What Back Labor Is Really Like

Laboring people don't always feel contractions solely in their abdomen. In fact, as labor contractions become longer, more frequent, and more intense, they can cause sensations throughout the body, including the back. When that back pain is severe and shows up with intensity during (and sometimes even between) contractions, it is often referred to as back labor.

Back labor usually happens in the lower back, just above the tailbone, and it can be a sign that your baby is in the occiput posterior (OP) position (sometimes called "sunny-side up"). While back labor can be extremely uncomfortable for you, it's usually not a problem for your baby. The majority of babies in the sunny-side up position will rotate on their own by the time it's time to push. Only around 5% to 8% of babies will remain in the OP position, and even when they do, most babies can be born vaginally without complications.

Although it's good news that your baby likely won't have complications because of being in the sunny-side up position, the bad news is that it can cause severe back pain for you. Fortunately, there are strategies that can help relieve back labor pain. Here's what you need to know about what back labor pain feels like and how to cope with back pain during labor.

What Causes Back Labor?

Back labor is thought to be caused by the baby's position in the pelvis during labor and delivery.

There are many positions that a baby can be in during labor. The most ideal position for labor and delivery is head down facing the pregnant person's spine. This is called the occiput anterior (OA) position.

But some babies who are head down instead face up toward the ceiling with their back facing the pregnant person's spine. This position is known as the occiput posterior (OP) position (sometimes referred to as "sunny-side up" or "back-to-back"). Around 15% to 20% of babies who are in the head down position are in the OP position.

It is this OP position that is thought to contribute to back labor, since the baby's head can press painfully against the spine and tailbone, says Laura Riley, MD, medical director of labor and delivery at Massachusetts General Hospital in Boston.

It isn't known why some babies end up in the occiput posterior position while others don't. It could be influenced by factors like the baby's size or the pregnant person's anatomy, but more often than not, the reason is unknown.

What Does Back Labor Feel Like?

With back labor, pain is generally concentrated in your lower back because the back of the baby's head is pressing against your tailbone or spine, says Dr. Riley. Some people who have experienced back contractions say they're excruciatingly painful, while others find that the pain of back labor isn't worse than ordinary labor (merely different).

Just like with other types of labor pain, back labor can be experienced differently by everyone. Some people might have back pain instead of or in addition to the abdominal discomfort of contractions.

As your baby moves down into the pelvis, back labor pain can become more severe. In some cases, back labor may also not let up between contractions. Some people may also experience painful muscle spasms with back labor.

Back Labor vs. Back Pain in Pregnancy

Back pain is a common symptom of pregnancy. At least half of pregnant people experience back pain in the first trimester of pregnancy while that number can reach as high as 70% to 80% of pregnant people in the third trimester. Pregnancy back pain has a few culprits, including your growing abdomen affects the center of gravity and the pregnancy hormone relaxin loosens ligaments.

So how can you tell if you're experiencing normal back pain or back labor? In general, back labor pain won't start until you're in labor while back pain during pregnancy can be felt all throughout your pregnancy. In some cases, however, back pain can be a sign of premature labor, so call your doctor right away if you're earlier than 37 weeks pregnant and experiencing sudden back pain.

When to Go to the Hospital for Back Labor

First things first, if you are experiencing any sudden pain, vaginal bleeding, or leaking fluid at any time during pregnancy, call your doctor right away, but especially if you are less than 37 weeks pregnant.

Once you're past 37 weeks, if you are experiencing pain and think that you may be in labor, follow your doctor or midwife's advice regarding the timeline of when to go to the hospital. Oftentimes, they'll admit you when you're having frequent contractions that are getting closer together. You should also contact your doctor if your water breaks.

Does Back Labor Affect Delivery?

People who experience back labor commonly have labors that last longer and deliveries that require more pushing than people who don't experience back labor, says Dr. Riley. Most babies in a posterior position will rotate the necessary 180 degrees on their own as labor progresses. Sometimes a doctor or midwife will attempt to rotate the baby with their hands.

If the baby stays in a posterior position, they can still be delivered vaginally if they fit through the birth canal. However, if a posterior baby is angled in such a way that they need a little extra space, and there is not enough room in the birth canal, the doctor may recommend a cesarean delivery. Back labor also increases the risk for prolonged labor and interventions such as an episiotomy, assistance with forceps or vacuum extraction, or medications to keep labor going.

Relieving Back Labor Symptoms

If you experience back labor, it's recommended to change positions, because lying on your back can substantially exacerbate back contractions during labor. In addition, any position that puts more pressure on the baby's head against the tailbone can increase back labor pain. To relieve the pressure, try positions such as kneeling on all fours, rolling onto your side, or squatting.

Some movements, such as pelvic tilts, might help reposition the baby. To do a pelvic tilt, get down on your hands and knees and gently rock your pelvis by tucking your bottom in and then releasing it. This tips your baby slightly out of the pelvis and relieves some pressure. It also gives the baby optimal room to rotate.

A technique called counterpressure can also significantly relieve back labor pain. To use counterpressure, ask your partner, doula, or nurse to push against your back where you feel pain. They can press on it with their hands, a tennis ball, or another round object to help relieve pressure from the baby's head against the tailbone. They can also help apply ice or heat to your lower back or massage your lower back to help decrease the pain.

Pain medications or an epidural can also help, although an epidural may not completely take away all of the pain of back labor. But even if the epidural doesn't completely take away back labor pain, an epidural can help your body relax more to allow the baby to move into a different position and relieve some of the pain.