Belly Mapping article
Belly Mapping teaches a pregnant woman to tell her baby's position for herself - during the last month or two of pregnancy. Visit Belly Mapping on Facebook and tell us your experience with this activity!!
Too often, the posterior (sunny-side up) baby isn't identified until labor is troubled. Mothers ask, sometimes after a cesarean was done for a long, OP labor, “Why didn't anybody know? Can't the nurse or doctor tell when doing an exam?” Trying to feel fetal head position with an internal exam is difficult. Fortunately, other clues exist. Click here to go to the entire Baby Positions section for details on fetal positions.
The following article is a variation of "Belly Mapping: Using kicks and wiggles to predict posterior labor" in
Vol. 12. Issue 4 (Fall 2004) International Doula, a quarterly publication of DONA International (previously Doulas of North America).
This page is simply an article, not the workbook.
Please, don't copy this Belly Mapping article for public use, it is copyrighted by DONA International and used here at Spinning Babies with permission. If you didn't get written permission from DONA you don't have permission to use this Belly Mapping article, or any portion of it, on your site, even as a pdf. But you may either link to it, or set up a wrapper page and have this page appear in full on your site without copyright violations. Download the free Belly Mapping parent handout in English, or in Spanish: De Mapeo del vientre los padres.pdf
Belly Mapping by Gail Tully, BS, CPM, CD(DONA)
Belly Mapping is a three-step process for identifying baby’s position in the final months of pregnancy. Parents can use Belly Mapping for their own enjoyment. Medical care givers can enhance their skills by using the visual clues of Belly Mapping. Doulas will be able to suggest strategies for fetal repositioning when a posterior lie is suspected.
Most women, in the ninth month, can tell without Ultrasound if their head down baby is facing the right, left, front or back. A few women, though, will find it hard to use Belly Mapping alone.
Firm tone, abundant amniotic fluid, a placenta on the anterior wall, or a well-padded tummy can mute the kicks and bumps from which to map baby parts.
Mothers often know more about their baby’s position than they first
think. If a woman hasn’t already, encourage her to take a day or two to learn her baby’s habits. She will notice more details of baby’s movements when she is semi-sitting and breathing deeply and slowly.
Julie, on the left, feels for her baby's head. It feels a bit like a ball deep inside the pubic bone. On the right, she finds the bottom on her left and baby's feet on her right.
Step One: Draw a pie. Step 1, draw the belly in four quadrants
Draw a circle with four parts, or pie pieces. Imagine you are drawing a map of your abdomen. The top is your fundus, or the top of your uterus at the end of pregnancy, about the 7th or 8th month.The bottom is where your pubic bone is. Your right side is on the left side of the paper map, and your left side is on the right. Just like looking in a mirror.
Make marks on the paper where you feel kicks and show where you feel big ones and little ones. Show where a big bulge pushes up occasionally. If you know, draw a heart where the doctor, nurse or midwife finds the baby's heart beat. Is one side of your belly a lot firmer than the other side when you lay down? Draw a line or write firm on that side.
Its easier to tell the baby's body parts if you divide the womb into four parts
The four pie pieces each offer clues to baby parts therein!
The mother draws where she feels a bulge and the firm side of the womb
With words or with pictures, the mother or doula marks each quadrant where she feels:
The biggest kicks,
Smallest kicks or wiggles,
The firm back, A big bulge, usually up top, or on one side or the other
If you know, circle where the head is, and
If you remember where the heartbeat was last heard, draws a heart there.
Leave out any parts you are unsure of, and just draw what you are sure of.
Step Two: Visualize the baby
Barb begins by putting the doll's head downwards
Barb begins by putting the doll's head down near her pelvis.
Get a cloth doll or teddy bear.
Match the toy feet to the feet on your “map,” and so on.
Choose a doll or bear with bendable arms and legs.
LOA baby (left)
To make Belly Mapping easier, keep in mind three opposites in the baby’s body:
The head and the bottom are found in opposite halves of the
Head and bottom
Tummy and back
Feet and hands
This drawing shows an ROT baby. See below for meaning of letters.
These opposites show up in opposite sides of the “pie.”
The bottom is always opposite of the head, up when the head is down. So, when head down, baby’s feet are at the top, hands might be felt in the bottom half. (Feet kick stronger than hands.) Limbs are opposite the back. Knees bend, but when the legs stretch, the feet bulge out like a ball. Baby can make a triangular shape when straightening the legs. The bulge where the feet poke out seems rounded. Be reassured, the baby does not have two heads!
The mother sometimes feels the baby's parts as bulges and rising little lumps
Getting the parts clear in your mind gets easier with practice!
If a mother has been told her baby is head down, she holds her doll head-down with the doll's head near her own pubic bone.
The doll in front of the mother's pregnant belly
Put the doll's bottom where the biggest bulge is ...
A mother turns the doll so its feet are in the same “pie piece” that she feels the biggest kicks. A baby’s feet are on the belly side of the baby, so turn the doll’s back towards the other side of the “pie.”
If a bulging butt rises up, as it often does near the top of the womb, match the doll butt to that quadrant.
This bulge can be confusing, are both bulges feet, or is one a head? If the baby is head down, it can’t be the head. Is baby breech? (The head will not have legs extending of it [but the hips will!].)
Knees bend often changing where kicks are felt. A posterior baby’s knees may be the baby parts closest to the surface and can occasionally be felt close to the mother’s navel.
Opposite from the kicking feet is a firmness--the baby’s back. This is the quadrant where baby’s heartbeat is best heard at the clinic visit.
When completely posterior, neither side of the womb is particularly firm and filled in. Knees, feet and hands might be moving on both sides of the womb. Whenever hands are felt in the front, right above the pubic bone, the baby is facing forward.
Hands often feel like wiggles, or champagne bubbles might feel, if felt at all. In a head down baby, wiggles between the pubic bone and navel (not thumps on the pubic bone) are certainly hands. But in a breech, low wiggles can be a foot “tapping.” Other sensations in this area could be bladder pressure, forehead “grinding” in a face-forward baby, pubic bone shifting or, if deep, cervical ripening.
Now think of how a baby’s arms and feet move. They are always going to be more on the tummy side of the body and often near baby’s mouth.
When hands are in front, baby is posterior.
See pictures of painting babies on mama's bellies and our Lamaze ICEA Mega exhibit booth
If a mother can feel hands in front, baby is facing the front!
Step Three: Naming the Position
Sharing a common name for fetal positions helps us study and talk about birthing together. Three questions in this very specific order give us the position name:
1. Which side of the mother is the baby’s back on?
2. Which part of the baby is coming into the pelvis first?
3. Which side, front or back of the mother is that baby part along?
In this specific order, a one word answer tells us:
1. Mother’s side
2. Baby’s part
3. Mother’s side, front or back
The first answer, for instance, can be “Left” or “Right,” (“L” or “R.”)
An LOA baby is in one of the ideal starting positionsAgain, 2.) Which part of the baby is coming into the pelvis first?
The second answer tells which of the baby’s body parts is coming first that has importance in the birth process. The most common part will be Occiput.
The occiput is the bone shaping the back of the skull. Another landmark is the sacrum, which is the triangular shaped bones making up the base of the spine. “S” is used for a breech (bottom first) even if the feet come before the sacrum. The chin (“M for mentum) is used for face-first, and “Fr,” Frontum (brow), is for forehead-first babies, rare but adventurous variations.
3.) Which side, front or back of the mother is that baby part along?
The third and last letter is for the mother's front, back or hip. The words, anterior (towards the front of the body); posterior (towards the back of the body); or transverse (to the side or sideways) are used. If question one and question three have the same answer, we just use number three.
The fetal compass rose with the transverse lie shown (lower right)
Left Occiput Transverse
The left occiput transverse (LOT) is one of the ideal starting positions for labor.
Talking the talk: A Left Occipital Transverse baby has her
1.) Back leaning into mother’s left;
2.) Head down, and
3.) She's facing mother’s hip and kicking mother’s upper right abdomen.
We say she is LOT.
(When the words “transverse” and “lie” are used together, the baby is lying sideways in the womb.) When a baby’s back is up front we say “OA” rather than “AOA,” OK?
The feet can move in an arc over a quarter of the circle. Bottoms move a bit, too.
Fetal Position influences the course of labor.
The three anterior starting positions for labor
The three anteriors
The three “Anteriors,” LOT, LOA and OA are all ideal for the start of labor. Both LOA and OA require less rotation than LOT and may start a faster labor, but may be less common than LOT. Generally, few midwives or doctors pay strict attention to the actual head position so the LOT baby is very often called LOA or just OA.
Four starting positions often lead to (or remain as) direct OP in active labor. Right Occiput Transverse (ROT), Right Occiput Posterior (ROP) and Left Occiput Posterior (LOP) join direct OP in adding labor time. The LOP baby has less distance to go to get into an LOT position. The incidence of posterior babies at the start of labor is scantly studied, and existing studies almost universally ignore all but direct posterior babies.
The four posterior fetal positions
As labor begins, the high riding ROT baby struggles to ROA getting past the sacral promontory at the base of the spine, and then swings to LOT to engage in the pelvis.
Most babies go on to OA at the pelvic or perineal floor.
If a baby engages as a ROT he or she will commonly go to OP, but a few to ROA in midpelvis, and continue down to finish as either an ROA or OA.
Some of these babies will rotate quite easily, especially in mothers with round pelvises, good vertical positions with strong contractions and who have given birth well before.
Julie is delighted with her baby!
Childbirth texts estimate 15-30% of babies are OP in labor. Jean Sutton in Optimal Foetal Positioning describes that 50% of babies tend toward posterior in early labor upon admission to the hospital. My observations are that 75% of babies have their hands in front before early labor, indicating their backs are closer to their mother’s backs than her front. Strong latent labor swings about a third of these to LOT before dilation begins (in “pre-labor” or “false labor”).
The difference between the text books, Jean Sutton's and my observations indicates that some of the babies starting in a posterior position rotate before arriving to the hospital and then another set rotates before the average caregiver notices. In other words, no big problem. It's about a third that have a dramatic effect, and a few more that have some effect.
Only 5-7% of babies emerge directly OP, the rest rotate in labor. At least 12% of all cesareans are for OP babies that get stuck due to the larger diameter of the OP head in comparison to the OA head. It’s more common for ROT, ROP and OP babies to rotate during labor and emerge facing back (OA).
Due to the physical therapy background of DONA co-founder, Penny Simkin, our DONA birth doula trainings and annual conferences include helpful techniques for babies whose heads are less than ideally aligned in the pelvis. Two key books, Optimal Foetal Positioning and The Labor Progress Handbook, give caregivers non-surgical strategies with movement and gravity.
Belly Mapping is a pleasant, bonding experience for a family. Fears about posterior fetal positioning should be reduced with a calm and confident response about a variety of solutions a mother can choose from. Simple demonstrations of some of the techniques taught in doula trainings, such as the Abdominal Lift, the Lunge and the Open Knee Chest will reassure parents that rotational support is available.
The "Three Anteriors" babies have the easiest time, now, rotating to the final birth position of Occiput Anterior.
When baby is descending well in a posterior labor, it is usually ok. The exception happens with a labor in a woman with a smaller, usually triangular or "android" pelvis shape. If the presenting angle of the fetal head makes the head seem too larger for her body, a quickly progressing labor will bring a surprise ending. After a pretty normal seeming first part of labor, there gets to be a long time with no more fetal descent. The baby is often born with cesarean surgery. If the posterior baby can back up and try again, there is hope for a vaginal birth. To help the baby do this, an inversion of some type is necessary.
thank you so much for you wonderful presentation this weekend in Atlanta.
I learned so much and am excited to share these helpful and practical tools with my moms-to-be. As a fairly new doula I was having difficulty actually 'seeing' the fetus during labor, but your 'mapping' technique has helped me there as well. I can't wait for my next birth!
Guina Bixler, a CAPPA doula who attended the Georgia Birth Network sponsored Spinning Babies Workshop in April 2005
Simkin, Penny and Way, Kelli (1998) Position Paper: The Doula’s Contribution to Modern Maternity Care Position Paper Doulas of North America (DONA)
Simkin, Penny (1991)Just A Day in a Woman’s Life? Women’s Long Term Perceptions of Their First Birth Experiences, Part 1 Birth: Issues in Perinatal Care 18:4 December
Gardberg, M. and Tuppurainen, M. (1994) Persistent occiput posterior presentation – a clinical problem. Acta Obstetrics Scandinavia 73: 45-47
Fitzpatrick, M. et al. (2001) Influence of persistent occiput posterior position on delivery outcome. Obstetrics and Gynecology Vol. 98, No. 6, December
Ponkey, Susan et al. (2003) Persistant Fetal Occiput Posterior Position: Obstetric Outcomes. Obstetrics and Gynecology Vol 101, No. 5 part 1, May
Sutton, Jean and Scott, Pauline (1996 )Understanding and Teaching Optimal Foetal Positioning, New Zealand, Birth Concepts
Simkin, Penny and Ancheta, Ruth (2000) The Labor Progress Handbook Blackwell Sciences
(See the expanded new edition published in 2005)
From an online forum, June 30, 2010
R: "I still can't figure my baby out."
H: "well, if i remember correctly, occiput left is what you want, meaning little [r's] face is facing your back and the rest of 'em is hanging around on the left side."
R: "ooh that was exactly what I needed to know!!!!!!!!!! Thanks!!!!! Last update was that the midwife thinks baby is occiput *right* but I don't think the right/left is too big of a deal. At least the midwife thinks baby is no longer posterior and thankfully not breech."
Gail adds here, If you think head down is the end of the story, you haven't read the book. Women pregnant with their first babies, or who are planning their first vaginal births, will benefit in spending time each day to balance their bodies with simple exercises. Read here about babies who are head down with their backs on the right and their faces towards the mother's left hip (ROT) or facing the front (ROP) and if the back can't be felt because its right along the mother's spine (OP, Occiput Posterior).