Why You Might Experience 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. In approximately 25 percent of women, back pain also occurs in labor—and it can be excruciating. Knowing the causes of "back labor," as it's called, and what you can do to ease the pain can make the experience more manageable.

Back labor is generally thought to be related to the position of your baby in relation to your pelvis. The ​occiput posterior position (OP) in particular 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 the pain.

Some research suggests that being pregnant for more than 40 weeks, being overweight, and being a first-time mom can result in the baby ending up in the OP position. This position also tends to occur more frequently in induced labors and in those involving artificial rupture of the membranes.

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

Most babies end up in the face-up position toward the end of pregnancy, but if it doesn't seem to be happening, your doctor or midwife may try to manually turn the baby. This procedure is called external cephalic version (ECV). After giving you a medication to relax the uterus, your practitioner, 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 doing the following:

• 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, try to make a habit of doing pelvic tilts for about five minutes several times each day. (To do a pelvic tilt, lie on your back with your knees bent and feet on the floor. Lift up your pelvis as far as it will go, then down again. Repeat.)

If you do experience back labor, an epidural can help relieve the pain, though back pain is often more resistant to the effects of an epidural than "regular" labor pains.

If the pain persists, or if you are hoping for a natural birth, these techniques can help:

Counter Pressure

Have someone push at or just above the sacrum, 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.

The Hands and Knees Position

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. And 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.

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 fall on your back. You can place towels on the floor of the shower to make it more comfortable, or lean over a birth ball.

Using a 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 and roll around or bounce on it, or place it against a wall and lean on it—whatever works for you.

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.