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Sayer Clinics > News

Squatting Childbirth is safer, quicker, less injurious with the 'mother in-control'.

My observation is that childbirth is more challenging in the 21st Century because women are older now at childbirth than in the 1960s, 70’s and 80’s and are generally more overweight, less fit and have stiffer joints and ligaments.

In hospital they are not generally enabled to squat, kneel or move around (central to natural childbirth) due to the 'stranded beetle' supine position necessary for the current fad of monitoring and medically controlling childbirth. Watch any TV programme about childbirth today and we see a woman lying on her back with painful, slow, completely medicalised labour which increasingly ends in exhaustion and too frequently a Caesarian section or forceps, ventouse or episiotomy with varying degrees of trauma to mother and child.

The problem with lying on your back or sitting semi-reclined on your sacrum and tailbone is that the birth canal opening, the pelvic outlet, is reduced by as much as 30%. Homo sapiens uniquely has very large-brained offspring relative to a woman’s pelvic outlet compared to all other primates. The overlapping of the skulls cranial bones at the fontanelles helps but without gravity, reclining means 'nothing to push against'. Modern women at childbirth in their late thirties are often physically disconnected, weak and unfit, often overweight or obese, can't push, find labour psychologically stressful and are quickly exhausted. Maximising the pelvic pathway for the baby's birth is common sense. There is no good medical reason to give birth on your back - and every reason to give birth in a safer position that works with gravity, female anatomy and physiology. 

Supported squatting or kneeling on all fours allows the pubis, sacroiliac joints and sacro-coccygeal joints freedom to stretch apart under the influence of the hormone relaxin and lets the unrestricted coccyx move backwards as the baby passes through the widened canal. This has always happened with all mammals - except for women in the last 200 years in the 'civilised' western world since Emperor Louis 14th decided on supine childbirth so his court could witness the birth of his heir. Strangely it has been the fashion since.

Supine positioning narrows the birthing canal and increases the risk to the baby of:

  •  need for forceps or vacuum/ventouse delivery
  •  broken clavicle/collarbone
  •  bruising 
  •  pressure on baby’s neck vertebrae
  •  excessive head moulding
  •  compression of umbilical cord
  •  hypoxic stress on baby from poor positioning of baby relative to pelvis
  •  brachial plexus injury
  •  broken humerus
  •  disruption of the baby’s oxygen supply 

and increased risk for the mother of:

  •  less effective contractions
  •  labour slowing and not progressing
  •  possible increased hypotension or pregnancy-induced hypertension
  •  ineffective pushing
  •  illusion of cephalo-pelvic disproportioin due to reduced pelvic diameter 
  •  increased risk of need for Caesarean section with all risks of major surgery 
  •  strain and tearing to the maternal tissues
  •  Increased rates of episiotomy
  •  back pain - risks of epidurals.
  •  fractured or dislocated coccyx/tailbone - moreso with forceps / ventouse.

The tailbone is designed to extend backwards as the baby’s head descends. Forceps or ventouse during birth can cause backwards dislocation of the coccyx, with extreme ongoing pain after the birth until manipulated by an experienced chiropractor back to a normal range of movement.

My study of sacroiliac movement in squatting childbirth lead me to the following logical mechanism: the mother's body weight acts down through the hip joints which in tandem with the loosening of the sacroiliac and pubic symphysis ligaments, act to flare the lower pelvic outlet. As delivery nears, the mother squats lower with her legs wider apart until the large thigh adductor muscles strongly stretch apart the symphysis pubis. Simultaneously the inferior sacrum glides posteriorally relative to the ilia under the pressure of the engaged foetal head bearing constantly down with gravity and maternal contractions. This further increases the outlet, the cervix dilates fully and effectively delivers the baby's head. The whole process of hormonal release and cervical dilatation is complex and finely tuned with body movement, gravity and soft-tissue stretching.

This delicate process is disrupted by lying supine with an epidural, often followed by injection of syntocinon to kick-start contractions which are slow (due to supine position) against a cervix which hasn't yet dilated sufficiently, causing increased intrauterine pressure, resulting in maternal exhaustion, foetal hypoxia and distress, leading to emergency Caesarian, increased risk of post-surgical infection. This is often followed by mastitis and then antibiotics. This disastrous cascade of intervention limits the exhausted mother's ability to bond with and breast-feed her baby. But this is all considered "normal" in the 'West' and, progressively, third-world countries follow the modern medical practice of supine childbirth.

It is NOT normal - and needs a total rethink based on tens of thousands of years of erect childbirth. Midwives should be well-trained and confident in natural childbirth with the back-up of modern emergency medicine as the optimal path

I have been fascinated by the genetically/geographically-related range of connective issue laxity and joint mobility in my patients from all over the world over four decades of clinical practice and I recently studied at University College London with Professor Rodney Grahame, the world expert on hypermobility. Collagenous ligaments, tendons and joints lose flexibility progressively with age which accords with my experience in treating pregnant women suffering sacroiliac subluxations, coccyx dislocation and fracture after forceps and ventouse births. It is also clear that mothers at childbirth are much older now than ever before in the history of mankind. 

21st century older mothers in their late 30's and early 40’s are less flexible and their sacroiliac, pubic and coccygeal range of movement is significantly reduced in comparison with mothers in their teens and early twenties which had always been the norm through millennia until the 1960's. The big change followed the advent in the late 60's of 'The Pill', widely available contraception, which gave women the freedom and the opportunity to delay starting a family and to enjoy a career.

Women now are largely sedentary at desk jobs with administrative computer and office work from their school and college days until their first maternity in their mid-to-late 30s and are often unfit, overweight and stiff jointed. 

Add to this the comparatively recently concept of giving birth semi-reclining or supine and there you have the reason for a continuing rise in rates of Caesarian section ... 25-30% of all UK births, especially in Northern European more hypo-mobile people . A large majority of the world's people ... Indian, Arab, African and Chinese are generally at the more flexible or hypermobile end of the spectrum of tissue and joint mobility and many in rural areas still easily give birth naturally by squatting. Northern European Caucasians, Celts, Germans, Scandinavians as well as peoples from some mountainous regions like Northern Pakistan and Japan are ranged generally towards the less flexible or hypomobile end of the spectrum ... making childbirth, particularly in now much older mothers, far more challenging. 

All the more reason to encourage squatting for safer, quicker, less injurious, and 'mother in-control' childbirth. Freedom to constantly move in an upright position helps the frequency, length, and efficiency of contractions to move the baby through the birth canal.

Michael Durtnall DC MSc FRCC Ortho
Fellow Royal Society of Medicine
Chairman: Sayer Back and Neck Pain Clinics London