“Is squatting an optimal position during delivery?” A common question I get from pregnant people and from some of the lovely birthy people in my circle.
My answer, in short, is no.
There are lots of reasons why pelvic physical therapists will educate birthing people to consider (or avoid) certain positions during labor and delivery. Someone who is working through SPD (symphysis pubis dysfunction) may want to avoid asymmetrical positioning (½ lunge, foot on chair, etc) as one example. Every pregnant person at our clinic receives a thorough evaluation which takes into consideration many variables including symptoms and results from a functional movement screen in order to support them on optimizing their birth outcomes.
And as I thought about this further, many questions came up for me. People have been squatting for birth since the beginning of time. What has changed? What am I noticing with squatting in clients that would lead me to recommend other positions during delivery? What do I know about body mechanics and birthing that has led me here? As I dove down this rabbit hole, I realized there were many variables in western culture that informed my present day guidance on this.
To sum it all up in one succinct sentence....We do not squat correctly!
See Image 1 below. Working with weight-lifters, I see it all the time. The ‘butt wink’-Google it! Essentially this is where the butt bones and tailbone tuck under, the lumbar spine curves and the pelvic muscles shorten. This often happens before we even reach the deep squat position. This is due to many variables, one big one being that functionally we never use a squat. We don’t socialize, eat, cook, clean or eliminate in a squat. What we don’t use, we lose (or in reality, never had)
See Image 2. Also, we tend to turn our feet outward, externally rotate our hips and come up onto the balls of our feet. This is likely due to poor ankle and hip mobility and if we accommodate like this, it becomes a much more comfortable deep squat.
Why does squat form matter for birth outcomes?
When we butt/tail tuck, this reduces the pelvic outlet space. This position might be advisable in the early stages of labor when we want to increase the pelvic inlet space but not advisable when we want to open the pelvic outlet space for delivery.
This changes the orientation of the pelvic outlet and we may end up working against gravity, which is one reason why we educate birthing people on concerns with lithotomy position!
This shortens the pelvic muscles and makes them less resilient. Resiliency is key to having an intact perineum. Empirically, the incidence for perineal tearing in this position during delivery is higher. In addition, many of the pregnant clients we work with already have over-worked and tight muscles, so this just adds to it.
When we turn our feet out and externally rotate our hips, this compresses the sacroiliac joint and may restrict motion. Often times (and for many reasons) we may educate people on keeping hips neutral among various birth positions or even coming into slight internal rotation to free up that pelvic outlet space, especially during delivery!
I would love to hear your experiences with squatting for delivery, please let me know! The more we discuss, debate and learn from each other, the better for the people we support!!
Note: Not every person has poor squat form and with guidance, squat form can improve. See my attempt to compensate and improve squat form below however, even with compensation, my butt tuck and pelvic outlet orientation is not drastically improved. I truly don’t believe there is a ‘perfect’ way to squat. However, we can’t NOT squat regularly and then expect it to magically work well during L&D based on the above biomechanical considerations.