Squatting For Birth or in Water Tubs: Women 'Take Control' of Birthing Positions

History shows that opting for these 'comfortable birthing positions' was actually the norm.

When Roopa Sajwan, a 43-year-old Delhi-based entrepreneur, was pregnant with her second child three years ago, she was staunchly against the idea of giving birth at a hospital. All she wanted was a natural birth with minimum intervention from outside.

That, she says, led to the most peaceful labour and delivery experience she could have asked for. She delivered her child in all fours – a version of a squatting birth.

But why would a woman in the 21st century opt for home births or delivering at birthing centres, especially if and when she can afford the best of medical facilities.

For Sajwan, it was about trauma.

Trauma, Lack of Consent: Disregard For a Mother's Body

A little over 11 years ago, when Sajwan was pregnant the first time, doctors, nurses, and the maternity hospital where she’d delivered her baby girl gave her "enough trauma to last a lifetime," she tells FIT. 

“When I went into labour, the doctors induced an artificial labour which was not necessary. They did so because it was convenient for them as the doctor had to leave for somewhere. It was a torturous experience – and I ended up getting a third degree tear.”

For her second pregnancy, Sajwan took control – and opted for a natural birth, in a hospital setup, assisted by a doula and nurses.

“When I was in active labour, I wasn’t able to sit. I couldn’t even lie down. At the hospital, I held the bed and kneeled down. I gave birth while I was on all fours.”

Roopa Sajwan

Samantha Evans, a UK-based former nurse and sexual health expert, too chose to have home water births when she was pregnant with her second and third babies.

“(My first hospital birth) experience was traumatic, chaotic at times, and mismanaged. I had no control over decisions being made. I complained that the epidural wasn't working but was ignored, then I discovered it had fallen out! Everything about the delivery was intensely painful. Our daughter had to be delivered by ventouse and had to be resuscitated outside in the corridor as the room was too small.”

Samantha Evans

Evans, too, chose to have water births at home with the support of a midwife and a general physician. 

For Evans, these experiences weren’t just free from the hassles of a hospital, but were less painful and easier for her to manage too. She tells FIT:

“Although these deliveries were 19 and 21 years ago, I still remember them and would recommend a home water birth if anyone wanted one.”

Not All Who Opt For This Have Prior Bad Experience

Evans and Sajwan both had prior bad experiences that led them to these decisions.

But for Supriya Sharma (32), who works with a multinational corporation in Bengaluru, the decision came out of the urge to give birth “naturally without any medical interventions.”

She did consult a few hospitals but realised that they won’t be open to accommodating her choices when it came to the birthing position, pain relief measures, or anything else too.

She finally consulted a birthing centre where she went in for a natural water birth.

“I brought my baby into this world in a knee-down position because that worked for me and my baby. Going the natural way felt right for me.”

Supriya Sharma

There's Science At Play Here

More and more women are now opting for home births, water births, and standing births and moving away from convention, Dr Deepika Aggarwal, Senior Gynaecologist and Obstetrician, at Gurugram’s CK Birla Hospital, tells FIT.  But to be fair, this wasn’t always the norm.

“When women are squatting, it helps open the pelvis outlet. The woman would need assistance with two people holding her hands, but it will be easier for her since she’ll be more in control and can apply pressure with comparatively less pain.”

Dr Deepika Aggarwal

In positions where the woman is even slightly mobile or vertical, gravity works in her favour too. 

Dr Sunita Verma, Director – Obstetrics & Gynaecology, Fortis Hospital, Shalimar Bagh, tells FIT:

“Staying upright, walking around, squatting, sitting on a birthing chair or a ball – all these help tolerate the pain better. Even rocking your pelvis can help it open up. Squatting actually aligns your pelvis and the baby perfectly which causes less pain during delivery.”

Neha Misra, a childbirth educator and doula based in Bengaluru, also emphasises that women are not actually moving away from medical science.

“At birthing centres and home births, general physicians, doulas, nurses, or gynaecologists are supervising these births,” she says.

In 2017, Scroll.in reported that after Delhi’s Sitaram Bhartia Hospital moved towards midwifery, the hospital’s caesarean rate fell from 79 percent in 2001 to 28 percent in 2015.

This is the only such data available in public domain.

Misra, who assisted Sharma and Sajwan in their deliveries, says that there are more reasons that women are making these choices:

• Women are equipped with all the important pregnancy knowledge, they don’t have to blindly follow what the doula or doctor is telling them.

• They are having fewer children so they’re getting the luxury to focus on the process.

• Women are realising that they don’t need an unnecessary surgery when natural births are possible.

Dr Aggarwal, in fact, says that it's a significant development that while these "birthing choices" are still not accessible to everyone, women are increasingly getting to make these choices on their own.

"Birthing options should be the choice of the patients which healthcare professionals should discuss with them, to help them make the right decisions – as long as it doesn't compromise the safety of baby and mother."

Dr Deepika Aggarwal

Going Back to the Past Or Modern Way Forward?

History, however, says that opting for these 'comfortable birthing positions' was actually the norm.

A 1987 study, titled The Evolution of Maternal Birthing Position, published in the American Journal of Public Health, depicts a bas-relief in an Egyptian temple where Cleopatra is delivering a baby while kneeling on the ground.

According to the 1987 study, François Mauriceau, a French obstetrician, was of the view that a reclining position would be more comfortable for the pregnant woman as well as the person facilitating the birth.

In his book, titled The Diseases of Women with Child and in Child-Bed, published in 1668, he wrote:

“The best and surest is to be delivered in their bed, to shun the inconvenience and trouble of being carried thither afterwards.”

In the Indian context too, sculptures across timelines show women giving birth in different positions.

But Most Doctors Still Recommend Supine Births

However, doctors still advocate for supine (laying down on your back) births in multiple cases to avoid complications. Dr Verma explains that doctors find it easier to supervise and take control of the situation. 

“Sometimes, during labour, we have to apply vacuum or use forceps. We need to monitor the baby’s heartbeat. We need to ensure postpartum haemorrhage doesn’t happen. We might have to expedite the delivery in critical situations. In all these cases, management becomes easier when the patient is supine.”

Dr Sunita Verma

She goes on to add that there are several other reasons as well that doctors still prefer the now-conventional birthing position. 

• Many women are administered with epidural anaesthesia during labour which leads to a sensory blockage, resulting in decreased muscle power and overall weakness in the body. 

• In cases of prolonged labour, squatting becomes a difficult position to maintain.

There are no laws prohibiting home births in India, but several states have specific policies encouraging people to opt for institutional deliveries – especially those from lower income groups.

However, whether giving birth at a hospital or a birthing centre, doctors maintain is that standard protocols and precautions need to be followed to avoid any kind of infections and complications.