What Is Back Labor and How Is it Treated?

Most of the pain people experience during labor is focused in the uterus as a result of the intense contractions that help move the baby down into the birth canal. However, for some people, back pain can also occur and, in some cases, become excruciating. By understanding the causes of so-called "back labor," you can take steps to better manage the symptoms.

Causes of Back Labor

Back labor has traditionally been attributed to the baby's position during labor, and the ​occiput posterior position (OP) is often pinpointed as the most likely culprit. In the OP position, the baby's head is down but is facing toward the parent's pubic bone, causing the harder part of the baby's skull to rest on the back of the pelvis and along the spine.

This can result in pressure on the nerves and cause pain. Around 10% to 34% of cephalic (head down) presentations are OP at the onset of labor, but only 5% to 8% will persist until birth.

Some research shows that causes other than the baby's position can trigger back labor. The size and shape of the parent's pelvis, the parent's body size compared to the baby's body size, postural positions that cause an inward slant to the coccyx, and muscles and ligaments that are either too tight or too loose are all thought to contribute to the presence of back pain during labor.

There also may be a link between weight gain during pregnancy and/or body-mass index and back labor. And one study found that people who had back pain during their periods might also experience back pain during labor.

Changing the Baby's Position

Back labor isn't uncommon. "Overall, it occurs to a significant degree in about one-fourth of pregnancies. Most women, though, have some back pain in labor," says Cynthia Flynn, MD, a Florida-based ob/gyn. Many women start labor with low back pain." 

But parents whose babies are in a face-up position tend to push longer. And when the position persists to the second stage of labor, they have a 70% greater chance of requiring forceps, vacuum assistance, or a Cesarean section.

The OP position is also associated with higher rates of induction, augmentation, and third and fourth-degree perineal tears. So healthcare practitioners may try to change the baby's position to avoid these outcomes.

External Cephalic Version

While most babies end up in a more favorable anterior position toward the end of pregnancy, your doctor or midwife may try to manually turn the baby if this is not happening. The procedure is called external cephalic version (ECV). "A baby can be manually turned by the OB doctor from an occiput posterior position to an occiput anterior position," says Flynn, adding that "most babies normally rotate on their own." 

If there are no contraindications, your doctor may offer you medication to relax the uterus. Sometimes a regional anesthetic, like a spinal or epidural, is used. Then, using ultrasound for guidance, they will apply pressure on your belly and attempt to manipulate your fetus into the desired position.

Over half of ECV attempts are successful, but it is not without risks. Risks of ECV include premature rupture of the membranes, fetal distress, placental abruption, and preterm labor.

Pregnancy Positions

There is little research that shows exercises or positions in pregnancy are effective in moving a fetus into a favorable position for birth. Researchers studied one commonly recommended position—hands and knees—and found that when used during the first stage of labor, it did not correct the posterior position. People did, however, report more comfort in that position.

Theoretically, pregnancy positions use gravity to encourage a fetus into an optimal position. Common positions include sitting or leaning on an exercise ball or using a hands and knees pose, in which you get on all fours and gently rock back and forth (cat-cow pose). Another is to prop your hips: Lie on your back on the floor with your knees bent and raise your hips in the air (bridge pose).

You can also try an upright and forward-leaning position to encourage more pelvic space for fetal positioning. Another option is to keep the knees lower than the hips. In this position, it helps to place a pillow behind your back for comfort. Some people find success and comfort while walking or swimming. Gentle exercise encourages natural pelvic movement.

Ways to Relieve Back Labor Pain

If you do experience back labor, an epidural can help relieve some of the pain. With that being said, back pain is often more resistant to the effects of an epidural than uterine labor pains. If the pain persists, or you are hoping for an unmedicated birth, these alternative techniques may help.

Low Back Massage

Low back massage has been proven to reduce pain during labor. Having someone push at or just above the sacrum (tailbone) where you're feeling the most pain may also help. Using a warm pad, a cold pack, a tennis ball, or a rolling-pin-like massage device may be useful during back labor, since these can provide more pressure.

Hands-and-Knees Position

This labor position is relatively easy to do and studies have found it offers pain relief during labor. When you're on your hands and knees, the baby is tipped slightly out of the pelvis, giving it more room to rotate. Another variation of this position is to rest your upper body on your forearms, keeping your buttocks high and your knees wide.

Double Hip Squeeze

While in the open-knee position, have your partner crouch behind you and press on both sides of your buttocks with the palms of the hands, fingers facing inward toward the spine. Doing so can help the pelvis relax, which can alleviate pain.

Rebozo

A rebozo is a long shawl that can be used in labor in a variety of ways to support a laboring person. The technique has shown promising results. One study found that when the rebozo is used to gently shift the abdomen, it can be a potentially valuable tool to correct malposition. Another study found evidence that using a rebozo during labor resulted in pain relief.

Birth Ball

A birth ball is just like the exercise balls you may have seen at a gym or in a physical therapist's office. It can be used in many different ways to ease labor pain. You can sit on it, roll around, bounce on it, or place it against a wall and lean on it—whatever works for you.

Research has found the use of birth balls to be an effective method of reducing pain during labor. In a randomized, controlled trial, participants who used a birth ball during pregnancy and labor had shorter first stages of labor, fewer epidurals, and a decreased number of c-sections.

Water Therapy

Immersing yourself in a tub can also be a great comfort during labor. Or you can assume the hands and knees position in the shower and let the warm water flow on your back. You can place towels on the floor of the shower to make it more comfortable, or lean over a birth ball. 

Hydrotherapy during the first stage may decrease the length of labor and reduce the need for a spinal or epidural.

Movement

Using upright positions and staying mobile has been found to reduce the length of labor, reduce the need for interventions, and reduce pain. Walking, standing and leaning on your partner, or leaning over a chair are good upright positions to try.

Another upright technique is called the  birth dance. For this, your partner holds you in their arms as if dancing. Allow your arms to hang loosely as you and your partner sway back and forth, shifting the weight from one leg to the other.

Sterile Water Block

A sterile water block involves the injection of sterile water along the sacrum. While there may be an initial sting, the water block can often provide relief for several hours. As an alternative to pharmacological pain relief, it is effective at relieving back pain during labor.

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) uses small electrical pulses to help disrupt the sensation of pain via electrodes placed on your back. Research is lacking, but older studies have not shown evidence that TENS is an effective way to deal with pain during labor. It may, however, offer someone a sense of control during labor.

A Word From Verywell

Labor can be a frightening experience, even if you've gone through it before. All labors are different, and most are at least a little uncomfortable if not downright painful. It's important to remember to lean on your birth team for support, advocate for yourself, and most importantly, don't feel ashamed if your birth plan goes out the window.

Ask for the relief you need or empower your birth partner to advocate on your behalf. Back labor is hard, so don't be afraid to use the tools that are available to you to make it easier.