Every first-time mother wonders what being in labor will feel like. Queries to friends, family, or the internet will turn up plenty of answers about the sensations you can expect.
You may have heard some women mention that they had ‘back labor’. They may have described it as being incredibly painful, long, and even frightening or unexpected.
If you want to know what this condition is, what causes it, how to avoid it, and what to do if back labor happens to you during your birth experience, you’re in the right place!
This article will address each one of those topics and give you tips and resources for making your birth experience a great one, regardless of whether it ends up including the infamous back labor or not.
What is Back Labor?
Back labor is a term used to describe the sensation of contractions centering in your back, rather than wrapping around your abdomen as most contractions do.
There’s nothing wrong with feeling your contractions in a different place, it’s considered a variation of normal, but when unanticipated and unprepared-for, this type of contraction can throw a birth plan off track fast.
When you have back labor, you feel the tightening and/or pain of the contraction in the center of your lower back, near your sacrum.
These contractions should follow a typical contraction pattern of being regular (meaning you can time them), and grow in intensity and frequency, indicating that labor has, indeed, begun.
What Causes Back Labor?
What would cause contractions to happen in the back instead of the front? Does it indicate a problem? Should I be worried?
The short answer to this is no, it’s not a problem and there’s no cause for worry.
Most of the time back labor is caused by your baby being “occiput posterior” (also known as ‘OP’).
When your baby is facing posterior, it means their face is towards your tummy, and that the hardest, largest part of their head is towards your back, pressing on your spine and sacrum.
Babies can be born in this position, although studies show that labor can be longer and sometimes more painful when a baby is in a posterior position.
Why Would My Baby Be Posterior?
Basically, the structure, tension, and position of your uterus, abdominal muscles, pelvic bones and pelvic floor muscles, along with anything unique about your baby, all determine how your baby will lay inside of your body.
Some uteri are tilted or twisted because of weak muscles or poor posture.
Some pelvises are wider, some are more narrow.
Some babies are larger or smaller, fatter or thinner, taller or shorter…you get the picture.
Every body is different, every baby is different, and each factor plays a part in your baby’s position when it comes time for the birth.
We’ll talk in a moment about what you can do to prevent posterior position – but for now, just understand that there are many variables at play.
Q: My doctor says my pelvis is too small, and that’s why my baby is posterior. Is that true?
When doctors talk about pelvises being “too small”, they’re really just making a guess, and it’s not a very good one at that.
The pelvic bones, ligaments, joints, and muscles are all made to move and expand as your baby descends during labor.
You can read more in this article, but to sum it up, there is no way to tell for sure if your pelvis is too small or your baby is too big until you go into labor and baby starts to descend.
Very few women have a too-small pelvic or a too-big baby, but it gets mentioned often because doctors use it as a way to explain what might be going on when they don’t have another explanation.
Be wary of assuming your pelvis is too small before you give your body a chance to experience labor. It might surprise you!
While it’s possible that a narrow pelvic brim (the wide part of your pelvis) may cause baby to be in a posterior position, it’s much more likely that your muscles are tight or twisted, or that you frequently sit in a slumped or poorly-angled posture, both of which can be remedied through diligent exercises.
Q: Will I Have To Get An epidural?
You only need an epidural if you decide you want one.
It’s important to remember two things when considering an epidural with back labor:
1) Epidurals don’t always work completely, which could leave you in bed unable to change positions to find comfort, and;
2) Position changes are your best friend, as they widen your pelvis and enable your baby to come down easier, faster, and less painful than laying on your back with an epidural.
On the other hand, an epidural may relax your tight pelvic floor enough that your baby is born more readily.
Only you can determine whether an epidural will serve you, and even then, some posterior babies will need to be born with extra medical help (ie, forceps or vacuum assistance) or by cesarean section.
As some studies have shown, an occiput posterior baby increases the length of labor (by about an hour on average), and the chance that a cesarean section will be needed.
How Can I Prevent Back Labor?
The best way to prevent and relieve back labor is to get baby into a favorable, or anterior, position.
The following are several things you can try to loosen up your muscles and ligaments and get baby to turn around.
1) Stair Or Curb Walking
Walking up and down stairs or stepping onto and off of a curb can open your pelvis and help baby to move.
Try to bring your knee up to a 90-degree angle when stepping.
2) Side Lunges
Just like stairs, doing lunges can widen your pelvic opening and encourage a change of position from your baby.
Stand sideways next to a bed or chair and put your foot up, then lean into that same foot.
Be sure to have someone standing nearby for support in case you lose your balance.
3) Rebozo Sifting
Also called “shaking the apples”, this move takes a long scarf, or rebozo, and places it around your pregnant belly while you are on all fours.
Your partner holds each end of the rebozo and pulls enough to just lift your belly a little, then shifts back and forth, gently shaking your belly.
This loosens round ligaments in your abdomen and may encourage your baby to turn to a better position.
Learn when to use rebozo sifting and when to avoid it, along with a more in-depth description of how to do the technique properly, on the Spinning Babies website. You can also watch this video to see it done:
The Spinning Babies website is a goldmine of exercises meant to open your pelvis, strengthen and relax your muscles, and learn all about fetal positioning and how it affects your labor.
Every pregnant woman would benefit from knowing more about what Gail Tulley teaches in her Spinning Babies exercises.
4) All Fours Or Open-Knee-Chest
Get down on all fours, then stretch your arms out in front of you, making your head and chest touch the floor but keeping your bottom in the air.
The release of tension in your muscles and the aid of gravity all allow your baby to back out of the pelvis and change their position.
As mentioned in this article, there are a number of reasons baby just won’t turn, no matter what you try.
Don’t be discouraged if your baby is posterior when you go into labor, we’re covering comfort measure techniques for back labor in the next section.
5) Visit A Chiropractor Or Massage Therapist
Besides the fact that getting a massage is heavenly when you’re pregnant, they can also help loosen tight muscles and relax your ligaments, giving the baby a better chance at changing positions.
Webster-Trained chiropractors know how to work with pregnant women to adjust their pelvis and spine gently and get baby moving; some chiropractors will even attend you at the hospital or birth center in labor!
Another practitioner that knows a technique called Myofascial Release could be extremely beneficial to see, as they can use gentle, sustained pressure on certain areas of the body to eliminate pain and restore greater motion, both of which would be beneficial to have during labor.
How Will I Know My Baby Has Turned?
The most obvious sign is that you’ll be able to feel baby’s back against your stomach.
Some women can feel this more easily than others, so also pay attention to where you feel your baby’s little kicks and jabs.
If your baby is head-down and posterior, you’ll be able to feel their hands wiggling down low on your abdomen, with their feet kicking up high in your ribs.
If your baby is anterior, which is the direction you want them facing, you won’t be able to feel those little hands moving because they won’t be against your belly anymore, they’ll be against your back.
If you aren’t sure, ask your doctor or midwife at your next appointment; they should be able to tell you what direction your baby is facing by feeling your belly, and if you ask they can show you how to do it at home.
You can also look into belly mapping and practice figuring out what direction your baby is facing on your own.
What To Do When You Have Back Labor
Stay calm and relaxed! Back labor is just a variation of normal.
It’s good to remember that even if you have back labor, your baby could still be born easily whether they change positions or not.
Yes, many posterior babies can take longer to come or need a little extra help to get here, but not all of them.
There are plenty of women with back labor and posterior babies who still have a great time of labor, so there’s no need to add extra stress.
You’re especially in luck if you have a professional doula who can help you navigate various positions, comfort techniques and any changes that might need to happen with your birth plan.
You and your birth partner will definitely find a doula invaluable during a birth experience where you have back labor.
Whether you have a doula or not, try the following comfort measures and techniques if you happen to have this condition while you’re in labor.
Massaging the lower back where the contractions are being felt can bring a lot of relief with back labor.
The harder the pressure, the more effective this technique will be.
Just let whoever is giving the massage know if you would like the pressure applied to be harder or softer.
2) Shower/Warm Water
It’s ideal if you can labor and/or give birth in a tub, but even a warm shower can be very effective “hydrotherapy” during labor.
If a shower or tub isn’t accessible for some reason, a hot compress on your back could feel great too.
3) Leaning While Standing position
Standing and swaying or rocking from side to side can help you find a rhythm to manage your contractions.
It also gives your nurse, doula, or birthing partner access to your back to provide massage or counter-pressure.
4) Counter Pressure
This is like massage – only instead of rubbing, your support person will use their palms or even their fist to hold firmly against your back.
This will feel especially great during a contraction, and even better with heat or ice being held in the same spot.
A doula can help you learn how to use counter pressure most effectively.
5) Double Hip Squeeze
This is another type of counter pressure and is pretty intuitive.
The palms of the hands are applied to the outside of the birthing woman’s hips and squeezed together during contractions.
There are many ways to perform the double hip squeeze, all of which your doula is likely to know.
Why does this help? The inward pressure causes the pelvis to flare out slightly, relieving pain and helping the baby move into a better position.
6) Leaning While Kneeling
Like the similar standing position, leaning over a bed, birth ball, or chair while kneeling can be a very helpful position when you have back labor.
The worst position for any kind of labor is said to be laying on your back (especially with your feet in stirrups), as it narrows your pelvis, worsens contractions, and makes many coping mechanisms difficult to use.
7) TENS Unit
A Transcutaneous Electronic Nerve Stimulation unit is often given to patients experiencing chronic back, knee, hip, or other kinds of pain.
It’s a small device that sends a harmless electric shock pulse through electrode pads placed on your back.
Call your maternity ward and ask if they keep a TENS unit on hand, or purchase one yourself.
Some doulas may even be trained to use these.
8) Sterile Water Injections
These aren’t used very often in the U.S., but they could be your ticket to a more painless labor.
A sterile water solution is injected just barely under the skin in several spots around the sacrum/lower back area.
It’s administered by a nurse, doctor or midwife in a hospital, birth center, or even a home birth.
There are no drugs, just sterile water, so it’s perfectly safe and can be repeated as desired.
Some women find a lot of relief, others don’t find any, and some others are too freaked out by needles to try it.
If you fall in that last camp then you’re better off trying some of the other techniques.
9) Backward Chair Sitting
Notice a trend, yet?
All of these positions keep your back exposed, allowing a support person to massage, apply TENS, etc.
For this position, get comfortable sitting backward on a chair.
It doesn’t get more simple than that.
10) Slow Dancing
Bring your partner to the floor, dim the lights and turn on some peaceful tunes.
Wrapped in the strong arms of your husband could be the place you find the most relief.
Lean on him and sway. He can even rub your back if you like.
Wrapping It Up
Back labor is just another way women can experience labor.
You may or may not ever find out what it feels like, but if you do, armed with knowledge and the tools mentioned above you can experience a positive and peaceful birth experience no matter what position your baby ends up being born in.
Have you experienced back labor, or know someone who has? What brought you the most relief? Share your insights and experiences with us in the comment section below!