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). 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. Download the free Belly Mapping parent handout in English, or in Spanish: De Mapeo del vientre los padres.pdf.
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 caregivers 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.
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.
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.
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.
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Check out this great video of Belly Mapping and painting fun at the Twin Cities Birth and Baby Expo 2012. This video montage was lovingly created by Brook Walsh: peace-love-babies.com
- 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).