Counter pressure is a non-pharmacological comfort measure that involves applying steady, firm force to a specific area of the body during labor contractions. This technique is often used to manage intense lower back pain, a sensation commonly associated with what is known as “back labor.” The goal of this focused pressure is to provide a physical counterbalance to the deep, internal discomfort felt during uterine contractions. Counter pressure offers a tangible way for a support person to actively assist the laboring person.
Understanding the Purpose and Mechanism
The primary reason counter pressure is effective relates to the mechanical cause of back labor, which is often the baby’s position in the pelvis. When the baby is positioned with the back of their head resting against the mother’s spine, each contraction pushes the baby’s skull directly into the sacrum. This constant pressure creates the characteristic, unrelenting ache.
Applying external force directly to the area of pain helps interrupt the pain signals traveling to the brain. This concept is partially explained by the Gate Control Theory of pain, which suggests that the nervous system can only process a limited amount of sensory information. The strong sensation of counter pressure essentially floods the sensory nerves, effectively “closing the gate” to the more painful labor signals.
Pinpointing the Target Area
Identifying the correct location for pressure is paramount for the technique to be successful. The most common target is the sacrum, the large, triangular bone at the base of the spine, just above the tailbone. This is the area where the baby’s head is often pushing, causing the characteristic back pain.
The laboring person can usually point directly to the spot where the pain is most intense, which should be the guide for the support person. Sometimes, relief is found by applying pressure to the iliac crests, the upper, bony curves of the hips. Pressing inward on these hip bones, a technique called the double hip squeeze, can help open the pelvic outlet and relieve pressure on the sacrum. The key is to continuously ask the laboring person for feedback, adjusting the location until the most effective spot is found.
Step-by-Step Application Techniques
The support person should position themselves directly behind the laboring person, who is often leaning forward over a bed or birthing ball. Using the heel of the hand or a closed fist is the most common method for applying sacral pressure due to the small, concentrated surface area it provides.
For the double hip squeeze, the support person places the heel of each hand on the bony knobs of the hips. The pressure is applied inward and slightly upward, as if attempting to gently squeeze the hips together. Alternatively, a tennis ball or a specialized massage tool can be placed under the heel of the hand or fist to provide a more targeted, consistent point of pressure. A long piece of fabric, like a rebozo, can also be wrapped around the hips and pulled tightly to create a mechanical double hip squeeze, which allows the support person to use their legs and core strength.
Coordinating the Timing and Intensity
Counter pressure is a dynamic technique that must be coordinated with the rhythm of the contractions. The pressure should begin the moment the contraction starts, as soon as the laboring person feels the tightening sensation. The support person should then gradually increase the intensity of the pressure as the contraction builds to its peak.
Maintaining the maximum tolerable pressure is necessary through the height of the contraction, which can last for 60 to 90 seconds. As the contraction begins to fade, the pressure should be slowly and smoothly released, allowing the laboring person a moment of rest before the next wave begins. Continuous, clear communication is paramount throughout this process, with the laboring person using simple cues like “harder,” “more to the right,” or “stop” to guide the support person’s effort.