January 16, 2009

Squatting Births

Inspired by what I saw on my bike trip through Vietnam, since returning I have been obsessed with incorporating more squatting poses into my prenatal yoga classes. I have long been fascinated by the incredible ease with which many people from other cultures (particularly in Asian countries I have visited) can assume a squatting position, compared to the struggle I often see in the yoga community I typically teach. So many of the Vietnamese people I saw just folded right up and sat down into self-made collapsible seats. Our bodies are designed to do just that: Fold at the ankles, knees and hips. If you watch little kids play, they take this shape effortlessly. So why is it so hard for us adults?

I think that we Americans have difficulty with this pose because of the daily routines and physical habits many of us have adopted: We sit for long periods of time, which shortens the hip flexor muscles and creates general stiffness in the body. Women tend to wear high-heeled shoes, which shortens the Achilles tendons and keeps the calves in a state of contraction, which makes it difficult to lengthen the muscles.

You’re probably wondering why it matters whether or not one can squat and what purpose it serves in a prenatal yoga class. In a previous blog entry, Birthing Positions: Don’t Just Take It Lying Down, I wrote about the importance of exploring a number of positions for laboring and pushing and not just limiting oneself to the traditional supine position. Many women find that birthing in a squatting position is ideal. Now we can delve deeper into the benefits of this particular choice.

For one, squatting tips the pelvis and uterus forward, placing the baby in an anterior position, which is good alignment for birthing. And, there is great benefit to using gravity to your advantage as the baby is making its way down. Additionally, you are widening the space for the baby to pass through. Squatting actually opens the pelvic outlet on average 15-20% wider than reclining back and shortens the birth canal. If the diameter of the pelvis is increased and the birth canal is shortened, the second stage of labor is likely to be shorter. (Read: Less pushing!) As I jokingly say in class a lot, “Nobody I have ever worked with requests more hours of pushing.” If you can shorten this stage, by all means do so! One final “shout out” for the benefits of this fantastic position: Squatting can also lessen the necessity for the use of forceps and vacuum extraction.

As great as squatting is, I would be irresponsible if I neglected to mention the one downside of this pose, perineal tearing. Because births tend to happen more quickly while squatting, there may not be time for the muscle tissue to stretch, and the attending care provider may not be able to offer the perineal support needed to prevent tearing. It is nevertheless a pose worthwhile exploring for the reasons listed above.

So what can one do to better prepare the body for taking this position? Here are a few tips: As I mentioned before, our bodies are not too accustomed to squatting. I would recommend doing calf and hamstring stretches to help open and release the backs of the legs. In yoga we do Downward-Facing Dog and Janu Sirsasana for this purpose. It is also important to build some leg strength, and you can cultivate this strength by practicing some standing yoga poses. I would also recommend wall squats; leaning your back against the wall and sliding down while trying to keep your heels on the floor. Allowing for the wall to bear your weight, just get your joints used to folding. You can also practice squats with a partner. If you are practicing away from the wall and without a partner and your heels pop up, simply place a rolled blanket or towel under them. You want to feel supported, and you should not have to hold yourself up with your leg muscles. While the legs are engaged, you want to relax into the pose. Finally, you can practice a wide-knee child’s pose to give your body a feeling of folding at the hips and knees.

What can you do if you have tried squatting and it is really difficult for you, but you’d like to explore squatting as you’re birthing? Well, you can labor on a toilet or bedpan. This allows for similar opening of the pelvis but offers support under the legs. You can do a partner squat or hold onto a railing or squatting bar (many hospitals now have these available to use), both which will help support your weight. Or you can use a birth ball (more for laboring than pushing). If your hospital or birthing center has a large tub or if you are doing a home birth and you have a rented tub, you can squat in the water. This has the additional benefit of buoyancy, making your body feel lighter and thereby making it easier to stay in this position for a length of time.

If you are intrigued by the idea of squatting during birth, there is a beautiful 10-minute Brazilian video called “Birthing In the Squatting Position”. It is truly remarkable. It shows several women calmly birthing in a squat, many of them reaching down and scooping up their own babies. I have seen it a number of times, and it still takes my breath away how at ease these mothers look while birthing.

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