Q. What is back labor, and why does everyone say it's so horrible?
A. Ordinarily, if you are lying on your back during delivery, your baby will be facing down toward the floor. (This is called the occiput anterior position.) Some babies face up toward the ceiling (occiput posterior position). Laboring with a face-up baby causes more back pain and is known as back labor.
Back labor usually lasts longer and may require more pushing than an ordinary labor if the baby remains in the occiput posterior position. Pain is concentrated in your low back because the back of the baby's head is pressing against your tailbone or spine. Some women who have experienced back labor say it is excruciatingly painful. Others find that the pain of back labor isn't worse than ordinary labor, merely different.
Most babies in a posterior position will rotate the necessary 180 degrees on their own as labor progresses, especially if mom's pelvis is not completely relaxed with epidural anesthesia. Sometimes a doctor or midwife will attempt to rotate the baby with her hand. If the baby stays in a posterior position, he can be delivered that way if he fits through the birth canal. However, if a posterior baby is angled in such a way that he needs a little extra space, and there is not enough room in the birth canal, the doctor may recommend a cesarean delivery.
To reduce pain during back labor, try changing positions -- kneeling on all fours, rolling onto your side, or squatting. Your labor coach or doula can apply ice or heat to your low back, massage your low back, or press on it with a tennis ball or other round object. This is called counter-pressure, and it sometimes reduces the pain of back labor. Pain medications or an epidural will also help.
Originally published in You & Your Baby: Pregnancy.
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