University of Virginia Library

2. SQUATTING.

This position naturally follows the erect sitting posture, although the body is always inclined forward to a certain degree; it is hardly to be defined with exactness, yet we may, in a general way, consider all postures as squatting which

resemble that assumed in defecation. Though apparently inconvenient, and repugnant to the refined woman, this position is certainly the most natural one for expulsion from the abdominal or pelvic viscera, and will certainly, in many cases, facilitate labor. Thus a friend relates his experience: A colored woman, a house servant, carefully reared, who had undergone several very difficult labors, in her fourth or fifth pregnancy, feeling a little uncomfortable and desiring to be ready, took a pail and went to a pump for water. She carried it for twenty or thirty steps, and arriving at the gate, felt violent contraction. She set the pail down, squatted, and was delivered of her child.

"So easily she yields her bosom's load

You'd almost think she found it in the road.''[32]

In other confinements she had assumed the squatting position, and was easily delivered.

Then, again, he tells me of attending a lady of good position in society in two labors. "In her first labor, delivery was retarded without apparent cause. There was nothing like impaction, or inertia, yet the head did not advance. At every pain she made violent efforts, and would bring her chest forward. I had determined to use the forceps, but just then, in one of the violent pains, she raised herself up in bed and assumed a squatting position, when the most magic effect was produced. It seemed to aid in completing delivery in the most remarkable manner, as the head advanced rapidly, and she soon expelled the child by what appeared to be one prolonged attack of pain. In subsequent parturition, labor appeared extremely painful and retarded in the same manner; I allowed her to take the same position, as I had remembered her former labor, and she was delivered at once, squatting.''

The Irish, also, are familiar with this most natural of all positions, although the knee-elbow position is more common among them. A striking instance is related to me of a poor Irish woman who was found upon a vacant lot in New York city, squatting upon the ground, endeavoring to express the placenta, the child having already been delivered in the same position.[33]

Dr. John Williams, physician to the Green Bay Indian Agency, seems to consider with great favor this position as assumed by the Pawnee Indians. He has had extensive experience as Agency physician, having been associated with different tribes of Indians in different localities, and he does not think that climate has anything to do with the labor of the parturient woman. He says: "I am satisfied that the Pawnee Indian women are far more exempt from the maladies resulting from parturition than the Menemonee, Stockbridge, or Oneidas of Wisconsin. Possibly this may be attributed to the position assumed during labor. The position of the Pawnee woman in parturition is generally

a squatting one with the Indian woman who assists her squatting at her back, the two being back to back, and the accoucheur, who is generally a medicine man, in front of her upon his knees, with a gourd in one hand, which he rattles constantly, and a pipe in his mouth which he smokes blowing the smoke under the clothes or covering of the patient until after the delivery of the child.'' Evidently, a warm vapor bath to soften the parts. Precisely the same position is assumed in West Micronesia, where the mother during the expulsive pains, assumes a squatting—half-sitting,

FIG. 10.—Pawnee Labor.

[Description: Medicine man rattles gourd and blows pipe smoke towards abdomen of squatting pregnant woman. Another woman squats nearby. Black and white illustration.]

half-lying position, her back resting against the back of an assistant.[34] So also the Wazequa women squat during labor.[35]

Others of our Indians, than those already mentioned assume this position, with slight variations. Thus[36] the Nez-Percés and Gros-Ventres: during the first stages of

labor the woman is in a stooping posture, with the buttocks resting on the heels. An assistant places herself back of the patient, clasping her body with her arms, letting the fingers reach below the ribs over the base of the uterus, making steady pressure backwards and outwards during the pains. During the third stage, or expulsion of the child, the patient, however, lies down indifferently on either

FIG. 11.—Squatting Posture of the Tonkawas.

[Description: Pregnant woman in squatting position. Black and white illustration.]

side or on the back, while the pressure by the hands of the assistant is kept up continuously, if on the side; if on the back, the assistant remains by the side of the patient and keeps up the pressure in the before-mentioned directions. In difficult labors the knee-elbow position is assumed. The Tonkawas retain the squatting posture until after the expulsion of the child:[37] so also the Coyotero or White Mountain Apaches: "The Coyotero squaw occupies any position she pleases, generally standing or walking, until bearing down pains supervene, when she assumes the squatting posture until after the birth of the child and placenta; but in tedious cases the patient is suspended in a half-kneeling position by a lariat from the limb of a tree and the child stripped out, as it were.''[38]

A slight variation of this position is found among some of the larger branches of the Sioux Nation, the Brulé, Loafer, Ogallala, Wazahzah, and Northern, who stoop, and with their hands grasp deer-thongs attached to stakes driven into the ground, against which they pull.[39]

The Mexican half-breeds, in New Mexico and vicinity, sometimes suspend a cord from the ceiling, with a stick attached, so that the women can seize it in a half-upright, squatting position.[40] The same we find among the Kalmucks upon the borders of China and Russia, and not unfrequently during the third stage of labor they squat lower in bed on their heels, whilst holding with their hands on to a pole, the abdomen being pressed from behind by an assistant.[41]

The squatting position, with the body bent forward, is assumed by the women of Southern Arabia in the vicinity of Aden, who, however, rest their hands upon the ground instead of crossing them upon the breast, as the squaw does. But, among these people, as among so many of our Indians, and the tribes of Africa, massage is freely resorted to if any obstruction seems to prevent the labor, sometimes with the hands, sometimes with the feet; in the latter case, the assistant, standing with her heels upon the lower ribs, works the fundus of the uterus with her toes.[42]

Every people varies its customs a little. The Polynesian and Australian negresses squat, as in defecation, over a small hole which they have scratched in the ground for the reception of the child.[43] Ploss also states, upon the authority

of Dr. Pollak, physician to the Shah, that the Persians are sometimes confined squatting on the ground, cross-legged, sometimes kneeling or sitting cross-legged; but it seems that the most popular position, and the one which appears to me to be far the most natural, and which bears a strong resemblance to our semi-recumbent position, whether in bed, or in the obstetric chair, or on the husband's lap, is the squatting position, as represented in the illustration of a woman with her legs apart, supporting herself upon her arms on a pile of three bricks, which she has placed on

FIG. 12. Obstetric Position of the Persians.—From Ploss (after Pollak and Haentsche).

[Description: Front and side view of a pregnant woman supporting herself in a squatting position by placing her hands of stacks of bricks on either side of her. Black and white illustration.]

either side of her. In this position we have a remarkable illustration of the points which are developed in every perfect obstetrical position, namely, absolute relaxation of the muscles of the lower extremities and the pelvis, and separation of the limbs, in order to allow space for the passage of the child. The strain, if there be any, being upon the muscles of the arms and the chest.

The Zuñi women of New Mexico are delivered in this same position, which we may call a squatting one, and which is described to me as "half standing and half sitting;'' an attendant supports the patient, and facilitates expulsion by pressing the abdomen from above downward.[44]

In the neighboring Laguna Pueblo pretty much the same custom is followed. In the early stages of labor the patient stands, as she urinates, with her hands on her knees; later, she stands up, supported by a woman on each side, or a rope is cast over a joist of the roof and allowed to hang down in a wide loop; she puts her breast in the loop and holds on to the ascending ropes, her feet on the floor, in a half-sitting (squatting) posture, thus obtaining great expulsive force; if tired and worn, she lies down. All these positions are assumed at the choice of the patient or the advice of her assistants, two to six in number.[45]