Alternative Therapies: The Squatting Position During Labor

1. Alternative Therapies: The Squatting Position During Labor Alternative Birthing Presentation HH382.04, San Francisco State University

2. Introduction to Alternative Birth Options & the Squatting Position • “There is no single position for birth. Labor is a dynamic, interactive process . . . [and the] woman may want to assume various positions for childbirth, and she should be encouraged and assisted in attaining and maintaining the position of her choice (Lowdermilk & Perry, 2003).” • “Squatting is highly effective in facilitating the descent and birth of the fetus. It is considered to be the best position for the second stage [or pushing stage] of labor (Lowdermilk & Perry, 2003).”

3. Squatting Position: Advantages • Decreases the amount of time mother pushes during labor • Reduces the necessity for forceps use on infant • Lessens the use of episiotomy to aid in labor, due to “relax[ing] and stretch[ing] of the pelvic floor muscle” • “Shortens the depth of [mother’s] birth canal” • “Increases pelvic diameter by 10+%” • “Encourages and strengthens the intensity of contractions, while relieving back pressure” (Weiss, 2003) • Improves blood circulation of fetus • Improves health care practitioner’s access to mother’s perineum • “May increase pelvis diameter by as much as two centimeters” • “Uses gravity” to assist with birthing process (Perez, 2003)

4. Squatting Position: Disadvantages • Use of this position is exhausting to mother • The health care practitioner monitoring the infant may have difficulty hearing fetal heart tones • This position impairs the mother’s ability “to assist in delivery” (Perez, 2003)

5. Positioning of the Mother • “Women should assume a modified, supported squat until the fetal head is engaged, at which time a deep squat can be used (Lowdermilk & Perry, 2003).” • A firm surface is required for this position, and the woman will need side support (Lowdermilk & Perry, 2003).” • If the mother is interested in supporting herself, a squat bar can be attached to a birthing bed to allow for her to maintain the squatting position (Lowdermilk & Perry, 2003).

6. Use of the Squatting Position in Combination with the Birth Ball • “A birth ball can help a woman maintain the squatting position (Lowdermilk & Perry, 2003).” • “The fetus will be aligned with the birth canal, and pelvic . . . relaxation will be facilitated as she sits on the ball or holds it in front of her for support as she squats (Lowdermilk & Perry, 2003).”

7. Other Alternative Positions & Tools to Aid During Birth • Standing Position: This position allows the mother to remain upright, increasing the diameter of her pelvis by approximately one centimeter due to the downward pressure on the mother’s pelvic region. • Birthing chair/stools: Birthing chairs/stools, such as rocking chairs, permit the mother to remain in a sitting position during birth, which “enhance[s] bearing down efforts during childbirth.” • Beanbag chairs or floor pillows: “mold around and support the mother in whatever position she selects” • Side-lying position: This position “is an effective position for the second stage, with the upper part of the woman’s leg held by the nurse or coach or placed on a pillow.” • Hands-and-knees position: This position “enhances placental perfusion, helps rotate the fetus from a posterior [or back] to an anterior [or front] position, and may facilitate the birth of the shoulders, especially if the fetus is large.” (Lowdermilk & Perry, 2003)

8. Conclusion • Alternative birthing practices provide additional options to all mothers who are currently pregnant or are planning a pregnancy in the future. • Discovering such options provides each mother with the necessary education to consider which choices best suits her ideal birth process. • Therefore, this choice is an individual and personal decision. • Use of the squatting position can be a beneficial alternative approach to delivery and is especially effective during the second stage of labor. (Lowdermilk & Perry, 2003)

9. References • Active Birth Centre (2003). <All Images> Retrieved December 4, 2003, from www.activebirthcentre.com • Lowdermilk, D. L. & Perry, S. E. (2003).Nursing Care During Labor andBirth. In K. A. Piotrowski (Ed.), Maternity Nursing (pp. 320-372). St. Louis, MO: Mosby. • McGrath, K. (2001). Childbirth Expert: Is squatting a dangerous exercise late in pregnancy?. Retrieved November 30, 2003, from http://www.lamaze.com/experts/childbirth/qas/0,,257151_282231,00.html • Mother’s Care Doula Services, Inc. (2003). Birthing Balls. Retrieved December 4, 2003, from http://www.mothersdoula.com/birthballs.html • Perez, P. G. (Reviewed 2001). Birthing Positions. Retrieved November 30, 2003, from http://www.lamaze.com/birth/choices/articles/0,,167805_67431-1,00.html • Weiss, R. E. (2003). Pregnancy/Birth: Squatting for birth. Retrieved November 30, 2003, from http://pregnancy.about.com/cs/laborbasics/a/squatting_p.htm