Belly Mapping Breech
A childbirth educator and doula wondered why the doctor of a mom she is helping wasn't 100% sure about the signs of a breech baby. He suggested an Ultrasound (sonogram). Is telling up from down really that hard to tell by hand?
Keep reading for tips on discerning a breech position and see pictures of palpation.
Using Ultrasound sonography (imaging) is a parent's decision. There are considerations in making the decision to use Ultrasound.
- Your provider may want a more sure way of telling baby's position than their hands can detect.
- Your provider may want you to have a concrete way of knowing for sure your baby's position to help you make decisions from fact.
- You and your provider may both want to seek visual indications of whether or not a vaginal breech birth might be reasonably safe for your baby.
Ultrasound is justified if your care plan will change based upon what was found by an Ultrasound examination. But Ultrasound is not without risk.
Jane Evans of the United Kingdom raises a unique question around ultrasound and breech. Since babies often cover their faces in response to ultrasound, can an ultrasound exam be the cause of the complication of extended arms (drawing, above right)? This is an important question and birth outcomes could be compared with and without prenatal Ultrasound (or use of Ultrasound in labor). It would also be necessary to make sure that no one is touches the breech baby during the entire birth process, because touch is another cause of extended arms. With these two variables and many dozens of breech vaginal births, we might be able to tell if Ultrasound is a risk in breech birth. Though it does seem possible.
There is another way to tell baby's position other than Ultrasound imaging, and that is by palpation, or feeling the baby through the abdomen. Palpation is not as reliable as Ultrasound. Not all women are easy to palpate. It takes less skill to interpret an Ultrasound image of a breech baby than palpate the baby's position accurately, especially in women that aren't easy to palpate.
Parents may well want to see "proof" of breech presentation as well, to prepare themselves and make choices for childbirth. Finding out that the baby is breech can definitely change birth plans, whether to plan a cesarean or make the necessary preparations, sometimes including travel, to find a safe breech practitioner.
Learn more using the The Belly Mapping Workbook. There is a pretty good section with illustrations on figuring out if your baby is breech (after 30 weeks or so) and what to do about it.
Breech is sometimes difficult to tell with palpation (feeling the abdomen with the hands), and other times quite easy to tell. Even if the doctor is sure, s/he'll recommend an ultrasound (sonogram) to get hard data to enter into the mother's chart.
Here are some pictures of palpation and drawing the findings of the breech presenting baby on a Sunday, when baby was still breech. The mom did a forward-leaning inversion that night and the next day, Monday, before her scheduled Ultrasound. Then we found out the baby had flipped head down! (photos by Clare Welter, CNM)
With palpation, we look for a cylinder shape coming from the firm bulge at the top of the fundus. This is the thigh coming off of the buttocks.
If we find cylinders low in the abdomen and a firm ball at the top we are considering a possible breech position.
Listening with a fetoscope or doppler is helpful, but not diagnostic.
Location of the heart beat is not a reliable indicator.
Sometimes the heart beat can be heard far from the heart when the physician or midwife uses a doppler. A doppler is a hand held monitor that uses ultrasound (sonogram) to detect the heartbeat. A firm tummy allows the heart rate to be heard a distance away from the baby. So does ample amniotic fluid. Water carries sound.
"I had one child, breech vaginally. I would not let them do an ultrasound so I escaped the knife." -Dr. Lucia Lein, DC about her own birth.
There are three major types of breech presentations and the rare kneeling breech. Variations include one leg up and one down, or one knee up and one down.
To help tell what position the baby is in, the parents may look at the four breech types.
Types of breeches
- Frank breech (50-70%) - Hips flexed, knees extended (pike position)
- Complete breech (5-10%) - Hips flexed, knees flexed (cannonball position)
- Footling or incomplete (10-30%) - One or both hips extended, foot presenting
- Kneeling (rare) - both knees are coming first, the feet are folded up behind the baby's thighs.
Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22% of births prior to 28 weeks' gestation to 7% of births at 32 weeks' gestation to 1-3% of births at term.
See more in About Breech.
Belly Map of a Breech Baby
The drawings here begin with the four quadrants of a Belly Map. A simple circle can be drawn on a piece of paper. Then draw two crossing lines; the lines cross at the navel.
Next, the bumps and wiggles that the mother with a breech might feel are drawn.
Finally, we see the breech baby drawn in for this Belly Map. This particular breech baby is in the complete breech position. He or she is a bit oblique, not unusual at 32 weeks gestation, but less common, and certainly less favorable at 40 weeks gestation.
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.
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 uterus) feels warm and tender.
When the baby is stretching a leg away from his body, the hips will have a cylinder shape emerging from it-the thigh. The head doesn't have a cylinder coming out of it.
There may, at times, be a cylinder shape overlapping the head, when the baby has their arm up. Sometimes fingers can 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 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 lay sideways. Nothing will be in the pelvis. Limbs will cross the belly, high or 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 with the baby's wellbeing.
Benefits of a sonogram/ultrasound
The doctor won't do a cesarean for a head down baby s/he 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, if they decide on an ultrasound, to have the baby's position explained to them in detail.
Of interest are:
- Which side the baby's back is on (when planning a physiological breech birth, breech babies whose back is 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
- Baby's weight (not always accurate, but we want the head and body to be in teh same proportion rather than having the baby's head much bigger than usual for the size of the body a baby has. If the full term baby's frank breech bottom fits, we expect the head to fit, but it must be flexed chin down).
Learn how and why to do the maternal inversion on the Spinning Babies blog at http://spinningbabies.blogspot.com/2007/02/how-to-do-inversion.html
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.