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What Is Back Labor and What Causes It?

Labor and giving birth may be one of the most exhilarating events of your life. It’s also probably one of the most physically demanding, unless you have your sights set on, say, climbing Mount Everest.

And when bringing new life into the world involves back labor, it gets a bit more challenging. (But don’t worry. You can still handle it, we promise.)

Back labor happens when the back of your baby’s head presses against your spine and tailbone as they make their way through the birth canal — ouch.

Although it may sound terrifying, knowing what it’s all about can make it easier to manage. You’ve got this, mama.

Labor begins when the muscles of the uterus contract.

Gradually, those first twinges will become more intense with each contraction — beginning, reaching a peak, and then fading away. As the contractions become more intense, they’ll last longer — which is exactly what you want, no matter how much you wish it would stop when you’re going through it.

These contractions are the tightening of your uterus as it pushes your baby lower into your birth canal. Most of us feel intense pain, cramping, and pressure during active labor.

Usually, the pain you feel will center in the lower abdomen and pelvis. But 33 percent of women will feel more pain in the lower back, sometimes due to how baby is positioned.

In an ideal world, all babies would be born sunny-side down — with their faces turned towards mom’s cervix. But in back labor, your little one’s face is sunny-side up and the back of their head — or should we say, the hardest part of their head — is against your cervix. (Even so, thank goodness for a baby’s relatively soft skull!)

So no, back labor isn’t a myth.

If you hear your doula, midwife, or doctor say baby’s in the occiput posterior position, that means sunny-side up. And carry right on with your breathing exercises because, well, it happens — and it can un-happen, too.

One small, dated study of 408 pregnant women showed that even though 15 percent of babies were sunny-side up at the onset of labor, the vast majority of them turned themselves ’round during labor.

If you’re wondering what it feels like when your baby’s sunny-side up or how you can tell the difference between back labor and plain ‘ole pregnancy back pain, here are some pointers to keep in mind:

  • Back labor will set in when you’re actively in labor. Don’t worry that the aches and pains that you may be feeling in your back are a sure sign of back labor — they’re not. The American College of Obstetricians and Gynecologists ticks them off as regular back pain that comes from strain on your back muscles, weak abdominal muscles, and pregnancy hormones.
  • Here’s where it can get confusing: Regular contractions come and go, giving you time to catch your breath between contractions. But back labor may not give you that rest. You may feel a constant pain in your lower back that becomes especially intense at the height of a contraction.
  • If you go into labor preterm (after week 20 and before week 37 of pregnancy) you probably won’t have back labor. Some experts says that back labor is more likely if you’ve passed week 40.

Remember that we said that if your baby is sunny-side up, you’re more likely to experience back labor. Well, the good news is that even if your baby is sunny-side up and stays that way, that’s no guarantee for back labor. You may still get off easily — or, rather, more easily. Birthing a little human is hardly easy!

There are a few other possible risk factors for back labor. If have pain during your menstrual cycle, are giving birth for the first time, or have had back labor in the past, you may be more likely to experience back labor regardless of which way your baby is facing.

One small 2008 study found that women who had lower back pain during their pregnancy or who had a higher body mass index (BMI) were more likely to have pain in the lower back during labor.

Back labor can’t always be prevented. Since back labor is often caused by the position of your baby, you may want to try out these tips during your pregnancy to encourage your baby to slip into the best position for you:

  • Even when you don’t feel up to much, don’t give up on pelvic tilts. This fun exercise may remind you of a cat arching their back in the sun. Once you’re on your hands and knees, arch your back up and then straighten it.
  • Keep your knees lower than your hips by bouncing on an exercise ball, sitting on the toilet backwards, or straddling an armless chair backwards and resting your arms and head on the back of the chair.

Having back labor may put you at higher risk of having a cesarean delivery, assisted vaginal delivery, an episiotomy, or perineal tears. Talk to your OB about your concerns — they’re there to help.

When you’re heading towards the finish line and are feeling those pains in your back, here are some things that can help.

How to help yourself

  • Make gravity work for you. Try to walk, bounce on a birthing ball, or lean against a wall. Keep your baby’s head off your spine by getting down on your hands and knees, leaning over, or crouching. Avoid lying on your back, as this will put more pressure on your spine.
  • Take a warm shower and aim the water at your back or relax in a warm bath.

How your partner or doula can help you

  • They can place a heating pad, heated rice sock, or cold compress against your back. Try both heat and cold to see which works best for you.
  • A small 2008 study showed that over 65 percent of women with lower back pain, even those who had continual pain, said that massage was the best relief. Have someone apply pressure to your lower back. They can use their fists, a rolling pin, or tennis balls.

How your medical team can help you

  • If back labor is caused by your baby being sunny-side up, it may be harder for your baby to move through the birth canal. You may want to talk to your doctor about pain meds for labor and delivery, such as a spinal block.
  • Sterile water injections are an alternative to medication. A 2018 study of 168 women in labor with severe back pain showed that their back pain scores lowered significantly — in the words of the analysts — 30 minutes after the shot.

Good practice throughout your pregnancy is to call your OB’s office if you notice any new symptoms during pregnancy. But some women hesitate, especially if they’ve had false alarms.

So what if you’ve been uncomfortable with lower back pain for what seems like hours? How can you tell if you’re in labor? Here are some signs that may mean it’s the real thing:

  • Let’s start with an unpleasant reality — diarrhea. A sudden onset of loose stools can be sign that labor is starting.
  • Spotting (bloody show) can happen when the mucus plug that’s protected your baby from outside germs starts to loosen.
  • Water breaking. Feel a sudden gush of fluid or a non-stop trickle? Labor may be on its way.

If you’re having very painful contractions every 5 minutes that last for about a minute, you’re probably in labor. Add back pain to this and you may also be experiencing back labor. Take a deep breath, call your OB, and head to the hospital.

Back labor can be an added challenge to any woman’s journey through labor and birth. But you can make it. Hey, you’re bringing new life into the world. And that’s a heady feeling.

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