and potentially even if you also opt for pain relief like an epidural, shares Angela.
This of course will depend on the strength of the epidural and how your body reacts to it. Additionally, some caregivers are more open to active birth than others.

Discussing different positions for labour and delivery, foetal monitoring and pain relief, with your caregiver, should therefore be part of your birth plan.

Position yourself differently

  • Stand and lean: Lean forward onto the back of a chair, table top or even in the arms of your caregiver or birth partner.
  • Sit and lean: Sit and lean forward onto the back of a chair or toilet. For some women, the toilet is the place where they fel comfortable letting go, and so it can be a very comfortable position during the second stage of labour, shares doula Lana Petersen.
  • Kneel and lean: Position yourself on your knees with your arms resting on a birthing ball, the side of the bed or even on the floor.
  • Knee up: Sit on a bench or bed with one knee up, or stand with one knee up on a chair.
  • Recline: Side-lying to conserve energy in between contractions, works well, as this can be done on the bed or in the bath, says Lana.

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