Back labor is intense pain felt primarily in the lower back during contractions, differing from typical labor where discomfort is concentrated in the abdomen and pelvis. This pain is often more severe and challenging to manage than standard contraction pain. While back pain is common in late pregnancy, true back labor only begins once a person is in active labor.
The Distinct Sensation of Back Labor
The feeling of back labor is often described as a crushing, deep, or sharp pressure focused intensely in the lower back and sacrum. Unlike classic rhythmic contraction pain that builds and resolves, back labor frequently presents a continuous baseline of severe discomfort. This persistent ache does not fully disappear between contractions, depriving the laboring person of the momentary rest and recovery period that typically occurs.
During a contraction, this constant back pain is amplified into an excruciating wave that can feel like forceful pressure on the spine or tailbone. The intensity can be so overwhelming that the pain in the back is felt as much or more strongly than the pain in the abdomen. This deep, agonizing feeling is the defining characteristic that sets back labor apart.
Why Back Labor Occurs
The primary cause of this distinctive pain is the position of the fetus within the pelvis, specifically the “occiput posterior” (OP) presentation. In this position, the baby is head-down but faces the mother’s abdomen, rather than facing her back, which is the more common position. The occiput, or back of the baby’s head, is the hardest and boniest part.
As the uterus contracts, it pushes the baby downward, forcing the bony occiput to press directly against the mother’s sacrum and spinal nerves. This bone-on-bone pressure generates the intense, persistent pain in the lower back. While most babies starting labor in the OP position rotate on their own, the 5 to 8% that remain cause back labor that continues until delivery.
Techniques for Pain Relief and Management
Managing back labor focuses heavily on relieving the pressure exerted by the baby’s head against the sacrum.
Non-Pharmacological Methods
Specific techniques can leverage gravity and counter-pressure to encourage the baby to shift off the spine.
- Counter-pressure: Applying firm, sustained pressure to the lower back during contractions, often delivered by a partner using the heel of their hand, a tennis ball, or a rolling pin pressed into the sacrum.
- Leaning forward positions: Positions such as being on the hands and knees or draped over a birthing ball are recommended to relieve sacral pressure.
- Movement: Moving frequently, including walking, rocking the pelvis, or doing lunges, can help open the pelvic outlet and encourage the baby to rotate into a more favorable position.
- Hydrotherapy: Standing in a shower with the water directed at the lower back or soaking in a warm tub can provide significant relief from the deep ache.
Medical Pain Management
For medical pain management, an epidural remains a highly effective option for back labor. The procedure involves inserting a fine catheter into the epidural space in the lower back, delivering a combination of local anesthetics and narcotics. These medications work by blocking the nerve impulses from the lower spinal segments, which are the pathways transmitting the severe back pain to the brain. This intervention can eliminate or significantly reduce the intense back pain, offering the laboring person the opportunity to rest and cope with the remainder of labor.