This post first appeared on the Voices blog at Down Under School of Yoga: https://www.downunderyoga.com/blog-voices/the-problem-with-squatting-by-bec-conant

Malasana: The squat.

Of all the yoga postures I think this one was the most often associated with childbirth. We hear stories about how women have been using this mythic birthing posture for centuries. Even natural birth enthusiasts will wax poetical about the benefits of squatting, and how it can speed up the birth process. But is it really that simple? Should we all simply be squatting when pushing to help our babies fall out smoothly? To be honest, there is a way to squat which is quite useful, and another way which can literally get in the way of birthing smoothly.

The benefits of squatting come from a combination of the mobility built into the pelvic structure, and the specific alignment used when performing the position. Done properly, the squat can help to tone the musculature of the pelvic floor, align the birth path through the pelvis better with gravity if done in an upright position, and create more space between the pelvic bones if done with proper knee and thigh placement. Katy Bowman, an exercise physiologist in Seattle has suggested that rather than constantly practicing Kegel exercises we should simply squat properly to promote pelvic health and well-being. Done improperly however, and we can end up narrowing the very bones through which the baby needs to maneuver.

Let’s take a closer look at the mechanics involved in the squat.

**The lower segment of the pelvis changes shape depending on how we orient the thigh bones**

Comprised of 3 primary bones, the female pelvis is effectively a wide bowl to contain the organs of the lower body, and to support the weight from the upper body as it transfers into the legs. The bones create a central ring within which there are 3 joints; the two SI joints between the sacrum and ilium bones at the back, and the pubic symphysis joining the two pubic bones at the front. Because of the subtle articulation of these bones it is possible to make subtle changes to the shape of the pelvic bowl depending of where we place the femurs (thigh bones) which articulate into the ilium. This means it is not only possible to open more space when, say, a baby is moving down, but prior to labor it is possible to stretch and tone the connective tissue which surrounds and supports the uterus and other pelvic organs.

When we practice malasana, we bring the femur bones into full hip flexion pressing them up against the top rim of the pelvic bowl at the iliac crest. This pressure against the upward edge can subtly draw the top of the bowl together. As the top narrows, the base widens, and thus the outlet of the pelvis between the sitting bones is able to expand. For some it can expand as much as 1-2cm wider, a dramatic change when we think of the relative size of a baby’s head. So yes a squatting position can help in making space in certain areas of the pelvis. But for most women the style of squat they are encouraged to use during labor and birth involves spreading the knees wide and curling the tailbone forward. This position is also often done from a supine position rather than upright. The idea is that this position maintains the opening quality of the squat, while allowing good visibility and helped the baby to come under the pubic bone.

But there are two fundamental mistakes in performing a squat with the knees spread wide, especially if we are talking about labor and birth. The first is that in spreading the legs, we have inadvertently changed the position of the femur in relation to the pelvis and in so doing we have removed the benefit of the squatting position. With the legs apart the femurs press less against the top of the pelvis, but even more the external rotation of the femur bones closes rather than opening the lower pelvic outlet. It opens the top by spreading the ilium bones, but it closes the base where the baby emerges! The second problem in the supine squatting position is that when reclining there is less assistance from gravity. In fact given the curve of the sacrum, the head literally has to move uphill from a supine position, not the most helpful in making space for baby.

Learn about Preparing for birth with yoga

If we instead squat with our knees and toes facing forward, the femur bones come into better contact with the upper front side of the pelvic bones because the foot position encourages an internal rotation of the femur bone, which in-turn spreads and opens the opposite side of the lever- namely the sitting bones located in the lower back quadrant of the pelvis. In contrast, if the legs are spread apart, instead of continuing to widen the sitting bones we draw them together as the wing bones of the ilium rotate outward with the femurs. Put simply, external rotation of the femur equals less space between the sitting ones, not more. Try it for yourself. Squat with a yoga block beneath your hips and take the knees wide apart, feeling for how much the sitting bones spread. Now try the same action keeping the legs parallel? Even better, try squatting half way down as in Goddess squat, and actively tuck the tail, then try knocking the knees together and arching the tail backwards. Nearly always the second option will spread the sitting bones and the pelvic floor more than the knees out, tail tucked option.

External thigh rotation- moving the knees apart- bring the sitz bones together which means less space for birthing

Internal thigh rotation- knees parallel or moving together- combined with untucking the tail moves the sitz bones apart making more space

This exploration can also indicate how we might use a squat in preparing our bodies for labor. The muscles of the pelvic floor run from the front to the back of the pelvis as well as from sitz bone to sitz bone. If we want these muscles to be supple- that is able to both contract and release so as to be strong and soft- we need to find ways to stretch them. Kegel exercises are often used to tighten these muscles, but one very simple way to elongate them would be to squat in a way that spreads our sitz bones and moves the pubis away from the tail. For properly toning the pelvic floor, the alignment Malsana wants to be done with the feet turned forward, and the tailbone arching backwards rather than tucking under. For most people this will also mean either letting the heels leave the floor, or placing a rolled blanket under the heels to provide support. The result of this alignment is that the sitz bones spread from the pressure of the femurs against the upper pelvic rim, and the tailbone moves away from the pubic bone creating the most stretching possible within the pelvic floor muscles. During labor this same position would also mean the bones spread the farthest apart, making more space as the baby’s head descended through the pelvis.

A note of caution: There are certain times when you might want to avoid or modify squatting positions. If your placenta is low lying or covering the cervix, it is inadvisable to put further pressure downward especially if you are hoping for the placenta to move upwards. Additionally, if the joints of the pelvis are extremely loose, the full squat, with the hips deeply flexed and rotated is not advisable as it can place a great deal of strain on the internal pelvic joints. This would be an instance where having support such as a block or even a chair would be a good idea. If the bones can’t hold together, put something in place that will help them. For those sitting on a chair there can still be a great stretch on the pelvic floor by focusing on the forward tilt of the pelvis and deepening the breathing into the Kegel muscles. This action is key with hyper-mobility as the muscles will often become further contracted trying to hold the bones together.

The squat is a position which can be helpful during pregnancy and labor. When done with awareness and good alignment it can tone musculature and create more space for baby to be born. It can even be from a reclining or side-lying position, as would be necessary with an epidural. The key is to move the femur bones inwardly rather than splaying them apart, and to focus on arching the tailbone away from the pubic bone once the head is well engaged in the pelvis. This opens the bones at the bottom of the pelvis to their maximal size, and helps to release the pelvic floor, making room for baby to emerge.

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TLDR section- Because some of us are in a hurry

Squatting is helpful for both preparation and during the pushing stage of labor when it is performed properly
To tone the pelvic floor muscles, squat with the toes forward, the heels up, and the tailbone backwards. This should create a sense of spreading around the back of the bum
Proper femur alignment for squatting should involve internal rotation (not external) and a forward tilt of the pelvis. This can be helped by using a rolled blanket under the heels, and/or a block under the hips.
For pushing, initially as the baby descends the wide knee squat can help to open the top of the pelvis, but once the head is well engaged or can be seen, then internal rotation of the femur bones and sticking the tailbone back creates the most space for the baby to emerge.