Back Labor

What is back labor?

Back labor is pain and discomfort in your lower back that happens during labor. Back labor may be most uncomfortable during contractions but can also remain painful between contractions.

As the name suggests, this pain only happens when you’re in labor — typically active labor, which usually means your cervix is 6 centimeters (cm) dilated and you’re having regular uterine contractions.

What does back labor feel like?

Childbirth and pain are both entirely unique experiences. What one person feels or experiences during labor can be extremely different from what you feel and experience. Additionally, it’s normal to have back pain during pregnancy and labor. But there’s a distinct difference between back pain or soreness and actual back labor.

People describe back labor pain as:

• Intensely painful or even excruciating pain that feels constant.
• Equally or much more painful, but different than regular labor pain you feel in your abdomen.
• Pain that worsens with each contraction and may not ease up between contractions. Contractions typically come and go, whereas back labor may never give you a break.
• Painful muscle spasms that can radiate to your hips.

What causes back labor?

Healthcare providers believe that the position of the fetus within your pelvis causes back labor pain. Specifically, pain develops when the back of the fetus’s head presses against your lower spine and tailbone while you’re in labor. This happens because the fetus is in the occiput posterior position. This means the fetus’s head is down in your pelvis, but its face and the front of its body are facing your abdomen.

The preferred position for an easier delivery is the occiput anterior position, which means the fetus’s head is down in your pelvis with its face and the front of its body facing toward your back.

Several recent studies suggest that factors other than fetal positioning may contribute to back labor.

These factors include:

• Short torso: Someone with a short torso carrying a larger-than-average fetus may have more lower back pain as there’s limited room for the fetus to rotate within their pelvis.
• Pelvic shape: Slight variations in the size and shape of your pelvis can add to back pain.
• Spinal abnormalities: If you have scoliosis or another condition that affects your spine, you may be more likely to have back labor.
• Ligament and muscle issues: Tight or weak muscles and ligaments attached to your pelvis can play a role in the fetus’s ability to get into an easier birthing position and potentially add to back labor pain.
• Bad posture: Posture that tips or tilts your pelvis forward or that tucks your butt inward can add to back labor pain.

You may also be more likely to have back labor if you:

• Are pregnant for the first time.
• Are pregnant with a larger-than-average fetus.
• Have low back pain during your period.
• Have obesity.
• Are at term (37 weeks pregnant) or past your due date (past 40 weeks pregnant). You’re not likely to have back labor if your birth is preterm (before 37 weeks).

When does back labor start?

Back labor typically begins when you’re in active labor, but it can sometimes begin earlier. Back labor usually continues for the rest of labor and becomes more intense during contractions.

Understanding when back labor begins makes it easier to sort out other types of back pain you may feel. While back labor can be continuous once labor begins, regular labor pain happens during contractions. Other types of back pain are muscle aches and pains that come with the strain of pregnancy.

How common is back labor?

About 1 in 4 people (or 25%) report having intense low back pain during labor.

How do I cope with back labor?

There isn’t only one thing you can do to treat back labor. Most treatment focuses on changing your position to help encourage the fetus to get into a better position. Other treatments are techniques and tips you can try to ease discomfort. Also, you can request an epidural to help ease/treat back pain during labor.

Methods that encourage the fetus to move its position

All of these movements help open your hips and balance your pelvis:

• If you’re standing, lean over while holding onto a couch or sturdy chair. You’re letting gravity do the work to nudge the fetus to move and to shift pressure away from your back.
• Sit backward in a chair or on the toilet with your arms and hands up. Rest your head into your arms.
• Walk, squat or do lunges. Acting like you’re using an imaginary hula hoop can also help.
• Bounce on a birthing ball (exercise ball). Rolling your hips around the ball or backward and forward across the ball also works. You can also kneel in front of the birthing ball and lean into it with your arms.
• Use a shawl or rebozo. Take a long piece of fabric like a shawl or sheet and stretch it across the bottom of your belly (in a U position under your belly). Have your partner or support person pull up on the edges.
• Have your partner press in and up on the sides of your hips.

Back labor pain relief tips

If moving and shifting positions isn’t helping, some of the following methods can help ease discomfort:

• Apply a warm or cool compress to your lower back (whatever works best for you). Never apply heat or cold directly on your skin.
• Sit in warm bathwater or stand in the shower and aim the shower head at your lower back.
• Apply pressure to your back by rolling against (or having a partner roll) a water bottle, plastic soda bottle or tennis balls along your lower back. This method is called counterpressure.
• Have your partner massage your lower back with their hands or a hard object like a rolling pin.
• Ask your healthcare provider about other pain-reducing aids such as TENS, sterile water injections and pain medications.

Remember, your healthcare team works with pregnant women all the time. Ask them what they recommend for pain relief when back labor strikes.

Can back labor be prevented?

No, you typically can’t prevent it. But there are many ways you can find relief from back labor if you experience it. Some healthcare providers recommend doing the following things to help with fetal position and your pelvic alignment:

• Stay active during pregnancy. Walking, gentle stretching or doing yoga are good ways to stay active.
• Do pelvic tilts. This involves getting on your hands and knees and rounding your back (like a scared cat) and then going back to a neutral position. In yoga, this is called cat/cow pose.
• Try not to slouch. When you’re sitting, sit up straight. When you’re standing, pay attention to your posture and make sure you aren’t rounding your back.
• Keep your knees lower than your hips whenever you’re sitting. For example, avoid sinking into couch cushions or reclining.
• Spend time sitting and circling your hips on a birthing ball.
• Don’t lay directly on your back during labor. Instead, try to lay slightly to the side. You can also try standing and leaning against something.

When should I call my healthcare provider?

Contact your healthcare provider if you have any of the following symptoms in addition to back labor:

• Contractions that come every five minutes and last one minute each time and continue for an hour.
• Bloody vaginal discharge or vaginal bleeding.
• You feel a gush or trickle of fluid from your vagina (your water breaking).
• You suddenly have diarrhea.

Can you have back labor and not feel contractions?

Yes, it’s possible to have back labor and not feel contractions. Contractions can range from minor twinges to painful spasms. It’s possible that back labor dulls contractions, especially small ones.

Does back labor hurt my baby?

Back labor can be extremely uncomfortable and unpleasant for you, but it doesn’t harm the fetus.

Can back labor cause complications?

There aren’t any major health risks if you have back labor. But the position a baby is in can affect how your provider handles delivery. For example, you may need to have a C-section birth if your baby is in a sunny-side up position. Or you may be at higher risk for needing an episiotomy or vacuum-assisted birth.