Causes and Treatment of Back Pain During Labor

Most of the pain women 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, in approximately 25 percent of women, 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.

Back labor is generally thought to be related to the position of the baby in your pelvis. The ​occiput posterior position (OP) is often pinpointed as the most likely culprit. In the OP position, the baby is facing up toward the mother's pubic bone, causing the harder part of the baby's skull to rest on the bony part of the spine, pressing on the nerves and causing pain.

Research suggests that being pregnant for more than 40 weeks, being overweight, and being a first-time mother can increase the risk of the OP position. The position also tends to occur more frequently during induced labors and in those involving the artificial rupture of the membranes.

Mothers whose babies are in a face-up position tend to push longer and may require forceps, a vacuum-assisted delivery, or a Cesarean section. The likelihood of having an episiotomy and perineal tears during vaginal birth is greater than it is when babies are face-down.

While most babies end up in the face-up 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). After giving you a medication to relax the uterus, your practitioner, using ultrasound for guidance, will apply pressure on your belly and try to manipulate your baby into the desired position. Over half of ECV attempts are successful.

You can also increase the likelihood that your baby will end up in the optimal position by taking the following steps during the final months of your pregnancy:

• Lie on your left side while resting or sleeping. This encourages the baby to move while keeping pressure off your vena cava (the artery responsible for returning blood from your lower body to your heart).
• Try to exercise at a moderate pace for at least 30 minutes most days of the week. Swimming with your belly facing down can be especially helpful. 
• Do pelvic tilts. Even if you aren’t up to doing a full workout in your last month, make a habit of doing pelvic tilts for about five minutes several times each day.
• Do chair lunges, resting your foot on the seat of a chair and pressing your hips forward into controlled lunging movement. Hold for a count of five and repeat. If your baby is positioned on the left side, do left-sided lunges. If on the right, do right-sided lunges.
• While standing, lean over counters or chair backs to encourage the baby into the correct position.
• Walking stairs is also helpful, using gravity and joint movement to gently ease the baby into the optimal position.
• Avoid semi-reclining with your knees higher than your hips as this reduces the angle of the pelvis and promotes the OP position.

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 a natural birth, these alternative techniques may help:

Have someone push at or just above the sacrum (tailbone) where you're feeling the most pain. It can also help to use an object like a warm pad, a cold pack, or a rolling-pin-like massage device to apply the pressure. Some people find that rolling a tennis ball or a cold beverage can offer the same level of acute pain relief.

This labor position is relatively easy to do and is great for pain relief. When you're on your hands and knees, the baby is tipped slightly out of the pelvis, giving it more room to rotate. Due to the decreased pressure on the cervix, you might not experience as much pain during contractions. This position also allows for great counter pressure for the lower back.

This is similar to the hands-and-knees position, but, instead of being on all fours, rest your upper body on your forearms, keeping your buttocks high and your knees wide. Trying alternating this position with the hands-and-knees position for 30 minutes each day, resting on your left side for a minute or so between positions.

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 during contractions helps to alleviate the pressure of your baby's head against the sacrum.

One of the best ways to alleviate pain and pressure is to literally lift the belly until the sensations subside. For this, you would need your partner to stand behind you and wrap his or her arms below your abdomen.

Lacing the fingers together, your partner should gently lift up and inward to change the horizontal angle of the fetal spine into a more vertical one. Doing so may not only ease the pain but help encourage the baby into a better position. If you feel discomfort or pain of any sort, stop immediately.

A birth ball is the same as 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 and roll around or bounce on it, or place it against a wall and lean on it—whatever works for you.

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.

For this technique, your partner holds you in his or her 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.

A sterile water block is something that a nurse or midwife can perform if the pain is especially severe. The block involves the injection of tiny papules of sterile water along the sacrum. While there may be an initial sting, the water block can often provide relief for several hours, presumably by stimulating the local production of endorphins to block pain signals.

Transcutaneous electrical nerve stimulation (TENS) has also been shown to be an effective way to deal with back pain during labor. This non-medicinal form of pain relief should be started early in labor for the best effects.

Small electrical pulses help disrupt the sensation of pain via electrodes placed on your back. You will need to provide your own TENS device as hospitals and birthing centers do not have them on hand.