Belly Shape and Fetal Position

We've discussed briefly before that belly shape can tell you a lot about the position of your baby before birth.

Now let's get into specifics about fetal position, how it can influence labor and birth, and why it is so relevant for women of size in particular.

Anterior vs. Posterior

The classic big round "basketball belly" usually means that the baby is anterior. The back of the baby's head ("occiput") is towards the mom's front (which is why the position is called Occiput Anterior or OA), and the baby's eyes are looking towards the mama's back.

Look at the picture below and notice that the mother's belly looks big and well-rounded. This is because it is following the curve of the baby's back (and later, when the baby's head engages, its bottom).

Generally speaking, occiput anterior is the ideal position for birth. As long as the baby's head is lined up well, there are no arms/hands in the way, and it tucks its chin, chances are that the birth of an anterior baby will progress smoothly, especially if labor is allowed to start spontaneously.

Obviously there are exceptions, but research supports that anterior babies have more normal, uncomplicated labors and vaginal births than other positions.




Anterior
Baby
Belly







A lumpy, bumpy, not very noticeable belly (especially one with a curved-in spot around or near your belly button) often means that the baby is posterior. Look at the picture below and notice how the belly is not as rounded and has a "dip" below the belly button.

In this position, the back of the baby's head (occiput) is towards the mother's back, so the position is called Occiput Posterior or OP, but most people think of it as the baby facing up, towards mama's belly ("stargazing").

This is usually a much harder position for birth because the diameter of the baby's head in OP is larger and doesn't slip through as easily, and because pressure on the cervix tends to be uneven and so labor progresses more slowly.



Posterior
Baby
Belly

(baby
facing
slightly
to the
side)



Go back and compare the two pictures above again. Notice again the difference in the shape of the mother's belly. The anterior baby belly is more rounded, while the posterior baby belly is more lumpy and bumpy and has a concave area just below the belly button.

Other Differences Between Anterior And Posterior

There are other differences between an anterior and posterior baby too. These include where the mother feels the baby's movements most strongly, how "pregnant" she looks, and clinical signs such as where the fetal heartbeats are found, etc.

Movement

With a posterior baby, often the mom feels lots of weird, fluttery movements in front (the baby's hands and feet). Mom usually feels a lot of movement, pretty consistently, and feels it quite strongly.

With an anterior baby, most movement is usually felt in the upper right-hand quadrant of the belly (or upper left-hand quadrant sometimes), and while she certainly feels her baby's kicks and movements, the feeling may not be as strong or as constant as with a posterior baby.

Belly "Look"

With a posterior baby, people often comment the mom doesn't "look" very pregnant. The belly is not as rounded and doesn't stick out nearly as much.

With an anterior baby, the mom looks much more pregnant. She usually has a more rounded "basketball" belly, and it sticks out amazingly far, like she is ready to go into labor at any minute.

The mother can have the same size baby but look totally different day to day if baby shifts position, and will look a lot less pregnant when baby is posterior than when baby is anterior.

Fetal Heart Tones

Clinically, there are a few other signs as well. With a posterior baby, fetal heart tones are usually more difficult to locate because the baby's back is away from the front of mom's belly. Clinicians usually have to search for the heart tones for a while before they find them and the tones may appear and disappear with even small shifts in the baby's position.

With an anterior baby, fetal heart tones are more easily located because the baby's back is up against the mom's belly. Heart tones are most typically found in the lower left-hand belly area, and they usually stay audible pretty well, even as the baby shifts a bit.

Caveats

Now, please note....fetal position is not that important until near term. Babies need to exercise like anyone else, and they will flip and turn and rotate and surf all through pregnancy until near term when they get too big to do so much gyrating. So before close to term, fetal position is not really something to be all that concerned about. Babies flip around a lot and it's no big deal.

However, if near term (getting near 37+ weeks), you consistently don't "look" pregnant, you tend to feel baby's movement all up front, you tend to have a concave belly around the belly button, and your birth attendant consistently has a difficult time finding the baby's heartbeat (and doesn't usually find it on the lower left-hand side of your belly).....you may have a persistently posterior baby.

If so, it may behoove you to see if you can influence your baby's position before labor. More on that later.

Why Fetal Position is Relevant

Although babies do shift their positions a lot in pregnancy and labor and it's important not to obsess too much about fetal position, a baby that consistently stays in a posterior position can be a cause for concern.

Labor with a persistently posterior baby tends to be longer, harder, and more painful than with an anterior, well-aligned baby. Furthermore, because posterior labors tend to be longer and more painful, they often have more interventions associated with them (breaking the waters, artificially strengthening contractions with pitocin, epidurals for the pain, more vacuum extractions, etc.), and babies may experience fetal distress more often.

As a result, most research shows that the rate of cesareans associated with persistent posterior babies is much higher than the rate associated with anterior babies. In one 2006 study, researchers found that a persistent posterior position was associated with 13 times the risk for cesarean section.

Thus a persistent posterior fetal position can be a cause for concern late in pregnancy, and awareness of fetal position may be important.

Fetal Position and "Obesity"

Fetal position is particularly relevant to women of size. Although no one has studied the issue of fetal position in "obese" women really conclusively, some recent research does show a higher rate of persistent posterior babies in "obese" women. (More details on that later.)

Older research (from the 50s, 60s, and 70s, when they paid more attention to fetal position), also sometimes noted a higher rate of malpositions (especially posterior) in "obese" women.

Anecdotally, my own birth stories and the birth stories of many fat women I've received over the years for my website seems to support the idea of a higher rate of malpositions as well. This may be one reason (among many) why our cesarean rate is higher (especially for "CPD" or babies that don't "fit" well).

More on how fetal position affects labor in the next post, and later, what you can do to try and encourage good fetal position before and during labor.

Thanks for the Photos

Thanks to everyone who has submitted pregnancy and birth photos to me. It's been great getting them!!! I've really enjoyed looking through them. There are a couple of great shots that I'm really looking forward to putting on the blog!

However, before I can put them up, I need to do some permission paperwork, so they are not ready to go yet. Once we've got that done, though, you can look forward to seeing several new photos on the blog!! Yay!!

I have several posts I have been working on in the last few days but I am leaving for a birth conference tomorrow and was not quite able to get them finished before going, so they'll just have to wait until afterwards.

Once I get back, I'll intersperse the new blog entries with the pregnancy photos to give a little variety to things. Oh, and I am still open to getting more photos, so if you haven't found yours yet or you haven't worked up the courage to submit 'em yet, it's not too late.

Have a great week! I know I will; this should be a great birth conference and these things always inspire new musings from me, so look forward to some good stuff when I get back!!

As a reminder, I'll be gone till next week so any comments anyone submits will have to wait till then to get approved.

Plus-Size Pregnancy Photo Gallery

Over the many years I have been talking and writing about pregnancy at larger sizes, I have found that many women of size really worry what they are going to look like pregnant...... yet it's very hard to find pictures of fat pregnant women online.

I have searched long and hard for images of women of size during pregnancy, birthing, and breastfeeding to use on my blog and website.

I have found almost no pregnancy and birthing images; I have found a few for breastfeeding (like the one I use for my blog, above right), but even those are hard to find. And often those images are not especially "well-rounded."

Now, of course fat women have been having babies for ages, but apparently there is a cultural taboo against showing it today. If you were looking for images online now of fat pregnant women, you'd be hard-put to find many.

And forget about finding any pictures of fat pregnant women in birth books. That might mean condoning obesity in pregnancy (gasp!).

So if you are a fat woman and want to know what pregnancy or birth as a woman of size looks like, you'd be hard-pressed to find any images, any inspiration whatsoever, anywhere.

This is ironic of course, because fat women were used as fertility symbols in many ancient cultures, like the picture below (from here) of "Goddess Giving Birth," or the famous Venus of Willendorf image.



Of course, many of you fat chicks out there have had babies in the digital age, yet few fat women post their pregnancy pictures online either. Because of body insecurity, fear of harassing emails, and the cultural taboo about being fat and pregnant nowadays, many women of size do not publicize their pictures of themselves pregnant.

I'd like to change that. I'd like to collect a gallery of photos of plus-sized women who are pregnant, birthing, breastfeeding, and parenting.

Right now, I'm especially interested in shots of fat women pregnant and giving birth, because those are the images I get the most requests for and the ones that are hardest to find online, but I'd be happy to have any sorts of pictures.

Let's show the world that fat women DO get pregnant, DO give birth, DO breastfeed, and DO have children and parent just like everyone else.

If you have a photo you are willing to share on my blog, please send me an email at kmom at plus-size-pregnancy dot org (no attachments, please).

You will need to give me permission to use the photo, and you might want to include a few details like how many weeks you were, number of prior pregnancies, a general idea of your pre-pregnancy size (dress size works well), things like that.

Don't send me 150 photos; pick a couple of the best and send those.

I especially want birthing photos because images of fat women giving birth are the hardest to find, and it's important to document that Yes, fat women can and do give birth vaginally too.

That's not to say that I don't want cesarean photos either, because these are important to document too. But if you have photos of yourself giving birth vaginally, I'd especially love to have those.

I am also always looking to add photos of fat women of color, because women of color are often already under-represented in pregnancy and birthing photos.

I have some photos already that I have used in slide shows about plus-sized pregnancy for NAAFA conferences, birth conferences, and midwifery conferences. However, I am still working on getting permission to use these on my blog.

So I don't have all that many pictures yet for my blog, but here's a few, and some links to others.

I have a series of pictures of a woman of size pregnant with twins, showing how her body changed all through her pregnancy. I've posted this video before, but in the interest of having several of these pregnancy photos all in one place, here's the link again.

Here are a series of pregnancy pictures from a dear friend of mine. You know her; I posted about her recent VBAC, and the image at the top of this blog entry is from her website. You can go to her blog to see her recent pregnancy documented in photos:

25 weeks
28 weeks
33 weeks
38 weeks
40 weeks
Labor and Birth

There's also a slide show of pictures of her from a previous pregnancy there, at the bottom of this link.

What about you? Do you have some photos to share?

On Bellies and Looking Pregnant

One very common fear I've heard women mention many times over the years is:

How will I look in my pregnancy? Will I just look like a giant blob or will people be able to actually TELL I'm pregnant? Will I have the cute pregnant basketball belly too?

And the answer is......it TOTALLY varies. Some fat folk look TOTALLY pregnant and some never do. Some don't look pregnant until near the end.....and some look pregnant right away.

A lot depends on your particular shape and size. If you are a "pear" you will probably show your pregnancy more quickly and obviously than an "apple."

If you have a rack o' doom, your pregnancy might not be as obvious because the boobs tend to overshadow the belly.

Women who are much larger tend to show less obviously than those who are closer to "average size"-----but I've seen very large women who were obviously pregnant and very petite and small women who didn't show their pregnancy much at all. You never know.

A lot depends on the position the baby is in, too.

If your baby is posterior (head-down, but the baby's face towards your tummy), then the baby's rump doesn't stick out nearly as much and you tend to look less pregnant, even at term.

But if your baby is anterior (head-down, baby's face towards your back, which is a WAY easier way to give birth, believe me!), then you tend to get the "basketball belly" look, because baby's rump is hanging out more forward.

[And actually, knowing the position of your baby is really important because fetal position does influence how easy or hard your labor is, and whether your baby fits easily through your pelvis. Poor fetal position is a cause of many cesareans......but more on that in a future post. Just know that it's good to be aware of your belly shape because it can tell you important things about your baby's position before labor.]

Really, whether or not women of size "look" pregnant and at what point depends on so many factors. And even those are generalities; not everybody follows the "rules." You just have to wait and see how you carry.....but in general most fat women actually DO look pregnant at some point. It's just not always right away.

One strategy to avoid the "Is she pregnant or is she just getting fatter" looks is to get some cute, obviously maternity shirts and start wearing them right away.

Empire waist or babydoll-style tops and dresses make you look more "pregnant" than tent-y shirts, which tend to just make you look elephant-ish.

Later in pregnancy, slinky silky knits tend to cling to the baby belly and accentuate it; these were some of my personal favorite pregnancy outfits.

If you are one of those folks who can't bear the cutesy nature of a lot of maternity clothes (and who could blame you?) yet who still dreads the "Hmmmm, is she pregnant or not" looks, don't worry about maternity clothes.....but put your hand on your belly and mention the pregnancy prominently any chance you get. That will get the message across too.

Certainly you don't need to conform to anyone else's perceptions about what you "should" look like or dress like when pregnant, so don't feel the need to do this kind of thing if you don't care what people think....but I know from my email that many women of size do worry about this kind of thing, a lot.

If it makes you feel better, go ahead and wear a maternity-ish shirt early or subtly remind people through words and gestures that yes, you are pregnant as well as fat.

And enjoy the beauty of your baby belly, whatever it looks like. Baby bellies are amazing and blessed miracles, whatever their shape and size.

*Photo from my friend Lexi at www.birthislife.blogspot.com.

Fears Follow-Up and "Silly" Fears

Thank you all for your input about your fears and worries about "obesity" and pregnancy as women of size. I think it's so important to talk about these things, and so helpful to get those fears out in the light of day.

You gave me a lot of ideas for blog entries for the future. Now I just have to find time to write 'em!!

Please note......for every person who shared their worries and concerns, you undoubtedly spoke for several others who were thinking the same thing but didn't write it.

One thing, though----don't ever worry about your particular concern being "too silly" or "trivial" to talk about here. Believe me, I've had all those "silly" and "trivial" worries too, and I've certainly heard many of them via email and support lists too. There isn't much I haven't heard of or thought of myself in my own years of childbearing, parenting, and learning about childbirth in childbirth ed and midwifery classes!

For example, while we all worry about complications in pregnancy that we might be at more risk for or how we will raise a self-confident child in a fat-phobic world, a lot of women also worry about the practical, everyday things.

Things like......how will I ever fit behind a steering wheel in my car at 9 months pregnant? Will my car's seat belt go over my belly? What will I do for clothes? How did I get people to understand that I'm pregnant and not just getting fatter?

Things like.....how will I handle activities of daily life with a giant baby belly in the way? How will I deal with hygiene issues? Will I even be able to feel my baby move because of all the fat in the way? And even.....will my fat crush my baby? Or......how will I ever handle the embarrassment of everyone in the universe seeing my fat ass while I'm giving birth?

I've heard all of those, and more too. So don't ever worry about sharing your "silly" or "ridiculous" or "embarassing" or "trivial" fears too. Believe me, if you've thought it, someone else has too.

Soooo......what are YOUR "silliest" fears about being fat and pregnant? If you are already a mom, what were your silliest fears and did they turn out to be true? If so, how did you cope with them? What would you say to women worried about these things? How would you reassure them or what hints would you give to them about coping?

No fears are "too silly" or "trivial" or "embarassing" for us here!

*Sorry for the short post; we are back riding the Vomit Comet at our house. 2 for 4 so far. Whee-haaaaa! Ah, those fabulous parenting moments we all know and love......!!