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.

What does back labor feel like?

People who have experienced back labor describe it as:

  • Intensely painful or even excruciating.
  • Equally painful or much more painful, but different than regular labor pain.
  • Pain that worsens with each contraction and may not ease up between contractions.
  • Pain along with painful spasms.

What causes back labor?

Back labor is thought to be caused by the position of your baby within your pelvis. Pain develops when the back of your baby’s head presses against your lower spine and tailbone while you’re in labor. Technically, this is called the occiput posterior position. Its nickname, the “sunny side up” position may refer to your baby’s face facing upward at birth, like the yolks of sunny side up eggs. The preferred position for easier delivery is the occiput anterior position, which means your baby’s head is down in your pelvis with their face and front of body facing toward your back.

Several recent studies suggest that factors other than baby positioning may contribute to back labor. These factors include:

  • Mom-to-baby size ratio: Moms with short torsos who carry long babies may have more lower back pain as there is limited room for their baby to rotate within their pelvis.
  • Pelvic shape: Slight variations in the size and shape of the pelvis can add to back pain if the baby isn’t in the occiput anterior position.
  • Ligament and muscle issues: Tight or weak muscles and ligaments attached to your pelvis can play a role in your baby's ability to get into an easier birthing position and also potentially add to back labor pain.
  • Bad posture: Posture that tips your pelvis forward or that tucks your butt can add to back labor pain.

How common is back labor?

According to published literature, the number of pregnancies in which the baby is in the occiput posterior position at the beginning of labor ranges between 15% and 32%. However, this number decreases to between 5% and 8% at the time of delivery. Most of the time, the baby eventually rotates to a more favorable position during labor.

When does back labor start?

Back labor begins when you’re in active labor and sometimes earlier. Back labor remains present during labor and may become 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.

Does back labor hurt my baby?

Back labor can be extremely uncomfortable for you, but it doesn’t harm your baby. Most babies turn their bodies to the preferred position (back of their head/back of their body against the front of your belly) during labor.

If my baby doesn’t rotate, can I still have a vaginal birth?

Usually, but if your baby doesn’t rotate, your labor may last longer, be harder and require more pushing than what would be otherwise expected. Your healthcare provider may attempt to rotate your baby with their fingers or hand.

However, there’s always a chance that you’ll need a cesarean delivery. Back labor may increase the chances for an assisted vaginal delivery (assisted with the use of forceps, vacuum extraction) and more vaginal tearing.

How do I know if my baby is in the occiput posterior position?

An ultrasound is the most reliable way to tell. Also, it’s possible — with some training — that you, your partner, doctor or midwife can sometimes feel the shape of your baby through your skin and figure out how your baby is positioned. Keep in mind that your baby’s position continues to change throughout your labor. During the end stages of labor, your midwife, doula or doctor can see or feel how your baby is positioned.

Can back labor be prevented?

You may not be able to prevent back labor — or can you? Here are some techniques you can try to help slip your baby into a better position for delivery, which will also relieve your back labor. All of these positions help open your hips, which can help your baby more easily move and rotate into a face downward (baby facing your spine) position. Your baby’s position can continue to rotate any time before you begin labor and during labor.

Let gravity help reposition your baby. Hang your belly from any position.

  • If you want to stand, lean over while holding onto a couch or sturdy chair.
  • If you want to be on the floor, get down on your hands and knees. Arch your back (like a scared cat), then flatten your back. This technique is called a pelvic tilt. You can also try crawling across your floor on your hands and knees.
  • If you want to sit, straddle an armless chair backward and lean forward. Grab the back of the chair and rest your head on your arms.
  • Walk, squat, do lunges.

Use a birthing ball as your baby repositioning assistant.

  • Sit on the ball with your feet on the floor, shoulder-width apart. Roll your hips in a circular fashion.
  • Sit on the ball with your feet on the floor, shoulder-width apart. Use your hips/buttock to move the ball forward and backward.
  • Get on your knees on the floor. Lean your belly against the ball with your hands crossed on top of the ball and your head resting on your hands. Sway or roll around with your belly against the ball.

Other partner-assisted techniques:

  • Double hip squeeze: Using both hands, have your partner press in and up on the sides of your hips and hold for several seconds.
  • Knee press: With you sitting in a chair, have your partner cup their hands over your kneecaps and press backward. This will press your lower back into the chair.

What else can be done to relieve back labor pain?

All of the exercises and techniques discussed above not only help reposition your baby but also relieve pain. However, you can try other methods.

Additional pain-relieving tips include:

  • 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 bath water 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 counter pressure.
  • Have your partner rub/massage your lower back with their hands or with similar equipment as above.
  • Lie on your side. Don’t lie on your back.
  • Keep your knees lower than your hips whenever you are sitting.
  • Ask your healthcare provider about other pain-reducing aids such as TENS, sterile water injections and medications.

A note from Cleveland Clinic

Back labor is painful and is caused by the position of your baby’s head against your spine and tailbone. There are many techniques your can try to reposition your baby, which will also reduce your discomfort. The most important message is not to get too worried about your baby’s position. Your baby twists and turns throughout your pregnancy and even during labor. Your partner and healthcare team are here to support you and will help you remain as comfortable as possible through the delivery process.

Last reviewed by a Cleveland Clinic medical professional on 09/17/2021.

References

  • American Pregnancy Association. Back Labor. (https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/back-labor/) Accessed 9/10/2021.
  • Lamaze International. Best Labor Positions for Back Pain. (https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/TitleLink/Best-Labor-Positions-for-Back-Pain) Accessed 9/10/2021.
  • Lamaze International. When Back Labor Strikes – Tips & Tricks for Optimal Comfort. (https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/TitleLink/When-Back-Labor-Strikes-Tips-Tricks-for-Optimal-Comfort) Accessed 9/10/2021.
  • Simkin P. The fetal occiput posterior position: state of the science and a new perspective. Birth. 2010 Mar;371 (1):61-71. Accessed 9/10/2021.

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