Squatting Birth Explained

Whilst giving birth is shown widely on TV, Movies and in photos as happening in a bed in a lying down (semi-recumbent) position, this is not how birth has always happened, or how it happens worldwide. There is an extensive body of evidence that highlights that birth in different positions (such as upright or via squatting aids) support the labour and birthing process for mother and baby. For many, this results in a shorter, less complicated, and overall more positive birth experience.

What’s wrong with giving birth in a laying down position?

Nothing at all, if that is what feels most comfortable and instinctive for you – it is after all your body, your baby and your birth and you should be guided by all 3 to determine what feels right.

However, with such a strong image in most people’s mind of birth needing to happen in a hospital bed through cultural references such as TV or Films, what midwives and birth workers find is that most people ignore their birthing and bodily instinct and gravitate towards lying on a bed even though their body is giving them very strong signals to do the opposite.

Birth traditionally hasn’t been in a laying down position – this came about with the advent of labour and birth moving to a hospital or medicalised environment. In many cultures around the world, squatting or standing during birth is the norm – highlighting that lying down is more of a recent change, rather than an upright birth.

There are many benefits associated with being in a more upright position for birth – and positions such as squatting are known to help with such as:

• Helping baby move down ready for birth
• Increasing the space in the pelvis to help with birth
• Help with the second stage of labour
• Reducing the need for interventions during the birth of your baby

Are squatting births used in the NHS when giving birth? 

Choice is embedded in NHS care and this is never more important than when you are pregnant and giving birth. Your midwife and healthcare professionals are dedicated to supporting you in whatever choices you make – including any positions you may choose to adopt during the labour and birth process.

Research studies highlight that alongside the benefits of a squatting position in the second stage of labour, it is vital for women and birthing people to be supported in adopting birth positions that feel right for them during labour to support a positive birth experience.

Your midwives will be aware of the benefits of upright birth and will support you with squatting in labour and during birth whatever the birth environment. At home it may be using your sofa or chairs to help support you into a squatting position, as well as your birth partner or midwife sitting behind you as a support. In a hospital delivery suite environment, you can still be supported into a squatting position. Birth stools which are easily available in all birth environments, can be really helpful as they provide support for you whilst squatting. Alternatively if you are on a bed, your midwife can support you into a squatting position – either by adjusting a specialised birthing bed to bring up a ‘squatting’ bar (worth asking your midwife if where you are having your baby has these specialised beds), or using bean bags or the bed itself by dropping down the bottom of the bed so squatting on the edge of the higher part of the bed with your feet on the lower part.

Advantages of a squatting birth

Squatting during the labour and birthing process can have many benefits that assist with the progress of labour, the power of contractions and the birth of your baby.

Squatting can increase the pelvic diameter. Research highlights that a squat position in labour can significantly increases the pelvic outlet that your baby’s head needs to navigate during the birth process. A squatting position helps to open up your pelvis much wider, which helps with your baby being born easier with the help of gravity. 

Gravity is a crucial element in the labour and birthing process, if you are upright or in a squatting position, you are working with gravity for the birth of your baby – rather than if you are lying down where you can be working against gravity. Think about – if you are upright and squatting, you are bearing or pushing downwards and gravity helps, whereas on a bed or lying down position, you will be pushing upwards and against gravity making the birthing process longer and harder.

This is primarily why a squatting birth position can also help with a shorter second stage of labour – the stage of labour which is focused on the birth of your baby.  

Similarly, in the second stage of labour, a squatting position has been shown to be beneficial in reducing the need for interventions such an episiotomy – when a cut is made in the second stage of labour in the area between your vagina and anus (bottom), to make the opening of the vagina wider for the birth of your baby  Squatting has also been evidenced as helping to reduce the need for assisted birth by vacuum/ventouse or forceps birth too.

Disadvantages of a squatting birth

The main factor to be aware of with any birth position is if it feels right for you.  It is essential to listen to your body in labour and during the birthing process and do what feels right. If squatting is something you have planned, but in labour it doesn’t feel right – change position, listen to your body to guide to what works best for you in that moment.

One of the issues that some people report with the squatting position for birth is how easily tiring it can be compared to other positions such as side lying. It is important that you are well supported and that equipment such as bean bags, birthing stools, rebozo cloths are offered to help you in finding a comfortable squatting position that works with you, not against you.

How to prepare for a squatting birth

During our live and interactive antenatal classes we cover preparing for birth and positions for birth in detail – so it’s worth joining if you would like further, tailored to you advice and information.

Understanding how labour and birth works is a great starting point – this will give you a real insight into how you stand, sit and relax from the last few weeks of pregnancy onwards, to how active you are and the positions you try at different stages in labour will help prepare for all kinds of births in positions that work with you.

Being active in pregnancy helps too – for some special pregnancy classes such as pregnancy Pilates or pregnancy yoga can help, either in person or online. Not only will they help with your changing shape and keeping you active, but you’ll also learn how your body adapts to pregnancy and prepares for birth.

Some people squat as part of their daily life – either culturally or through work/exercises they do. If you find squatting difficult, get some practice before labour and birth as it’s a skill that needs honing.  Always check with your midwife/doctor if it’s safe for you to do so – particularly if you or your baby has needed extra care or monitoring during this pregnancy.

And explore tools you can use – find out about what’s available for your birth, talk to your midwife about birthing stools, squatting bars on birthing beds, beanbags and other equipment you can use to help you with squatting. You don’t have to do it all alone – these tools are there to help you – part of the ‘labour and birth toolkit’ we talk about in detail during our Mind & Body Birth Preparation class in our bespoke antenatal course.

Finally, talk to your birth partner/supporter. They’ll be with you throughout your labour and birth journey and they need to know why squatting and upright birth is important, why you want to explore it and how to support you best.  As midwives we know feeling supported and understood is the key factor in a positive birth experience.

Are there other positions for birth?

The short answer is Yes! There are many positions that can help at different stages in the labour and birth process, whatever the circumstances of your birth.  It’s important to explore them all to get an idea of what can help when and why, this will help you feel informed and empowered during the birthing process, and to trust your body to birth your baby.

Have a read of some of our other blog pieces on birthing in water, optimal positions for labour and one of our favourites – a UFO (Upright, Forward, Open) birth position.

• https://nowbaby.tclstaging.com/ufo-not-an-alien-invasion-but-positions-for-birth/ 
• https://nowbaby.tclstaging.com/birthing-in-water/ 
• https://nowbaby.tclstaging.com/optimal-positions-for-labour/ 

Sources

• https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002006.pub3/full
• https://www.ajog.org/article/s0002-9378(14)00598-5/fulltext 
• https://pubmed.ncbi.nlm.nih.gov/17319414/ 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235063/