Belly Mapping® Breech

There are two main ways to determine if a baby is breech: an ultrasound (imaging) and palpation (abdominal examination). Breech is sometimes very difficult to tell with palpation, and even if the doctor is sure, they’ll often recommend an ultrasound to get hard data to enter into the mother’s chart.

The Spinning Babies^® Parent Class video walks you through all the first steps we recommend for helping your baby turn head down on their own, or making an external version easier & more successful. Plus, you will learn the Spinning Babies^® approach that uses balance, movement, and gravity for comfort in pregnancy and an easier birth. You can also try our self-directed program for Helping a Breech Baby Turn.

Let’s dive into what each one is and the benefits of using them.

Ultrasound

An ultrasound, also known as a sonogram, uses high frequency sound waves to develop an “image” of the baby’s position inside the mother. When deciding if an ultrasound is right for you, here are some things to take into consideration:

An ultrasound is a more sure way of telling the baby’s position than simply feeling through the abdomen.
Your provider may want you to have a concrete way of knowing your baby’s position to help you make decisions from fact.
Some obvious problems may be ruled out with an ultrasound.

An ultrasound is justified if your care plan will change based upon what is found by an ultrasound examination. However, keep in mind that the ultrasound itself is not without any risk.

Benefits of a sonogram/ultrasound

The doctor won’t do a cesarean for a head down baby they mistook for a breech. And, if the parents desire a vaginal breech birth, a sonogram can locate the placenta, check for head flexion, and help the parents and physician predict what type of breech position the baby may be in once labor begins.

The legs can change position in early labor, so the actual position is not for sure until the baby is coming through the pelvis in the pushing stage of labor. Even some ultrasound technicians are not accurate at telling the finer details of fetal position, so parents should ask to have the baby’s position explained to them in detail.

Using a fetoscope

Listening with a fetoscope (also known as a doppler) may be helpful, but not diagnostic. A fetoscope is a handheld monitor that uses an ultrasound (sonogram) to detect the heartbeat. A firm tummy and ample amniotic fluid allows the heart rate to be heard a distance away from the baby.

Location of the heartbeat is not a reliable indicator since sound travels through water. Expertise with listening to many babies helps sort out the difference and can be an important clue, but is still not diagnostic.

Palpation

Gail feels the shapes of the presenting parts of baby. Is it a head or a bottom?

Gail feels the shapes of the presenting parts of the baby.

There is another way to tell the baby’s position, and that is by palpation, or feeling the baby through the abdomen. Palpation is not as reliable as an ultrasound, and not all women are as easy to palpate, which means it often requires far more skill to correctly interpret a baby’s position this way.

Parents may well want to see “proof” of breech presentation as well, to prepare themselves and make educated choices for childbirth. Finding out that the baby is breech can definitely change birth plans, whether to plan a cesarean, find a safe breech practitioner, and make the other necessary preparations.

How to perform a palpation

With palpation, we look for a cylinder shape coming from the firm bulge at the top of the fundus, which is the thigh coming off the buttocks. If we find cylinders low in the abdomen and a firm ball at the top, we need to consider a possible breech position.

Belly Mapping® a Breech

The drawings begin with the four quadrants of a belly map.

A simple circle can be drawn on a piece of paper, with two lines that cross at the navel. Next, draw the bumps and wiggles (see image below) that the mother with a breech might feel when she is lying down.

The kicks may not be stronger than the hand movements due to the legs being straight in a frank breech position. Then they can’t kick. A footling or complete breech may wiggle their feet on your cervix or bladder.

The head may be easy to feel at the top or hiding in the back.

Details that will help you think about what you are feeling:

When the feet are folded near the baby’s buttocks, the pelvis and feet together make a hard ball shape.
Feeling the folded feet and hips of the baby through the abdominal muscles and uterus can, at times, feel much like a head.
The head, however, tilts on the neck when moved by hand. Grasping and tipping the buttocks will move the entire trunk of the baby.
Sometimes the uterus over the fetal head in the fundus (top of the uterus) feels warm and tender.
When the baby is stretching a leg away from their body, the hips will have a cylinder shape emerging from it — the thigh. The head doesn’t have a cylinder coming out of it.
At times there may be a cylinder shape overlapping the head, when the baby has their arm up. Sometimes fingers can even be felt near the face.
Lower in the pelvis, the foot movement of a breech is quite memorable. One mother said, “The baby has made a treadmill of my bladder.” Compare that to the Frank breech position, in which the legs are up towards the tummy and chest and there is little movement from the feet in the lower part of the abdomen.
A transverse baby will be laying sideways (nothing will be in the pelvis). Limbs will cross the belly, high, low, or right across, depending on how the baby is lying. The limbs might even be towards the back, which would make the baby seem less active. The bottom and head will still slide against the mother’s abdomen on a regular basis, reassuring everyone of the baby’s wellbeing.

Other areas of interest to look for:

Which side the baby’s back is on (when planning a physiological breech birth, breech babies whose backs are on the right may have an easier rotation)
Location of the placenta
Amount of head flexion (how much and which way the neck is bent)
What type of breech position the baby is in at the moment
Head size in relation to body
The baby’s weight (While not always accurate, we want the head and body to be in the same proportion, rather than having the baby’s head much bigger than usual for the size of the body. If the full term baby’s frank breech bottom fits, we expect the head to fit, but it must be flexed chin down.)

When a breech position is suspected using the maternal Forward-leaning Inversion and Breech Tilt, exercise can help the baby flip head down. These exercises and more are included in our 6-day plan for Helping a Breech Baby Turn.