The moment a pregnant woman goes into labor is filled with anticipation, excitement, and often a bit of anxiety.
While the severity of pain during childbirth can vary greatly, nearly all women experience some degree of discomfort from the waves of contractions moving the baby down the birth canal.
For most, the pain is centered in the lower abdomen and radiates to the back and sides.
But for some women, back labor brings an added layer of intense, focused pain in the lower back that can feel like unrelenting pressure on the spine.
What Is Back Labor and What Causes It?
Back labor refers to intense pain concentrated in the lower back during childbirth. This happens when the baby is in what’s called a posterior position, with their back pressed against the mother’s spine.
A posterior baby faces forward toward the mother’s abdomen rather than backward toward the birth canal. This inverse position puts direct and prolonged pressure on the lower spine, intensifying pain.
Back labor often comes with additional discomfort radiating around to the sides, buttocks, and thighs.
Some of the key factors that can contribute to a posterior baby and increase the chances of experiencing back labor include:
| Factor | Explanation |
| The shape and structure of the mother’s pelvis | A tilted pelvis or narrow pelvic outlet may make it harder for the baby to rotate into the optimal head-down position. |
| Prior back problems or muscular strain | Existing issues with the lumbar spine, such as a herniated disk or muscular tightness, can exacerbate back labor discomfort. |
| Pregnancy hormones | The hormone relaxin softens joints and ligaments to prepare the body for childbirth. But this can lead to pelvic instability and less space in the birth canal. |
| Previous births | If back labor occurred in a prior pregnancy, it is more likely to happen again. The uterus and supporting muscles retain “memory” that influence positioning. |
| Larger baby size | Babies over 8 pounds may have more difficulty maneuvering into the proper anterior position for birth. |
| Extended pregnancy | Going past 40 weeks can allow the baby to settle into a posterior position. |
While any expecting mother can experience back labor, staying active with pelvic tilts, lunges, and other optimal positioning exercises during pregnancy may help encourage the baby into the anterior position and reduce risk.
But there are no guarantees. Understanding how to manage the unique pain of back labor is key.
How Does Back Labor Pain Differ from Regular Contractions?
For most women in labor, contractions feel like intense cramping or tightening that starts in the lower abdomen and wraps around to the back and sides in a rhythmic wave pattern. There is often a brief rest period between contractions at the start.
With back labor however, the pain is concentrated right over the sacrum and tailbone in the lower back.
Instead of feeling relieved between contractions, this localized pain remains constant throughout the entire labor process.
Here are some of the key differences in sensation:
- Pain is focused on the lower back rather than starting in the abdomen
- Feels like intense downward pressure on the spine
- Minimal relief between contractions as pain remains steady
- Contractions may be more frequent but irregular in duration/timing
- Pain radiates to the hips, buttocks and thighs more than the front
- Cramping and tightness is secondary to the searing back pressure
- More nerve-like pain shooting into the legs compared to cramping
- Overall pain levels are often rated higher on the pain scale
Coping with back labor requires extra focus on pain management techniques both during contractions and the intervals in between. Having continuous support to apply pressure on the back, get into optimal positions, and offer encouragement is also key.
Tips for Managing Back Pain During Labor
If you’re experiencing back labor, don’t despair. Be sure to discuss any pain management techniques with your doctor or midwife first to ensure they are appropriate for your situation. With their guidance, there are many ways to help mitigate the pain and stay on top of the pain:
Use Gravity and Get Vertical
Remaining upright and mobile allows your pelvis to open more optimally as the baby descends and may take direct pressure off the spine. Try slow walking, lunging, sitting on a birthing ball, or leaning forward on a table or your partner’s shoulders during contractions. Let gravity lend a hand!
Apply Heat or Cold
Experiment to see if heat from a warm pack or cold from an ice pack offers more relief from back spasms when applied to the lumbar region. Have both on hand. The sensation can help override the contraction pain signals.
Get in the Water
Laboring and even delivering in a warm birthing pool, shower or tub allows your body to relax while buoyancy takes tension off pressured joints. The warmth will ease tight muscles. Lean forward and have a partner use cups to pour water over your back.
Massage and Counterpressure
Have your labor coach or doula apply firm, focused massage or counterpressure to the lower back during peak contractions. Tennis balls or massage tools like Back Buddy can be held in place as you sway and rock. The targeted pressure activates other nerve sensors to reduce pain signals to the brain.
Sterile Water Injections
Administered by doctors, these subcutaneous injections of distilled water into four points of the lower back can significantly reduce labor pain for up to two hours. The water irritates the tissue which blocks transmission of the contraction pain from nerves to the brain. After cleansing the skin, a very thin needle is inserted just under the surface about 2-3cm into each point.
Labor in the Side-Lying Position
Lying on your side with knees curled forward in a fetal-like position allows the pelvis to open wider so the baby can navigate the birth canal more optimally. Have pillows propped between your legs and under your belly for support. Focus on slow breathing as a partner applies soothing touch.
Get an Epidural or Spinal Block
If your back labor is severe and you want more substantial pain relief, opting for an anesthetic epidural or spinal injection can significantly ease discomfort. The medication will numb sensation from the waist down allowing you to rest, while staying awake for delivery. Discuss the timing and dosage with your provider.
Relax Between Contractions
The breaks between intense back contractions will be minimal, but utilize any short rest periods you get. Have your support team remind you to take slow deep breaths, fully exhale, and consciously release all tension from head to toe as you await the next wave. Saving energy this way helps you cope.
Change Positions Frequently
Shift positions often to alleviate pressure on one spot. Experiment with hands and knees, supported squats, sitting upright or reclining, pelvic rocks, and other motions that feel productive. Changing angles may help the baby rotate and offer relief.
Stay Hydrated and Nourished
Drink electrolyte fluids frequently and munch on snacks to keep strength up. Dehydration and low blood sugar can heighten any pain sensations. Labor is hard work! Have your support team offer sips and bites of easily digestible foods to keep you fueled.
How Can I Prepare for Back Labor During Pregnancy?
While you can’t ever be certain if you’ll experience back labor until those contractions start, there are proactive ways to prepare both physically and mentally:
Optimize Baby Positioning
Do prenatal exercises that encourage your baby into the optimal head-down, anterior position versus posterior. Cat-cows, pelvic tilts, hip circles, lunges, and leaning forward while sitting are some great examples. Visualize your baby rotating into the best position while doing these.
Strengthen Core and Back Muscles
Practice pregnancy-safe exercises to increase endurance in your core abdominal muscles as well as lower back muscles. Try modified planks and pilates, along with pregnancy yoga. Building strength will help withstand repetitive contractions.
Discuss Pain Relief Options with Your Provider
Talk to your OB provider or midwife about all your medicated and unmedicated pain relief options well before labor begins. Understanding the pros and cons will help you make informed requests in the moment when the back labor pain peaks.
Educate Your Labor Support Team
Take birthing classes together with your partner or others that will support you during labor. Make sure they understand back labor and ways to be most helpful through positions, massage, hydration, encouragement and other coping aids. They’ll be your invaluable advocates.
Visualize Yourself Handling the Contractions
Use guided meditation apps to practice relaxing your body part by part. Picture yourself breathing slowly through each pressure wave and use positive affirmations like “each contraction brings me closer to meeting my baby.” Envision getting through this temporary challenge.
Create Your Ideal Birthing Environment
Figure out what will make the delivery space most soothing for you when managing pain. Bring led candles, photographs, aromatherapy, music, cozy socks or whatever nourishes your soul. Surrounding yourself with comforts can divert focus from the pain.
The Reward Is Worth the Pain
Back labor presents an exceptional challenge for birthing mothers. But with the right support and techniques, you can absolutely get through this.
Stay present, trust your ability to cope in each moment, and don’t be afraid to ask for help. Relief will come.
Soon your little one will be in your arms, gazing up with fresh eyes. That magical instant will erase any memory of pain, replaced by overwhelming love and pride in your strength. You’ve got this mama! Now go meet your baby.
As you prepare for delivery, having an OB provider or midwife that fits your needs and preferences can make a big difference in your birth experience. The medical team at your side during this journey needs to be someone you trust completely. Platforms like Kaly allow you to find and connect with doctors, midwives, and other providers that align with your care philosophy and unique pregnancy needs.
Get matched with your ideal birth pros for the personalized support you want during labor and beyond. The reward of a beautiful birth is worth it!