When Back Labor Strikes -- Tips & Tricks for Optimal Comfort

Ah, the notorious "back labor." You may have experienced back labor yourself, but if not, you've probably heard about it from a friend/sister/mother who loves to talk about her experience with back labor. Back labor is just another variation of normal labor, but women who experience it often describe their pains or sensations during contractions as centering primarily in their lower back or above their sacrum. It is believed that back labor is caused by a baby's position during labor and birth. Most babies prepare for birth by facing their mama's back, with their head facing mom's pelvis. Some babies, for reasons not exactly known, decide to face in the other direction so that their head rests on mom's spine (also known as an occiput posterior or "OP" baby). Because of baby's "malpositioning" for birth, mom can experience added discomfort in her back.

If you or someone you are with experience what you think may be back labor, there are things you can do to either relieve the pain and/or change baby's position (which should then relieve the pain).

Position Changes

• Open-knee-chest position: This looks like being on all fours, but with your arms, head, and chest touching the floor. This position can allow baby room to back out of the pelvis and readjust his position.
• Side lunges: With one foot on the ground, bring your other foot on a stair step or low chair, opening your leg at a 90 degree angle, with your foot and knee pointing outward (to the right or left, depending on which leg you're using). Lunge in the direction of the leg that's up. Repeat and switch legs. Be sure to have proper spotting/support from your partner, doula, or nurse. This position opens your pelvis unevenly to help prompt baby to move.
• Stair or curb walking: For the same reasons as above, walking up and down stairs or alongside a curb with one leg stepping on the curb and one on the ground can encourage baby to change positions.
• Rebozo sifting: This gentle maneuver has also been shown to help with baby's position. For an excellent demonstration, check out this video by Jun-Nicole Matsushita, doula and author of Birth Movement.

Comfort Measures

• Massage: Lower back massage can feel great with back labor. Harder pressure is usually more effective, but you'll want to check with mom.
• Shower/water: Water or "hydrotherapy" can be very effective for pain relief and comfort during back labor -- or any labor!
• Heat or ice: When applied to the lower back, heat (heated rice sock, heating pad) or ice (ice pack, ziploc bag of ice wrapped in a wet towel) can offer quick, direct relief.
• Counter pressure: This little trick is the simple act of applying pressure to the area that hurts. With back labor, this would look like a support person using both hands to apply pressure to the lower back or sacrum. It can be used in conjunction with heat or ice.
• Double hip squeeze: This much-loved comfort measure for back labor can be done in a few different ways, using hands or cloth (like a rebozo), and by one person or two. The sweet spot for this measure is found by drawing an imaginary line from the top of the hip bones to the top of mom's natal cleft (aka "butt crack"). Right outside of this spot, on the fleshy part of each butt cheek is where you'll place your palms, fingers up, and push up and in. The more pressure, the better. This movement forces the pelvis into a relaxed position by flaring it out slightly, which helps relieve pain and make room for baby to adjust her position.
• TENS unit: TENS stands for transcutaneous electronic nerve stimulation and is a hand-held device that sends harmless pulses through electrodes attached to pads that sit on your skin in order to stimulate your nerves to provide pain relief. Some maternity wards will carry a TENS unit and be able to offer it to you during labor. Some doulas also are trained to use and carry a TENS unit.
• Sterile water injections: While this treatment is less commonly performed in U.S. hospitals, it can provide quick, effective, and safe relief during back labor. Sterile saline is injected just under the skin in four spots surrounding the lower back area. It can be administered by a nurse, doctor, or midwife in a hospital, birth center, or at a home birth. It does not contain any narcotics or analgesics. It can be repeated as desired.
• Backward chair sitting: This position sometimes feels better with back labor, but more importantly, it gives your support team full access to reach your back and provide the comfort measures listed above. This position can also be done on a toilet.

Have you experienced back labor? What helped you cope?

photo credit: cscott2006 via photopin cc