Serena William's pregnancy has made exercise and fitness during pregnancy very topical in 2017 and I get asked lots of questions regarding what exercises or activities can be done safely throughout pregnancy. ACOG's Committee Opinion 267, summarized here by the British Medical Journal of Sports Medicine is a useful reminder of guidelines for exercising safely in pregnancy.

A year ago I added a "Prep The Pelvis" activity to my classes which includes good pregnancy posture (including "sitting on the sitz" as Gail Tully calls it), using 'Bertha' (the name for our ball) to ease discomfort, hamstring, psoas and groin stretches, the pelvic tilt and transversus exercise. But ever since reading an Ina May Gaskin quote a few years ago ('Squat 300 times a day and you are going to give birth quicker') I have also been extolling the virtues of yoga style deep squatting throughout pregnancy to ready the pelvic floor, assist with descent in the 1st stage and use as a non-medicated pushing position in 2nd stage.

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 work if a person is not already used to doing them and can put their knee ligaments into an unstable position. An alternative version is demonstrated roughly a minute into this 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 fifty or so clips and articles I've reviewed wisely suggest consulting a care provider prior to beginning. But only a few of the web articles differentiate between the parallel and deep squat and even less listed any contraindications to doing deep squats - like hemorrhoids, vasa previa, placenta previa or a breech lie. But perhaps the more serious contraindication for squats is lightening (when the baby descends into the upper pelvis) which normally occurs around the 34-38 week mark in primips but could be earlier or later.

I have always thought and taught that a first-time parent's cervix dilates completely to 10cm before the baby enters the vagina. However, Nichols and Randal (Vaginal Surgery, 1989) claim that in most primips, the engaged head inside the thinning cervix often occupies the top third of the vagina for the last few weeks (or more) of her pregnancy and causes vaginal distention (swelling). People feel this as a 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" (lightening).

In order for lightening to happen, the top of the sacrum moves slowly up and out of the pelvic interior so the baby's head can enter into the pelvic inlet. The lumbar spine flattens (referred to as counternutation) and the cervix ' which has been pointing towards the back in pregnancy ' must now rotate anteriorly towards the vaginal opening for labor to progress.

Occasionally (and seemingly becoming more common) the baby's head enters the top of the pelvis posterior or too deeply to allow the cervix to rotate. Both of these positions can obstruct 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 encourage as the baby "drops" are deep squats. Deep squats encourage further progression downwards which may further engage a breech bottom, a posterior head or force an occiput deeper into a posterior cervix which could struggle to rotate.

So if indeed you are asked about or encourage deep squats in pregnancy, be sure to explain not only what the contraindications are but also how and why a deep squat could become a potential hazard as the baby begins to lighten. Better to use deep squats in labor once contractions are established and the baby rotates anterior instead of potentially obstructing labor without realizing why.

Is this news to you? Have you been educating pregnant people of the risks of deep squats in the third trimester for years? What other exercises do you demonstrate, facilitate or advocate in your classes? Please share your thoughts in the comments section below.

Photo of Serena Williams '© Serena Williams

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

About 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. Connect with Mindy through her wesbite, Learn4Birth.com or her Facebook page. A native of the Philadelphia area, she spent 20 years in London before relocating to Redlands, CA in 2010.

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