Don't Fall for the Lying Squat

When I hear about a natural birth from a friend or birth professional at one of our local hospitals where natural births feel more like blue moons... there are two questions I always ask: How long was she there? (the answer is usually less than 8 hours) And what position did she birth in? (most women are made to birth on their back there). I plan to keep asking because I TRULY HOPE that one day the answers will change! But for now, when I ask the latter, it's not uncommon to hear "She was pushing upright, or in a squat, and the nurse asked her to get in a lying squat... it all went great!"

The first time I heard this... I needed the doula to clarify... you might need that too...

Are we all familiar with a birth squat? See the picture. This position is one that many women will get into to birth their babies if they have not been conditioned by their culture to lie on their backs. In other cultures it's a position that people use often... you'll see men squatting during their smoking breaks, people waiting at the bus stop in a squat, and they go to the bathroom in a squat. This is a very healthy exercise to incorporate into your day... I pick up toys, change diapers, sometimes watch tv in a squat and I encourage my students to practice often as well. You can read more about the benefits of squatting here, back to the birth squat...

I also share the many benefits of birthing in an upright position. This can be a squat, which opens the pelvis by 30%, or with one knee down for support, on all fours... lots of options. Here is a list of advantages compiled by Giving Birth Naturally, you can see the whole post here:

"Advantages:

• Squatting opens the pelvis by up to 30% compared to lying down (1). (Just that one on its own is good enough reason for me!)
• Squatting is reportedly less painful than lying down. (2)
• Squatting ‘straightens' the birth canal as it helps the pelvic bones to line up, rather than emphasizing the u-turn caused by the lithotomy position or the semi-sitting position.
• Squatting to give birth makes use of gravity. If you think the effect of gravity is negligible, it isn't. Ever had that experience where you're lying down and the moment you stand up you desperately need to pee? That's gravity!
• All of the above help to shorten the pushing phase of labour. (3, 4, 5,6)
• Which means that less oxytocin is required to speed things up. (2)
• Squatting also decreases the need for the use of forceps when compared to the semi-sitting position. (5
• The dangling squat also helps to lengthen the body which can give the baby space to get into a better position.
• Some studies mention that squatting prevents tearing (3, 6), although some mention that tearing rates are the same (2) or higher (4, 7). As mentioned before I think that increased tearing is due to lack of support, as mentioned by the researchers themselves (4), as well as, in my hopefully well researched opinion, incorrect squatting technique (See above).
• Squatting can decrease episiotomy rates. (2, 3, 6)"
  
  

Squatting sounds like a good deal to me! So what is a lying squat and does is carry the same advantages?

When studies have been done on upright vs non-upright birth positions, the non-upright positions included are usually lying flat on the back (lithotomy), semi-sitting, like leaning back in the bed, and side lying. To imagine what a lying squat is if you haven't heard a nurse tell you to get in the position, or heard your client be told to get in the position... take a woman in a birth squat and put her on her back. Or lean her back into the bed.

Imagining it? Oh geeze... what does that look an awful lot like? A woman birthing on her back or in a semi-sitting position...

Friends... the lying squat is just nurses and doctors using our language against us. They are making women feel like they are getting what they want when in reality they are being manipulated into rejecting what their body is telling them to do and doing what is convenient or comfortable for the provider. The benefits that a woman enjoys in an upright birth position are lost in a lying squat! Who cares what the staff calls it! Lets call a spade a spade here ok?

Why aren't an upright and lying squat the same?

A squat is not all about the position of the legs. Even though in these two positions the mom's legs may be positioned similarly... the lying squat (whether with mom fully on her back, or lying back into a raised bed) compresses the pelvis, changing the size and shape of the pelvic outlet. Gravity is no longer on mom and baby's side. Mom will still experience all of the discomforts of lying on her back.

Most importantly... to me at least... the woman is no longer listening to her body. Also, many women who know enough to get into a squat during a hospital birth has most likely done her research and has decided that she does not want to birth on her back... women are vulnerable and highly susceptible to suggestions in labor, shame on every nurse and provider who uses this kind of language to talk a woman out of the birth she desires.

I've noticed some apathy from some doulas on this subject. I don't know why... because it makes me really mad. We are working SO HARD to inform women, give them options, give them the tools and the vocabulary to communicate openly to their providers what THEY WANT for their birth. This is simply a trick to get women to comply without resistance. It's not fair. We need to warn women just as we warn women about breastfeeding "booby traps" put out by formula companies. Lets remember whose corner we are in.

Moms, doulas, birth educators... it's ok to be mad! Let's not be so quick to give up and get on our backs! Saying "Well I/she pushed upright for some of the time." So? Did you/she want to BIRTH upright? If that's was the desire, and it was not allowed, that is not a victory! That is not progress... because YOU/SHE only births that baby once.

So let's not buy into the "lying squat" ok? Let's not be ok with putting women on their backs when they don't want to be there. Lets choose and praise the birth places who consistently support women in birthing how they desire.

Ok I feel better now... thanks for reading guys!