This is a review of why and how the obstetric staff at Trinity Hospital, a traditional hospital in Montana, incorporated the squatting position for birth. During the 16-month period of this study, 45 of the 152 vaginal deliveries were in the squatting position. Benefits of the squatting position discussed here include ability to push more effectively, encouragement of the rotation of the fetal head to an anterior position, better access to the woman's back, abdomen or sides for massage, and women feeling more in control of themselves. (BIRTH 12:2, Summer 1985)This paper describes practical methods for using the squatting position for birth in a traditional hospital setting. Trinity Hospital, an acute care facility with 42 beds in Wolf Point, Montana, has had 179 deliveries during the period of this study (August 15, 1983 to December 3 1, 1984), including 152 vaginal deliveries of which 45 were in the squatting position. Approximately one-half of the women are of Native American descent. Many are of low socioeconomic status and are considered to be at moderate to high risk of perinatal complications. The goal of this paper is to describe why and how we incorporated the squatting position for birth into this traditional hospital setting.Since 1981 we have encouraged the use of squat pushing t o encourage fetal descent in prolonged second stages, but never for the actual delivery of the baby. In the fall of 1983, we had a, delivery in which the mother had been pushing for over an hour with no progress. The fetal heart tones began slowing ominously. As a last resort, we took the mother out of stirrups and assisted her into a squatting position. Within Jude Kurokawa, R.N., B.S.N., is a labor and delivery nurse at Trinity Hospital and matemallchild health nurse for Roosevelt County Health Department. Address inquiries to 513 Dayton St., Wolf Point, MT59201. Mark W. Zilkoski, M.D., is Assistant Director of Education in the Department of Family Practice, Medical College of Ohio. Address inquiries to 26680 Sheringham, Perrysburg, OH 43551. minutes she delivered a 10 lb. 4 oz. (4649 g) baby over an intact perineum. In response to interest in the squatting position for birth, a maternity nurse began showing the film "Birth in the Squatting Position" by Polymorph Films1 to the doctors, childbirth classes, and members of the hospital staff. Interest was expressed in trying the squatting position for delivery on a trial basis.In December 1983, August Dowe of the Assiniboine and Sioux Tribal Industries, fabricated a "squat bar" consisting of a stainless steel rod that is bent into three sides and fits in the same holes where the stirrups usually go on a delivery table. We use either the delivery table with the squat bar or the labor bed for squatting deliveries, depending on the wishes of the doctor, parents, and the situation (Figures 1 and 2). In the squatting position the pelvic outlet increases an average of 28 per cent over its dimensions in the supine p o~i t i o n .~ There is evidence that when women in labor are encour...
