The Belly Mapping Workbook by Gail Tully

Read this book if: you are interested in learning about baby’s position inside of you and tips for spinning baby if baby is not in optimal position for birth.  See her website for lots of great info – SpinningBabies.com

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Bellymapping is a 3 step process for identifying your baby’s position in the final months of pregnancy and in labor. It’s a helpful resource for learning how your baby’s position may affect your labor and birth. Optimal fetal positioning describes the activities that help balance your body and guide your baby to a position that encourages a straightforward labor experience.

 

Step 1: Mapping the Bumps

Draw on paper where you feel baby’s bumps, kicks and wiggles. A map will organize your findings.

 

When to Start – Bellymapping works best after 32 weeks. Feet kicking and hands wiggling helpful clues about baby’s position, so map while baby is active. Depends on muscle tone, body fat and amount of amniotic fluid. Hopefully placenta isn’t right in front, blocking your baby from your touch.

 

Feelings Your Belly – good time is evening before you drift to sleep. Best when lying down as sitting/standing reduces accuracy as abdominal muscles are too firm. A pillow under your knees will relax your round ligaments (one set of uterine ligaments that anchor and support your womb) and prevent a jabbing discomfort during feeling the baby through belly. Sign deeply and release your lower abdominal muscles. Breathing deeply and relaxing the abdomen will help you feel your baby.

 

Feel with your finger pads, not the tips. Let fingers walk along contour of baby. Think of belly as 4 piece pie. Start with left side – feel what’s in top and in bottom. Feel: firm back and the consistent bulge, often at the top of the back. One side of your womb will be soft and one will be firm – the baby’s back. The bulge at the top of the back is the buttocks in a head down baby or the head in a breech baby. The bulge on a posterior baby will sometimes recede into the womb, out of reach.

 

Mapping Your Findings – Draw a circle and two crossing lines, or a “pie” with 4 pieces. The center marks your navel. The bottom of the circle is where your pubic bone is found. The left side of your belly is the right side of the pie – like looking at belly in mirror.

 

3 Opposites in Baby’s Body: heads and buttocks, or bottom; feet and hands; tummy and back. Baby’s buttocks are always opposite it’s head. Most babies are head down, but some are breech (ask care provider). If you know baby is head down, you can find feet at top of belly. If baby is head down, you’ll feel the feet kcik more strongly than you’ll feel hands wiggle. Back is opposite tummy. Back is opposite where you feel kicks and wiggles. Baby’s knees bend towards tummy, may find them near navel. If baby’s back is along your back, baby is posterior – you may feel 2 knees on either side of your navel, but back will be hard to find.

 

Where’s the Head? Reach above your pubic bone, deep into your belly to feel the firm head (unless baby is breech). If you feel big bulge above head and baby is head down, can assume that is buttocks.

 

Remember the Heart – where Dr. found heartbeat at last appointment – was probably near baby’s back. If baby is posterior and provider can’t feel baby’s back, was probably the chest.

 

Hands and Feet – the stronger kicks vs smaller “kicks”, wiggles or taps. Biggest kicks come from baby’s feet. Exceptions when placenta blocks the feet but not the hands or when baby is in frank breech or legs are straight and not kicking much. Small kicks, wiggles or random taps are usually hands (rhythmical taps may be hiccups). Hands wiggles less frequently than hands. Some don’t feel hands because baby is turned away from abdominal wall. When head down baby stretches his legs, a bulge will show up on both sides at top of belly – looking triangular.

 

Chart Your Findings – draw opposites you found in belly and any info from prenatal apptmt. Can write things like “kicks”, “bulges”, “Wiggles” etc but don’t write hands or feet unless very sure.

  • Mark back with strong, slightly curved line
  • Curved lump can mark bulge where baby’s butt pushes out (end of back)
  • Zigzag lines can mark kicks and wiggles
  • Draw a circle where you think head is
  • Mark a heart where caregiver hears heartbeat (can use line if theres a range)
  • Leave out parts you are unsure of

 

Date maps to reveal position changes.

 

Leopold’s Maneuvers – what caregiver uses to feel baby

  • What part of baby is presenting, or what will come through pelvis first?
  • Where is baby’s back?
  • Which part of baby is in the fundus, or top of the womb?
  • How well is baby’s head tucked? (Cephalic prominence)

 

Caregivers – ask where mom feels kicking. Leopold’s maneuvers. Bread-dough maneuver

 

Advanced Tummy Tips

  • Where’s Baby’s Head? Hard, round object under pubic bone. Small knob near head is shoulder. Occasionally, a head or forearm in front of head. Head may be high or may be so deep in pelvis, you only feel neck.
  • Head Up or Down? If you feel cylinder shapes extending from the bulge, and the largest kicks are on top, too, then your baby is likely head down. The head won’t have a cylinder coming from it, but the hips will – a thigh. If cylinders up top are smaller than the cylinders near your pubic bone, baby may be breech. Hiccups not a reliable source of whether baby is head up or down – they may be strongest on side where baby’s back is firm or affected by standing. If waiting for breech baby to flip, and hiccups moved to opposite part of belly, baby probably did flip.
  • Is baby facing backward or forward? Baby’s back to front of belly – anterior position – will feel firmness of back and buttocks. Feet will be tucked toward your back. Care provider doesn’t have to search for heartbeat since it’s in front. If in posterior position, legs may poke out on either side of navel and back can’t be felt; heartbeat may take a minute to find.
  • Is baby’s chin tucked? If baby is head down, press near pubic bone to feel sides of baby’s head. When you feel only one “corner” to head, and its on same side as limbs, shin is tucked or “flexed” (corner is cephalic prominence or forehead). If you feel corner on same side as baby’s back, cephalic prominence is occiput, or back of skull. Baby’s chin is pointed up or extended, which is associated with brow and face first babies (unusual).
  • Is baby’s head engaged? Most babies of first time moms engage, or drop in the pelvis by 38 weeks AKA lightening. If you are a first time mom, VBAC mom, or had a long labor in the past, may benefit from activities that encourage engagement. If baby’s head overlaps pubic bone, can mean: baby is posterior with an extended chin, baby is facing the side with his or her chin up and head tipped; baby’s arm is across your pubic bone; cephalopelvic disproportion (rare – when baby’s head is too big to fit into mother’s pelvic brim). Helping baby tuck chin will make overlap disappear, except in rare case of CPD. Sit on a firm exercise ball and make hula-hoop circles. Brisk walking, stair climbing and crawling can help. Chiropractic adjustments or myofascial release, can align the pelvis and let the head engage.
  • What about sensations in your lower front abdomen? If baby is head dwon, wiggles between pubic bone and navel are hands. Breech baby – low wiggles can be foot “tapping”.
  • Which limbs do you feel?
    • Baby’s thighs feel like a cylinder coming out of the bulge (hip). Small bump close to cylinder is foot
    • Head may have a cylinder (arm) folded next to it but not extending from it
    • Knees and elbows feel like lumps
    • When knees bend, they change where you feel the kicks
  • Is baby occiput transverse? Head position is classified in 4 directions: anterior, posterior, left occiput transverse, and right occiput transverse. If baby is left occiput transverse, they will occasionally tickle far right side – opposite baby’s back. Provider can help you find cephalic prominence – if they cant find, baby’s occiput is likely anterior or posterior. When baby’s chin is nicely tucked, the cephalic prominence is simply the forehead, opposite baby’s back.
  • How can you be more accurate? If unsure, give it another week. Or ask baby to help. Rest on hands and knees for a minute and relax belly – when you lie down, you can feel baby’s parts before they go deeper in womb. May also help differentiate breech from head down baby if you have abundant amniotic fluid. Some babies harder to feel than others (tight abdominal muscles, first time moms, abundant amniotic fluid, babies in unusual positions). Caregivers can misinterpret – look at 4 or more signs before assuming position. Head, heart, hands and thing will reveal the most accurate picture.

 

Step 2: Visualizing Your Baby

Matching a doll suddenly brings insight. Get a doll 12-20 inches long to approximate length of a fetus at 30-40 weeks w foldable arms/legs. Arrange doll over map to correspond with body

  • Put doll head to where you think baby’s head is.
  • Match feet to biggest kicks. If you also feel wiggles, move hands there
  • Put back to back. (Gets tricky if you didn’t mark a firm back on your map – which means baby’s back is likely toward your back – in that case, position doll with feet and face forward).
  • Match doll’s buttocks to the bulge.

 

Up or Down? Try baby’s head up and down. Do kicks and firm spots make more sense now?

 

Drawing baby on your belly – if you have an artistic friend, doula, or provider, bring a nontoxic washable market and your belly map to your next prenatal. Head makes up 1/3 of baby’s length, so make head bigger to be proportional. Draw feet smaller than they feel (1/3 of length of leg). Arms and legs are short compared to a child’s.

 

Step 3: Naming the Positionuse this specific order. If Q1 and Q3 have the same answer, drop the first word.

 

  • Where is baby’s back? Left, right, anterior (front) or posterior (back).
  • Which part of baby presents or comes into pelvis first? Occiput (head down), sacrum (breech), mentum (face first – rare) or frontum (forehead first – rare)?
  • Which way does baby’s presenting part aim? Anterior, posterior, transverse (towards hip)

 

 

Basic Head- Down Positions.

By 34 weeks, ,baby’s back will shift less often, and once head down will hardly change.

  • OA (Occiput Anterior): Baby’s back is firm in front center of belly. Kicking is up top and toward right. Baby’s bottom presses in top center. Head is low and you probably walk with a waddle. Can easily hear heartbeat in wide area in front
  • LOA (Left Occiput Anterior): Baby’s back is on front left. Kicking is way up top and to right. Baby’s bottom presses up in top left and occasionally in center.   Baby’s head is low and you walk as if walking around a ball. Can easily hear heartbeat left and center.
  • LOT (Left Occiput Transverse): Baby’s back is on left and may swing forward temporarily. Baby’s bottom is in upper left. Feet are clearly in upper right and sometimes go across the top or to the right just a bit lower than navel. Hands may wiggle on lower right occasionally. Lower half of belly is quiet. Baby’s head engages shortly before due date. Head may feel low, causing pressure on cervix and upper thigh. Can easily hear heartbeat left and center.
  • LOP (Left Occiput Posterior): Baby’s back is on left, but not very close to surface. Baby’s bottom makes a bulge in upper left. Feel hands and feel all over your front, but they favor right. Baby’s head may dip into pelvic brim for engagement before due date. May feel cervical pressure occasionally. Forehead aims a little right of center. Heartbeat on far left.
  • ROA (Right Occiput Anterior): Baby’s back fills front right. Feet on left only. Heartbeat heard on right. Baby’s chin may tuck well in this position. Labor often starts with normal progress pattern. Midpelvis diameters can affect outcome. OP babies often exit as ROA.
  • ROT (Right Occiput Transverse): Baby’s firm back is on right. Womb feels softer on left. Baby’s bottom makes a bulge in upper right. Baby’s hands and feet on left side. 1st time mom, baby engages close to or after due date or during labor. Chin may be extended. Heartbeat on lower right side.
  • ROP (Right Occiput Posterior): Baby’s back hard to locate, but may feel on edge of right side. Baby’s bottom makes occasional bulge in upper right or top. Hands more to left. Baby’s head remains high until labor. Forehead a bit left of center. Heartbeat on lower right side.
  • OP (Occiput Posterior): Baby’s back far to right, almost hidden or not found at all. Baby’s bottom top center, but sometimes feet are hiding buttocks. Can feel feet and hands all over. Baby’s head may slightly overlap pubic bone. Hard time finding heartbeat, but usually to lower right or in center if you don’t have a lot of belly fat or amniotic fluid. When birthing mama is wearing an electronic fetal monitor belt, baby might wiggle out of reach of monitor, losing heartbeat sound – just need to reposition.

Exceptions to above:

  • Unusual but anterior baby can have extended chin, delaying engagement
  • Posterior baby can have a flexed head when room is ample and mother is flexible
  • LOP is usually flexed and in easiest of posterior positions. Exception is extended chin and/or not fitting the brim
  • When baby has been transverse for weeks, may find more success getting him head down with forward-leaning inversions and bodywork
  • Not common to find first time baby in ROA; exception when placenta is in front left and blocking baby from settling on left

 

Belly Mapping a Breech Baby

Most babies will settle head down by 30 weeks. By 32 weeks, 15% are breech. Only 3-4% remain breech near due dates.

  • Frank (aka incomplete): baby’s legs are straight up along his or her trunk. Baby’s hips born first (if hips fit, head will fit, too). “Biggest kicks” will be hand movements or no kicks at all
  • Complete: legs folded and feet to center – like yogi sitting with knees bent. Feet wiggle near bladder and pubic bone. Lots of movement near pubic bone and less near cervix
  • Footling: one or both feet first. Bum may be as high as navel. May feel feet “walking” on bladder or cervix.
  • Ideal starting positions are right sacrum anterior (RSA), right sacrum transverse (RST), and even right sacrum posterior (RSP). When physiological breech birth is protected (not touched/startled), baby may move to allow hips to rotate until baby’s back is coming down from left side, which protects flexion of head.

 

Activities for Flipping a Breech or Transverse Lie

Begin balancing activities early in pregnancy to increase likelihood of baby being head down. Begin flipping activities at 30 or 32 weeks for breech babies.

*Don’t get upside down if you have a risk of stroke, high blood pressure, non-labor bleeding or heartburn. Consult provider and substitute with yoga sling if you have one.

  • Forward Leaning Inversion – Find high, firm surface to kneel on. Come down and prop self on forearms and elbows. Let head hang. Inverted womb stretches several uterine ligaments. Come back and sit on knees for a moment and return. Do for 1 minute and then do one of next 2 inversions. (With head down baby, hold pose only 30 sec daily).
  • Breech Tilt – helps baby settle weight on his head and causes chin to tuck (chin tucking necessary to flip head down). Brings baby’s bottom out of pelvis (disengages hips). Tuck feet into couch for stability and lift body as if slanted. Repeat 3x a day for 15/20 min.
  • Open Knee Chest – open knees while lying on chest. Or handstands in a swimming pool
  • Myofascial Release– helper applies lightest possible pressure. Unwind 15 min or longer with 1 or both release daily.
    • Diaphragmatic Release (abdominal release): Lie down, head, shoulders and knees propped with pillows.
    • Standing Release – see spinningbabies.com for video guidance
  • Chiropractor uses Webster Maneuver to align pelvis and release tension in round ligaments.
  • Moxibustion, acupuncture and hypnosis. Manual external cephalic version by doctor.

 

Belly Mapping Twins – see website

 

How Your Baby’s Position Affects Your Labor – maternal positioning, tone of abdominal muscles, balance of womb, via uterine ligaments and pelvic joints all affect position. During labor contractions, rhythmic movements with gravity promote fetal rotation, but extremes in the amount of your amniotic fluid may ake it too easy or too hard for baby to shift.

  • Ideal starting positions: Anterior positions (LOT, LOA, OA) are ideal. They have easiest time tucking chin. Shape of pelvis decides which anterior position. Make baby’s head seem smaller than if baby in “malposition” such as posterior or asynclitic. Fitting pelvis better leads to shorter, easier labor. ROA less than ideal because of chance of chin extension and rotating to posterior since liver is on right side
  • Posterior starting position: (LOP, ROT, ROP, OP) often lead to longer labors. Chins usually not flexed as well and trying to make way through pelvis with biggest diameter of heads leading the way. Chin tucking is leading variable in success of rotation. Most posterior babies come without drama or interventions.
    • OP: rotating out of OP may take 30 min -24 hours. Most rotate to LOT and then LOA. More time is needed if pelvis is small in relation to baby or if ligaments are tight
    • ROP: less rotation to complete than OP so rotate in higher numbers
    • LOP: may be better at tucking chin. Will rotate to LOT and continue labor from that ideal position
    • ROT: depending on pelvic outlet, baby will finish ROA or OP. If chin up, will rotate to posterior. First time mothers generally have to be patient.
    • Arrests in Rotation: posterior arrest, when posterior baby gets caught trying to rotate midpelvis. Lunch may help avoid cesarean.

Will baby’s head change position? Unusual for baby of first time mom to change head position near end of pregnancy. Narrowing lower uterus holds baby’s head in position over pelvic brim by 32-34 weeks, even though head not usually engaged at that time. If you have abundant amniotic fluid, baby may change, but not common. Womb tone promotes head stability. Hormones or bodywork can soften ligaments to get into more ideal position. When posterior baby switches sides frequently, may have strong “turning contractions” – sometimes called false labor.

 

Breech Starting Position – cardinal movements (series of changing positions a baby makes during labor and birth) are easier for breech baby when you labor in upright positions. Once baby appears on perineum, hands and knees position is better than lying on back. Spontaneous birth is physiologically sound and safer than breech extraction. “Hands off the breech!”

 

Cesarean: More cesareans for direct OP babies than anterior babies. Epidural may soften lower uterus, either increasing need for surgery or less likely, allowing rotation and descent. Reduce epidural side effect by waiting until baby is trying to rotate, usually 5 cm or later. Doula care also reduces rate of cesarean birth.

 

Spinning Babies for Easier Birth

  • What to Do During Pregnancy: the sooner you begin, the better your chances for baby to be in a good position.
    • Good Posture: make your belly a hammock for the baby. Let belly relax forward or down. Think of belly as flashlight shining forward or down. Will keep spine higher than abdominal wall, allowing gravity to secure baby in a better position. Good posture gives baby most room to rotate and enter the pelvis. Keep knees lower than hips (birth ball).
    • Move freely: brisk walking relaxes the psoas muscle pair, which when tight, can hold womb and baby up. Stretch with hip opening and pelvis balancing exercises and yoga. Swim. Dance. Belly dance is prep for birth. Sit on exercise ball and make rhythmic circles, like hula hooping. When baby is active, do 20-40 pelvic tilts while on hands and knees with belly relaxed. Squat daily for muscle strengthening and good bowel health. Don’t squat if having turning contractions
    • Rest Smart: use child’s inflatable swim ring to rest nearly belly-down with lower leg behind you and upper leg over high pillows. Alternate each hip with a pillow. Protect belly and small of back with pillow
    • Bodywork: discomfort in pregnancy, whether “false labor” or a general sense of being uncomfortable, is an indication for bodywork.
      • Chiropractor, craniosacral therapy, diaphragmatic release, sacral release, acupuncture, moxibustion, homeopathy, maya uterine massage, prenatal yoga
    • Find Birth Support – rates of satisfaction soar when mother/couple hires doula for birth support. Having a nonrelative, nonmedically trained person who knows birth and puts your emotional needs first adds tremendously to birth experience. She has helpful tips for labor progress, but more importantly, her continuous presences sooths stress and pain. Research shows it is the most effective labor intervention, making some medical interventions unnecessary. Visit www.dona.org
  • What to do During Labor – labor contractions help baby rotate
    • Let labor begin on its own! Avoid induction with Pitocin or manual rupture of bag of waters. Breaking amniotic sac may make slow labor slower or a fast labor faster. Avoid breaking bag is baby is posterior – amniotic fluid makes rotation easier so head can lodge before rotation, preventing a vaginal birth.
    • Bet patient with start and stop labor pattern – womb is trying to reposition baby’s head so it can engage and or descend
    • Work with gravity: you are designed to labor vertically. Unless you have to labor in bed due to health concerns, stand and lean forward to bring baby’s back forward, kneel with back straight or use hands and knees position. When you have to lie down for exam, roll on side and lean on pillows when exam is done
    • Continue to rest smart – good sleep is important. Uterus will work more effectively after sleep, even when sleep is brief. Regularly alternate laying on left and right sides. Try birth ball or head of bed while knees are on mattress
    • Stay nourished – frequent electrolyte drinks and easily digestible snacks
    • Move your body: womb moves baby down toward pelvis with a mild spiraling action. “To move the baby, move the mother”. Tip pelvis, hula hoop while standing or on exercise ball
    • Work with a supportive birth team!

Priorities When Laboring with a Posterior Baby

  • Let go of expectations: labor with a posterior baby is much different than labor with an anterior baby.
  • Help baby rotate: most posterior babies rotate to face their mother’s back before they actually come out. Some don’t have to rotate and will be born facing forward. After rotation, you’ll find labor easier to deal with and less painful. Second baby can be much faster than first, even if posterior
  • Take all the time you need in early labor: rest, eat. Squatting closes the brim a bit while opening the outlet, so wait to squat with a posterior baby until after engagement.
  • Open the Brim to Help Baby Descend and Engage: arch pubic bone away from spine for 3 strong contractions
    • Aim baby into pelvis – use abdominal lift. Flatten lower back against wall and bend knees slightly. At start of each contraction, link fingers to lift belly 2 inches up and tuck it 102 inches in. let go and move your legs between contractions. Repeat lift for 10 contractions. Relieves back pain and directs baby into your pelvis, perhaps tucking the chin
    • Widen pelvis in active labor – Put one foot on stool, off to the side. Rock side to side. Bed lunge can be done even with epidural. Typically effective 4-6 cm but can be done anytime
    • Widen pelvis during pushing stage – squatting opens outlet as does a double hip press lying on side is also helpful, especially if you hold upper leg bent and away from hip
    • Don’t curl back- curling back like letter C while pushing is okay with anterior baby, but need straight spine with posterior. Most cultures keep backs straight and knees bent – may hang from a pole, branch, or sturdy shawl over a ceiling beam. Straightening back gives baby more room to tuck chin and kick and wiggle lower through pelvis

 

What if you have a long labor? Baby is trying to engage. May have arm up by head. May need to rotate before dilation can proceed. Eat and sleep as needed. Use techniques to help baby rotate.

  • Stay patient – ask doula or nurse for support
  • Out of patience? 4 hour rule: 4 hours of strong, long contractions with 2-3 min apart and no progress? Not slow progress…no progress? Interventions are big tools for big challenges. Pitocin and or pain medication can promote fetal rotation. Epidural is occasionally useful, particularly for very tense ligaments or a super strong pelvic floor due to riding horses, running, ballet or past trauma. Labor can slow due to epidural as well. Pain medication often leads to other interventions and no pain medications are proven safe for babies or bonding period. Weigh risks. Cesarean is a blessing for those babies that can’t find their way through pelvis.

About The Author

Jessica