The question of whether a person can give birth while squatting in a hospital setting involves the intersection of modern medicine and ancient birthing practices. Squatting is a non-supine position, meaning it avoids lying flat on the back, which has historically been the standard in many Western hospitals. There is growing interest in returning to upright positions for labor and delivery, recognizing their potential benefits. Exploring the feasibility of squatting involves understanding the physical advantages, medical limitations, and practical policies and equipment available in a clinical environment.
How Squatting Aids the Birthing Process
Squatting is a powerful position that assists fetal descent by working with gravity. When a person is upright, gravity helps pull the baby downward, adding force to uterine contractions. This assistance can make contractions more effective and may reduce the total time spent in the second stage of labor.
The position also creates more space within the bony structure of the pelvis. Compared to lying flat on the back, squatting can increase the size of the pelvic outlet by as much as 28% to 30%. This widening occurs because the sacrum is allowed to move freely backward, providing a wider exit for the baby. Squatting also helps to relax and elongate the muscles of the pelvic floor, which eases the passage of the baby.
Medical and Safety Considerations
While squatting offers biomechanical advantages, certain medical factors can limit its use in a hospital setting. The most significant intervention impacting the ability to squat is epidural anesthesia. An epidural often results in a loss of motor control and sensation in the lower body, making it difficult or impossible for the patient to maintain a squatting position unassisted. Even with a low-dose or “walking” epidural, the ability to safely support one’s own weight in a deep squat is compromised.
For some high-risk pregnancies or medical complications, remaining in bed for close observation is necessary, which restricts movement and position choices. Continuous fetal monitoring, which tracks the baby’s heart rate, is often required in hospital settings, particularly with certain interventions. The external monitors need constant contact with the abdomen, and their wires can make it challenging to move freely or maintain an active, upright position like squatting. Adapting the monitoring equipment to allow for squatting is sometimes possible but may require specialized wireless devices or intermittent monitoring.
Understanding Hospital Protocols and Equipment
The feasibility of squatting depends heavily on the facility’s infrastructure and staff training. Most hospital beds can attach a removable metal device called a birthing bar or squat bar. This bar extends over the bed, allowing a person to hold or drape themselves over it, providing stability and support for a squatting position.
Birthing Stools and Staff Expertise
A specialized piece of equipment called a birthing stool or birthing chair may also be available. This low, U-shaped seat allows the person to sit in an assisted squat, taking advantage of gravity while offering rest and support. The expertise of the care team also plays a role, as midwives are generally more experienced with facilitating upright births than some obstetricians. It is helpful to discuss a preference for squatting in advance with the medical team to ensure the necessary equipment and staff knowledge are available.
Upright Alternatives to Squatting
When squatting is not possible due to fatigue, an epidural, or hospital policy, several other upright or gravity-neutral positions offer similar benefits. These alternatives provide a compromise, allowing for biomechanical advantages and comfort while addressing the practical limitations of a clinical setting.
- Kneeling is a common alternative, often done on the floor or the lowered foot of the bed, which utilizes gravity and helps with pelvic alignment.
- The hands-and-knees position, sometimes called all-fours, is particularly helpful for easing back pain and encouraging a baby to rotate if they are positioned facing the mother’s abdomen.
- Standing, often while leaning on a partner or holding onto a birthing bar, is another way to remain upright during the early stages of labor.
- For those with an epidural, the side-lying position, where a peanut-shaped ball is placed between the legs, is used. This position helps open the pelvis and encourages fetal descent while keeping the patient safely in bed for monitoring and medical access.