When we think of labor preparation movements, typically we think of deep squats with really wide knees. You may have been told it’s important to be able to squat because squatting helps with labor progress.
Preparing for labor?? Deep squats.
In labor?? Deep squats.
Pushing?? Deep squats.
But… there is more to birth than deep squats. Let’s explore why doing only squats may not actually be preparing you for birth!
First, what is the internal and external rotation of the femur?? Internal rotation of the femur is when the femur, or leg, is twisted towards the midline. Think knee in, ankle out. External rotation of the femur is when the femur, or leg, is twisted outwards or away from the midline. Think wide knees, toes pointed out.
1. There are several pelvic levels, and they all open in a different way.
There is no one movement that will open the entire pelvis. Squats won’t open the entire pelvis. This may be hard to believe, after all, we are told to do squats at literally every point of labor thinking it will help with progress. Deep squats with wide knees help to open the inlet of the pelvis, or the top of the pelvis. This external rotation of the femur (wide knees) helps to increase the pelvic diameter more side to side, which can help the baby enter, or engage, into the pelvis.
But the next pelvic levels need more than external rotation: we need to be able to find internal rotation too.
2. Internal rotation of the femur helps with the baby’s rotation through the pelvis
If we are externally rotated at the femur, we will see the pelvic outlet decrease in space. This can make it challenging for the baby to rotate through the pelvis. This difficulty in the rotation could cause a labor stall, or cause the baby to get “stuck” during birth.
During pregnancy, we may favor a more externally rotated position due to postural adaptations; we may shift into more of a posterior pelvic tilt with rib sway back posture that emphasizes external rotation at the femur. Or we may shift into more of an anterior pelvic tilt with rib thrust, that tightens the posterior half of the pelvic floor, making internal rotation more challenging.
Internal rotation of the femur helps the pelvic outlet open more. Internal rotation moves the ischial tuberosities, or the sitz bones, further apart, and increases the pelvic outlet diameter side to side. When the baby is rotating, being able to find internal rotation on one side can help the baby finish its rotation. When you are pushing, being able to find internal rotation on both sides can help baby extend their head under the pubic arch for birth.
If we can incorporate exercises into our prenatal workouts that help us find internal rotation, as well as external rotation, we can better prepare for birth. Only doing deep, wide knee squats will not help in our preparation. We need to be able to have a full range of motion within our pelvis. We can use clamshells with external and internal rotation focuses to work on being able to find both rotations in the hips.
3. Internal rotation helps with pelvic girdle comfort
If we are favoring more of an external rotation in the femurs, or even uneven or torqued position in the pelvis (favoring more of an external rotation on one side, for example), it can affect force closure at the pelvic joints (sacroiliac joint, pubic symphysis). If there is compensation during our gait, or within the pelvis, we may find that there is pelvic girdle pain (pain with single leg or pivoting type movements).
The anterior oblique sling and posterior oblique sling help to stabilize the pubic symphysis, front pelvic joint, and sacroiliac joints, the back pelvic joints. Both slings utilize internal rotation towards the midline to help with force closure on the pelvic joint. The anterior oblique sling has an internal rotation of the femur for force closure on the pubic symphysis; activating this sling helps to stabilize the front pelvic joint. The posterior oblique sling is on the backside, and counters the anterior oblique sling’s movement, with external rotation of the femur for glute activation and force closure on the SI joints. We can emphasize the strengthening of the posterior oblique sling by increasing the range of motion of the glute with an internal rotation at the bottom.
Here are a few examples of an anterior oblique sling and posterior oblique sling exercise combined. The reverse lunge + row utilizes the glute with opposite lat to stabilize across the SI joint, and then adding the knee press incorporates the anterior oblique sling. We incorporate exercises focused on helping to stabilize the pelvic girdle joints in our 3-Week Pelvic Stability Accessory program.
Another issue that we may have if we cannot find internal rotation, is that the tailbone may be painful. This is sometimes due to tension in the posterior pelvic floor. If there is an inability or lack of internal rotation, the posterior pelvic floor tends to have more tension. If we are one-sided with the tension (such as favoring a right or left stance), the pelvic floor tension can be one-sided, and pull the tailbone towards one side. Finding that internal rotation in breathing postures can help us release tension in the posterior pelvic floor, and may relieve tailbone pain.
Check out our Instagram post for some ideas on tailbone release exercises that focus on internal rotation.
3. How can we work to find internal rotation at the femur?
First, we can focus on our gait, or how we walk. When we walk, the pelvis shifts from being externally rotated to internally rotated on each side. When we step, the stance leg (the leg we are standing on) is in a posterior pelvic tilt, internally rotated, and in adduction. The swing leg moves forward into an anterior pelvic tilt, externally rotated, and in abduction. And then this switches from side to side with each step.
This shift from internal to external is how our pelvis should open and close as we walk. Sometimes, there is compensation in this gait which can lead to pelvic girdle pain and ultimately may affect labor.
Then, we can emphasize this shift with one-sided or unilateral movements, such as step-ups and lunges. See the video below for a breakdown of how to use single-leg movements to emphasize internal rotation!
When we are preparing for labor, we want to also incorporate movements that emphasize internal rotation! Only doing deep, wide knee squats, will not prepare us for birth, as the pelvic does not open with only wide knee movements. We need to also be able to find internal rotation to help facilitate the baby’s rotation through the pelvis and labor progress!
Our 40-Week Prenatal Strength & Conditioning programming incorporates both external and internal rotation at the hip movements to help prepare you for labor. You can start our program at any time, as we sync the program to your week of pregnancy & offer monthly payment options (only pay for the months you need). If you are 20 weeks, you’ll start on week 20 of our program; if you’re 35 weeks, you’ll start on week 35 and only pay for the month you need.
Learn more about prepping for labor in our monthly pelvic floor prep for birth webinar and our labor biomechanics webinar. Both webinars break down movements that you can do to prepare for and move through labor by connecting with your amazing body!