Not All Squats Are Created Equal in Labor & Birth

By Mindy Cockeram, LCCE

Serena Williams' pregnancy has raised many questions about what level and types of fitness are safe to do during pregnancy. Exercise during pregnancy is no longer taboo, and in fact it is now promoted for its overall health benefits and in the prevention and management of gestational diabetes (unless there are particular complications).

A year ago I added a 'Prep The Pelvis' activity to my Lamaze classes which includes good pregnancy posture and sitting positions, using 'Bertha' (the name for our birth/exercise ball) to ease discomfort; hamstring, hip flexor and groin stretches; and the pelvic tilt and exercises to strengthen the lower back. But ever since reading a quote from the infamous midwife Ina May Gaskin ('Squat 300 times a day and you are going to give birth quicker') I have also been extolling the virtues of yoga style deep squat throughout pregnancy to ready the pelvic floor, assist with gravity during labor and use as a non-medicated pushing position.

Search for 'squat in pregnancy' online and you'll find hundreds of articles and video clips informing women of the benefits of remaining active and squatting throughout pregnancy. Some of the information refers to 'parallel' squats (where the bottom does not go lower than the knees and knees do not go out further than the foot) and some refers to 'deep' squats (where the bottom is dropped very low in between the knees in a yoga style position). Parallel squats clearly help to build quad muscles and I did them for weeks hoping to strengthen my legs for ski season, but parallel squats in pregnancy can be hard if you are not already used to doing them and put your knee ligaments into an unstable position. An alternative version is demonstrated roughly a minute into this video clip.

Deep squatting seems to offer a better overall way to stretch and align the pelvis in pregnancy and help the baby to descend. Many of the 50 or so clips and articles I've reviewed wisely suggest consulting your doctor or midwife prior to beginning. But only a few of the web articles differentiate between the parallel and deep squat and even less listed any reasons to avoid doing deep squats - like hemorrhoids, low lying placenta, low lying umbilical cord vessels or a baby lying breech. But perhaps the more serious reason for avoiding deep squats is engagement (when the baby descends into the upper pelvis) which normally occurs between 34-38 weeks in first-time moms, but could be earlier or later.

I have always thought and taught that a first-time mother's cervix dilates completely to 10cm before the baby enters the vagina. However, research indicates that in most cases, the baby's head engaged head is actually resting at the top of the mother's vagina for the last few weeks, which causes vaginal distention (swelling). Pregnant women feel this as backache, rectal pressure, and an overall heaviness. On the other hand, breathing becomes slightly easier and indigestion may be reduced because the baby has 'dropped.'

Occasionally (and seemingly becoming more common) the baby's head enters the top of the pelvis 'back to back' (facing up, also known as 'posterior') or too deeply to allow the cervix to change position as labor begins. Both of these situations can slow or stall early labor and are not always easy to detect before contraction patterns give us possible clues. Therefore, one of the worst possible things we could introduce or continue to do as the baby 'drops' are deep squats. Deep squats encourage further baby's further progression downward, but can also make an early labor problem harder to correct.

So if indeed you are considering trying some deep squats in pregnancy and early labor, be sure to do so only if you are not already experiencing any of the symptoms above that may signal your baby is already engaged or in a posterior position. Better to use deep squats in labor once contractions are established and when your doula, nurse or care provider can confirm (or approximate) the baby's internal position.

Have you been doing squats in pregnancy? What exercises reduce your aches and pains the most?

References:

Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine 2003;37:6-12.

Kent C. Rethinking Deep Squats During the Last Weeks of Pregnancy. http://bjsm.bmj.com/content/37/1/6.full#ref-51 Accessed June 1 2017.

Nichols D Randall C Vaginal Surgery Williams and Wilkins 1989

Mindy Cockeram, LCCE

Mindy Cockeram is a Lamaze Certified Childbirth Educator teaching privately as well as for a large network of hospitals in Southern California. She has a BA in Communications from Villanova University and qualified as an Antenatal Teacher through the United Kingdom's National Childbirth Trust (NCT) in 2006. She is author of the recently published book Cut Your Labor in Half: 19 Secrets for a Faster & Easier Birth. Her website and Facebook site are both called Learn4Birth. A native of the Philadelphia area, she spent 20 years in London before relocating to Redlands, CA in 2010.