Ins and Outs of Squatting Births

Traditionally, women give birth lying down, but more and more women are assuming the squatting position for labor and delivery -- a move often reserved for the gym. Why? Squatting births can be a great way to have a "quick and easy" labor day, but you have to squat at the right time and in the correct way. So we asked experts to offer insight on the ins and outs of squatting births.

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Labor Pains

On average, a woman's first labor takes 12 to 24 hours, and subsequent ones last about half as long. If that's not your idea of a good time, stand up -- and then squat! Squatting births can help reduce the length of labor.

By forcing your upper leg bones (the femura) to act like levers on your pelvic bones, you can widen your pelvic opening by 20 to 30 percent, says Alana Bibeau, Ph.D, a doula and a member of the Rhode Island Birth Network Board of Trustees. The position also increases the amount of oxygen brought to the uterine muscles and baby, helps to dilate the cervix, relieve pain, reduce the need for an episiotomy or a cesarean section and lessen stress on the baby. All of that (plus the obvious gravity component) can help speed up the process, too.

But squats can be taxing on your body. "Squatting can strain the ankles, knees and hips," Bibeau says. That's where supported squats come in. A partner, doula or nurse can help hold you up while you squat, so you can focus on your breathing techniques and save energy that you'll surely need later throughout labor and delivery.

Some hospitals also have squat bars that can be set up at the end of the bed, which allow you to lean onto the bar while dropping your legs into a squatting position. Birthing stools and balls are also excellent ways to achieve a squat without the strain, says Kim Wilson-Stephens, an obstetrics nurse at The Christ Hospital in Cincinnati. And remember: The squatting position doesn't need to be held continuously, so take breaks!

Breaks are also important for physicians. When mom lies down, doctors and nurses can monitor the baby's heart rate, says Jonathan Schaffir, M.D., an obstetrician at The Ohio State University Medical Center. Fetal heart rate monitors are typically placed on abdomen of the the mom-to-be, and that can be difficult when she's upright and moving around. While it's less of an issue during low-risk pregnancies, in high-risk pregnancies the physician may ask that the mother stay in bed so the birthing team can closely monitor the baby's vitals throughout labor and delivery.

Squatting Birth Struggles

Although squatting can be empowering for many women, anatomy is not on your side when it comes to delivering in this position.

"If you try to deliver while in a squatting position, you push the baby's head right into the pelvic bone, rather than letting baby come from underneath," says Wilson-Stephens, who advises women to lie on their back and tilt their pelvis so the small of their back presses into the bed. That gives baby more room to make the almost 90-degree turn from the uterus through the birth canal. That's hard to do when standing.

It's also hard to stand after having an epidural, Dr. Schaffir says. Anesthesia can cause numbness and limit motor function in the legs. If you plan on having an epidural, don't plan on squatting after you get the goods.

Squat Prep

Most women instinctively stand, walk and squat during labor, but you may want to practice the proper technique before your delivery day. Squats are safe to practice during pregnancy as long as your doctor gives you the green light. In fact, some prenatal yoga classes include squats as preparation for labor and birth.

If you're hoping to have a squatting birth, it's important to talk with your physician and/or midwife about your birth plan. "Some physicians are more comfortable with alternative birthing positions than others," Dr. Schaffir says. "Find a facility and physician with experience in your desired birthing plan or position." Remember, however, that a safe birth is the number-one priority for both you and your doctor.

"The most important thing a woman can do, in my experience, is have multiple 'tools' in her labor 'toolkit,' rather than relying on one specific method of childbirth preparation or one position for birth," Bibeau says. "This way, if she finds that one of the coping techniques she thought would be helpful to her just isn't working or safe anymore, she has other tools to select from that might be exactly what she needs to get through that next contraction and bring her one step closer to meeting her baby."