What is Belly Mapping®?
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 and education, while medical caregivers can use it to enhance their skills via visual clues. Doulas are able to suggest strategies for fetal repositioning when a posterior lie is suspected. The main goal of Belly Mapping® is to enhance the parent’s ability to identify baby parts and to gain a sense of baby’s position.
Most people in the ninth month of pregnancy can tell without ultrasound if their head-down baby is facing right, left, front, or back. Some, however, find this hard to do through Belly Mapping® alone. Firm tone, abundant amniotic fluid, a placenta on the anterior wall, or a well-padded tummy can all mute kicks and bumps from which to map baby parts.
If a mother hasn’t already, encourage her to take a day or two to learn her baby’s habits. She will notice more details about her baby’s movements when she is semi-sitting and breathing deeply and slowly.
The three anterior starting positions for labor
The three anteriors — LOT, LOA, and OA — are all ideal fetal positions for the start of labor. Both LOA and OA require less rotation than LOT and may lead to a faster labor, but they may also be less common. Generally, very few midwives or doctors will pay strict attention to the actual head position, leading to the LOT baby often being referred to as LOA or just OA.
Why not ROA? ROA babies may have their chins up and this deflexed position may lengthen the course of labor. Less than 4% of starting positions are ROA, according to a Birmingham study. This might not be ideal for first babies, but is not a posterior position either.
The four posterior fetal positions
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 travel to get into an LOT position.
As labor begins, the high-riding, unengaged Right Occiput Transverse baby slowly rotates to ROA, working past the sacral promontory at the base of the spine before swinging around to LOT to engage in the pelvis. Most babies go on to OA at the pelvic floor or further down on the perineal floor.
If a baby engages as a ROT, they may go to OP or ROA by the time they descend to the midpelvis. The OP baby may stay OP. For some, once the head is lower than the bones and the head is visible at the perineum, the baby rotates and helpers may see the baby’s head turn then! These babies finish in the ROA or OA positions.
Feeling both hands in front, in two separate but low places on the abdomen, indicates a posterior fetal position. This baby is Left Occiput Posterior.
Studies estimate 15-30% of babies are OP in labor. Jean Sutton in Optimal Fetal Positioning states that 50% of babies trend toward posterior in early labor upon admission to the hospital. Strong latent labor swings about a third of these to LOT before dilation begins (in “pre-labor” or “false labor”).
This is one of many details included in the Belly Mapping® Workbook to help provide accuracy and insight into what to do about fetal positions.
Jean Sutton’s observation indicates that some babies starting in a posterior position will rotate before arriving to the hospital. Ellice Lieberman observed most posteriors will rotate out of posterior into either anterior or to facing a hip throughout labor. Only 5-8% of all babies emerge directly OP (13% with an epidural in Lieberman’s study). At least 12% of all cesareans are for OP babies that are 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 to emerge facing back (OA). Some babies become stuck halfway through a long-arc rotation and some will need a cesarean anyway.
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. The Labor Progress Handbook provides caregivers with non-surgical strategies utilizing movement and gravity.
What to do when baby’s position isn’t ideal
Belly Mapping®️ is a pleasant bonding experience for the family. Fears about posterior fetal positioning are reduced via 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 and the Lunge, help reassure parents that rotational support is available.
The “Three Anterior” babies have the easiest time rotating to the final birth position of Occiput Anterior.
When baby is descending well in posterior labor, it is typically okay. The exception occurs during labor in women with a smaller and usually triangular or “android” pelvis shape. If the presenting angle of the fetal head makes the head seem too large for her body, a quickly progressing labor will bring a surprise ending. After what seems like a normal first part of labor, there can be a long time with no further 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.
Check out our illustrated Belly Mapping® Workbook for further information and watch the fun video below of Belly Mapping®️ and belly painting at the Twin Cities Birth and Baby Expo created by Brook Walsh.
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).