What Is Back Labor and How Do You Deal With It?

You have nine months, give or take, to prepare yourself for labor. You’ve read up on it, talked to your friends and consulted with your doctor or midwife about pain relief options. In the process, you may learn about back labor — or pain in the lower back during labor that's usually linked to your baby's position.

Back labor can be unrelenting and very painful, especially when you're having contractions. The good news is, there are a lot of effective ways to relieve back labor pain. What's more, the majority of babies flip into the proper position all on their own before it's time to make the final push.

Here's more on back labor and what to do to manage the pain.

What is back labor?

Back labor is intense pain and discomfort experienced in the lower back during labor. It usually happens when a baby is positioned with his head down toward your cervix but is facing forward, toward your stomach.

The vast majority of babies turn to face backwards on their own before their moms are ready to deliver.

What causes back labor pains?

The main cause of back labor is a baby’s position during labor. For most women who experience back labor, their babies are positioned "sunny-side up." That means your baby’s head is nestled down by your cervix, but he's facing your stomach instead of your back. (Your doctor would more formally call this the "occiput posterior position", by the way.)

If your baby is facing your tummy, the back of his head (the hardest part) pushes down on your spine and tailbone. This presses on spinal nerves, causing pain.

When babies are positioned head down and face their mothers' backs with their chins tucked up into their chests (formally known as the "occiput anterior position"), their heads are less likely to press on the spine and cause back labor pain. This position is also ideal for labor because the head is lined up to fit through the pelvis as easily as possible.

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Fortunately, odds are good that your baby will flip all on his own. While up to 20 percent of babies in the heads-down position face forwards up at term, only about 5 percent of babies haven't turned around the other way by the time their moms' deliver.

It's possible you’ll still experience back labor even if your baby is facing your back. That may be because he was sunny-side up but recently flipped, leaving your back feeling extra sensitive. Other times, it just seems to be the luck of the draw: Some women simply experience more back pain during labor than others.

What does back labor feel like?

As delivery day approaches, your practitioner will try to determine which way your baby is facing. If you're in a hurry to find out, look for these clues:

• When your baby is anterior (facing toward your back), your belly may feel hard and smooth. (That's your baby's back.)
• If your little one is posterior (facing toward your stomach), your tummy may look flatter and softer because your baby's arms and legs are facing forward. (There's no hard, smooth back to feel.)

Once contractions start, back labor feels like strong pain in your lower back that gets worse during each contraction and doesn't usually subside as things progress.

Signs of back labor

How will you know whether you're experiencing back labor? Signs of back labor might include:

• Severe pain in your lower back
• Pain becomes excruciating during contractions
• Pain often doesn’t let up between contractions
• Back contractions or back spasms

When to go to the hospital with back labor

Your doctor has likely given you a list of the signs that suggest it may be time to head to the hospital during labor.

During early labor (when contractions are irregular, coming every five minutes or more, and lasting about 30 to 45 seconds each), you're best off resting at home. Keep in mind, early labor can last for a few hours to a few days.

No matter which position your baby is in, give your doctor a call if:

• Contractions become more frequent, consistent, longer in duration and more painful
• Your water breaks
• You experience any bleeding
• You have blurred or double vision, sudden swelling or a severe headache

Back labor vs. back pain: how can you tell the difference?

With the weight of your growing uterus shifting your weight forward and the pregnancy hormone relaxin loosening your joints, back pain is a common pregnancy complaint. It often starts in the second to third trimester and gets worse as pregnancy progresses. With normal pregnancy back pain, your lower back and upper hips feel constantly achy, stiff or sore.

Back labor, on the other hand, is much more intense back pain that begins when you’re in labor. While you might feel consistent back labor pain until you deliver, you'll likely notice it gets much worse during contractions and noticeably subsides between contractions.

Back labor vs. regular labor

Labor contractions can cause pain in just the lower abdomen or the lower abdomen and the back. Normal labor contractions feel like intense menstrual cramps that come and go with increasing intensity. Regular contractions are only slightly felt in the back.

Back labor is much more intense pain in your lower back. The pain in your back tends to continue between contractions and gets particularly uncomfortable at the height of a contraction.

Are there risk factors for back labor?

There's no surefire way to know whether you’ll experience back labor, since back labor risks vary from person to person. Some research, however, has suggested that you may be at greater risk if you:

• Have an "android" (or heart-shaped) pelvis instead of a gynecoid (or round-shaped) pelvis, since it may keep your baby from rolling into the backwards-facing position
• Are giving birth for the first time
• Are shorter in height
• Are overweight

Is back labor more harmful than regular labor?

Back labor itself doesn’t cause any more complications for your baby than regular labor. However, back labor may be more uncomfortable and increase the chances of some complications for you.

Babies delivered in the sunny-side up (occiput posterior) position may be more likely to have a lower five-minute Apgar score, but their score tends to be the same as babies delivered in the standard (occiput anterior) position by 10 minutes after birth. They may also be more likely to be admitted to the neonatal intensive care unit (NICU).

Back labor may take longer versus regular labor because your baby may have a harder time extending his head from under your pubic bone. You may also experience more pain than regular labor given all of the pressure on your spine, so you might be more likely to ask for an epidural or other medical pain relief.

Some research suggests that back labor increases the likelihood of having:

• A C-section
• Assisted vaginal delivery (using forceps or vacuum extraction)
• Induction of labor with oxytocin
• Third- or fourth-degree perineal tears
• Early postpartum hemorrhage

How can I prevent back labor pain?

Is your baby still in the sunny-side up position as your due date approaches? There's no research-backed way to prevent back labor. Some midwives suggest giving the following tactics a shot: 

• Try pelvic rocks. Get on all fours and rock your pelvis back and forth, arching your back. While there's no evidence that shows it will get your baby into a more accommodating position, at the very least the stretching can help with pelvic pain.
• Use warm and cold towels. Some midwives suggest placing cold towels on the front of your belly and warm towels on your back. It's not proven to work, but if nothing else, it might help relieve any pregnancy back pain you’re experiencing.

Remember, most babies turn from one position to another all on their own, so don't worry too much about which way your little one is facing before labor begins.

What can I do to relieve back labor pain?

If your baby is still in the sunny-side up position when you go into labor, you have a number of options for back labor pain relief:

• Consider an epidural. If you’re planning for an epidural, there’s no need to wait just because you’re in back labor — especially if you’re in a lot of pain. You may need a higher dose of medicine than you would otherwise for full pain relief, so discuss your situation with your anesthesiologist.
• Ask about other pain relief options. Talk to your anesthesiologist about using narcotics for pain relief. Some research also suggests sterile water injections may be especially helpful at relieving back labor pain. (It's exactly what it sounds like: an injection of sterile water under the skin at certain trigger points in the lower back.)
• Relieve the pressure. Get down on your hands and knees (place your head and shoulders on a pillow on the ground if your arms get tired) or kneel against a birthing ball. These positions help keep your baby’s hard little head off of your spine.
• Move around. See if walking, squatting, crouching or leaning over reduces the pain. Choose whatever position is least painful and most comfortable for you.
• Lie in the spider position. Be sure to stay on your side when you’re lying down, since lying on your back increases the pressure (and therefore the pain). Experts often recommend the spider position. Lie on your side so you're almost on your belly. Keep your bottom leg extended and your top leg bent up toward your belly and supported by a pillow, with your back well-rounded.
• Alternate heat and cold. Your labor coach can help apply a heating pad, an ice pack or warm/cold compresses to your back. Switch between hot and cold, or work with whichever temperature you find most soothing.
• Apply pressure. Have your practitioner or partner apply firm pressure (using their knuckles or even a golf ball) to your lower back wherever you’re feeling the most pain. Apply cream or oil to reduce skin irritation.
• Attempt reflexology. This involves having your birthing partner use a finger to apply strong pressure directly below the center of the ball of the foot. This acupressure technique is said to help relieve back labor.
• Use the double hip squeeze. Ask your partner or practitioner to place firm pressure on your hips as you lean forward onto something during contractions, which may help ease the pain.
• Try hydrotherapy. Relax in a warm tub (if you’re allowed and your labor room has a birthing tub), or get in the shower and aim the shower head at your lower back.
• Apply other pain relief tactics. If you’re familiar with natural labor pain relief options like meditation or self-hypnosis, they’re definitely worth a try and often ease some pain.

If your baby is still in the face-up position during the second stage of labor and your labor is taking too long, your practitioner may try to turn your baby manually. Otherwise, you may be able to deliver with your baby still facing toward your tummy, or your doctor may suggest a C-section.