Recently, I’ve heard from a couple of mums that they’ve been told that birthing in a squatting position is a bad idea.

They’ve been told that makes it more likely that they’ll have a 3rd or 4th degree perineal tear and/or increased blood loss after their baby is born. So, is there any truth to this?

A Look at the Research

Well, information from the research is mixed, but the main findings for birthing in a squatting position were:

  1. There doesn’t seem to be any connection between upright positions, such as squatting and increased blood loss. This differs from findings reported in other studies. These studies were unreliable as blood loss was estimated (not measured objectively).

    When researchers measured blood loss scientifically, it was less or the same in upright positions as in the lithotomy position.

  2. In one very large 2015 study of 113,000 women, the highest rate of 3rd and 4th degree tears occurred in the lithotomy position. Women who birthed their baby standing were the least likely to have a 3rd or 4th degree tear.

  3. A small study in 2016 reported that squatting while holding onto a bar reduced the length of the second stage. Mothers reported less pain in labour. These mothers also were less likely to require oxytocin (to strengthen their contractions) in labour.

  4. The research found using a birth seat or squatting, slightly increases the rate of 3rd and 4th degree tears for women who have given birth before. There isn’t any evidence that this is the case for first time mothers.

    The authors thought that this might be because Western women don’t squat very often. This might make it more difficult for the women to control the birth of the baby’s head. And this is important for reducing large tears.

So, to summarise; avoiding the lithotomy position can help you to avoid a large perineal tear. Adopting upright positions in labour generally leads to a shorter labour. It doesn’t increase blood loss after the birth.

lastly, if you’d like to birth your baby in a squatting, practice squatting regularly during your pregnancy!