What Back Labor is Really Like

Pregnant people don't always feel contractions solely in their belly. Indeed, between 13 and 32% of people experience back labor, especially during early stages of labor. Back labor happens in their lower back, just above the tailbone and may be a sign that your baby is in the occiput posterior position—or "sunny-side up" (head down but facing your tummy instead of your back), says Logan Van Lessen, a consultant midwife for the U.K.'s Nursing and Midwifery Council.

Back labor can be extremely uncomfortable for you, but it's not a problem for your baby. Nearly 90% of babies rotate on their own during labor. Your doctor or midwife can help you relieve back labor pain in the meantime. Here's what you need to know.

What Causes Back Labor?

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. But some babies face up toward the ceiling (occiput posterior position). Laboring with a face-up baby causes more back pain, since the baby's head can press painfully against the spine and tailbone, says Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston.

What Does Back Labor Feel Like?

Pain is 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). Some people might have back pain instead of or in addition to the abdominal discomfort of contractions as well.

Back labor pain often gets worse with each contraction, and it might not let up between contractions. Some people may also get painful spasms as a back labor sign. According to mom Becky Kleanthous, who experienced back labor herself, "I was writhing around, screaming. It felt like my lower spine was being hit with a sledgehammer, and with every contraction, I could feel my pelvis bearing down, like I was already pushing the baby out."

Back Labor vs. Back Pain in Pregnancy

Back pain is a common symptom of pregnancy; doctors say at least half of pregnant people experience this soreness and cramping. Pregnancy back pain has a few culprits: for instance, 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? Many people can easily tell the difference, since back labor feels much more intense. It also gets worse with contractions leading up to delivery. Call your doctor if you're unsure.

When to Go to the Hospital for Back Labor

Although back contractions can be painful, there's no special guidelines for heading to the hospital. In fact, if you visit the hospital too early, they might send you back home until labor progresses further. Simply follow your doctor's or midwife's advice regarding the timeline. 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, or if you're experiencing other strange symptoms.

Does Back Labor Affect Delivery?

Back labor usually lasts longer and may require more pushing than ordinary 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 hand.

If the baby stays in a posterior position, they can be delivered 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 have back labor signs, it's recommended to change positions, because lying on your back can substantially exacerbate back contractions during labor. Try kneeling on all fours, rolling onto your side, or squatting.

Some positions, 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.

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, their hand, or another round object. This is called counter-pressure, and it sometimes reduces the pain of back labor.

Pain medications or an epidural can also help, although an epidural may not completely take away all of the pain of back labor. However, 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.