Abstract
BackgroundThe squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat.ObjectiveTo compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor.Study designThirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve.ResultsSpontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal.ConclusionIn squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.
Highlights
The squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities
In squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation
When comparing squatting positions, feet flat on the ground is closer to optimal birth conditions than on tiptoes
Summary
The squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. As demonstrated by previous studies and in particular in European region, this position is rarely used in countries where birth medicalization is important. This position remains, widely used in countries where childbirth occurs in non-medical facilities (38.9% in Nepal in 2012) [2, 3]. Among the hypotheses that might explain these results, we can envisage that the vertical position, like the squatting position, is closer to the theoretically best birthing position This position enables the axis of progression to be perpendicular to the superior pelvic inlet plane and to encounter the fewest obstacles by flattening the dorsal hinge (or with kyphosis) as we have described previously [5]. To reach these optimal conditions, the pelvic inlet plane has to be close to perpendicular to the lumbar spine according to obstetrical theory [5]
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