Causes and Treatment of Back Pain During Labor

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.

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.

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.