Labor and Delivery Pain Relief Causes and Treatment of Back Pain During Labor By Robin Elise Weiss, PhD, MPH Robin Elise Weiss, PhD, MPH LinkedIn Twitter Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor. Learn about our editorial process Updated on June 14, 2021 Medically reviewed Verywell Family articles are reviewed by board-certified physicians and family healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Brian Levine, MD, MS, FACOG Medically reviewed by Brian Levine, MD, MS, FACOG Brian Levine, MD, MS, is board-certified in obstetrics and gynecology as well as in reproductive endocrinology and infertility. Learn about our Medical Review Board Print Layland Masuda / Getty Images 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 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. Around 10-34% of cephalic (head down) presentations are OP at the onset of labor, but only 5-8% will persist until birth. 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. Fetal Positions for Labor and Birth Changing the Baby's Position Parents whose babies are in a face-up position tend to push longer. And when the position persists to the second stage, they have a 70% greater chance of requiring forceps, vacuum-assistance, or a Cesarean section. OP is also associated with higher rates of induction, augmentation, and third and fourth degree perineal tears. 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). If there are no contraindications, your doctor may offer you a 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 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. Some common positions: Hands and knees: Get on all fours and gently rock back and forth (cat-cow pose).Prop your hips: Lie on your back on the floor with your knees bent and raise your hips in the air (bridge pose).Upright and forward leaning: Encourage more pelvic space for fetal positioning.Knees lower than hips: Place a pillow behind your back for comfort.Exercise ball: Sit on the ball or lean over it.Walk or swim: Gentle exercise encourages natural pelvic movement. Ways to Relieve 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, as the laboring person may have a high need for massage and pressure on the back during labor. 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 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 sift 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 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, 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, less epidurals, and fewer 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. Reasons to Have a Water Birth Stay Upright 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. What Is It Really Like to Give Birth? Loading shell for quizzesApp1 vue props component in Globe. Was this page helpful? Thanks for your feedback! Get diet and wellness tips to help your kids stay healthy and happy. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 14 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Guittier M, Othenin-Girard V, Irion O, Boulvain M. Maternal positioning to correct occipito-posterior fetal position in labour: a randomised controlled trial. BMC Pregnancy Childbirth. 2014;14(1). doi:10.1186/1471-2393-14-83 Phipps H, Hyett J, Kuah S et al. Persistent occiput posterior position - OUTcomes following manual rotation (POP-OUT): study protocol for a randomised controlled trial. Trials. 2015;16(1). doi:10.1186/s13063-015-0603-7 American College of Obstetricians and Gynecologists. If your baby is breech. Guittier M, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2016;123(13):2199-2207. doi:10.1111/1471-0528.13855 Cleveland Clinic. Positions of baby in womb. Airedale NHS Foundation Trust. Getting your baby into the best position for birth. Unalmis Erdogan S, Yanikkerem E, Goker A. Effects of low back massage on perceived birth pain and satisfaction. Complement Ther Clin Pract. 2017;28:169-175. doi:10.1016/j.ctcp.2017.05.016 Cohen SR, Thomas CR. Rebozo technique for fetal malposition in labor. J Midwifery Womens Health. 2015 Jul-Aug;60(4):445-51. doi:10.1111/jmwh.12352 Iversen ML, Midtgaard J, Ekelin M, Hegaard HK. Danish women's experiences of the rebozo technique during labour: A qualitative explorative study. Sex Reprod Healthc. 2017 Mar;11:79-85. doi:10.1016/j.srhc.2016.10.005 Gau M, Chang C, Tian S, Lin K. Effects of birth ball exercise on pain and self-efficacy during childbirth: A randomised controlled trial in Taiwan. Midwifery. 2011;27(6):e293-e300. doi:10.1016/j.midw.2011.02.004 American College of Obstetricians and Gynecologists. Immersion in water during labor and delivery. Ondeck M. Healthy birth practice #2: Walk, move around, and change positions throughout labor. J Perinat Educ. 2014;23(4):188-193. doi:10.1891/1058-1243.23.4.188 Genç Koyucu R, Demirci N, Yumru A et al. Effects of intradermal sterile water injections in women with low back pain in labor: A randomized, controlled, clinical trial. Balkan Med J. 2018;35(2):148-154. doi:10.4274/balkanmedj.2016.0879 Dowswell T, Bedwell C, Lavender T, Neilson J. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database of Systematic Reviews. 2009. doi:10.1002/14651858.cd007214.pub2 Additional Reading Abdolahian, S.; Ghavi, F.; Abdollahifard, S. et al. Effect of dance labor on the management of active phase labor pain & clients’ satisfaction: a randomized controlled trial study. Glob J Health Sci. 2014;6(3):219–226. doi: 10.5539/gjhs.v6n3p219. Dahlqvist, K. and Jonsson, M. Neonatal outcomes of deliveries in occiput posterior position when delayed pushing is practiced: a cohort study. BMC Pregnancy Childbirth. 2017;17:377. doi: 10.1186/s12884-017-1556-5.