Baby Got Back (Labor)
Depending how late you are in pregnancy you’ve probably been warned (unprompted) about the sensation known as back labor. If you haven’t received the spiel, let me fill you in on the basics. Don’t be worried though, I’m here to give you some tips and tricks for navigating this pesky discomfort in labor!
What is back labor?
Back labor is the delightful occurrence of consistent, intense pressure in the lower back during childbirth, similar to muscle spasms. This direct pressure lasts even between contractions, and the severity and frequency of feeling it can vary based on your baby’s presentation (particularly for ‘sunny side up’ babies, also known as occiput posterior). If your baby is sitting in this position, the contact between the back of their head against your spine and sacrum area can cause some pretty persistent discomfort. Other factors that can make this sensation more likely are tension within the body, preexisting spinal conditions, and certain pelvic shapes.
Options for relief:
Luckily there are a few available options to provide some comfort — even without medication.
Of course the most popular remedy for back labor (if appropriate for your stage of labor) is going to be the epidural. If you aren’t familiar with the in’s and out’s, this is a cocktail of an opiod (typically fentanyl) with local anesthetic (such as bupivacaine, ropivacaine, or lidocaine) to numb the nerves. This is administered upon request during labor, but works most effectively during the active stage (around 5/6cm dilated) with minimal effect on progress and pushing. One bonus about epidural administration is that it is continuously delivered through a catheter, so it lasts the entirety of your labor. If you are planning to use an epidural during your birth, keep in mind that 1: Once placed you are unable to walk, use the restroom alone (they will empty your bladder for you), shower, etc. This however does NOT mean you can only give birth on your back, and 2: It takes up to 30 minutes to kick in, so continue to use the pain relief techniques you practiced with your doula until the medicine begins to take effect.Counter Pressure is extremely effective at providing relief, and can be done by either a support person such as a doula or a partner. This technique involves applying steady force with the lower palm to the area experiencing the spasms and pain, to help relax the tight, strained ligaments. This can be done in nearly any position that allows full access to the laborer’s back, including on the birth ball, standing/swaying, etc. This application of pressure can also trigger the gate control theory — which causes the brain to focus on that stimulation rather than the pain (counter pressure is a dream for labor contractions as well). An added (and lesser known!) benefit in favor of counter pressure is that the act of pressing on the sacrum can actually stabilize the area and create more space, ultimately aiding the baby’s rotation and descent.
Hydrotherapy is nature’s (or a midwife’s) epidural! Think about it — what sounds better when you’re achy and uncomfortable than a warm bath, the smell of lavender, and a dimly lit room flickering with tealight candles. All of this is possible during labor (yes — even after your water breaks*), swap out the open flame candles for some that are battery operated and plug up your diffuser to disperse your favorite fragrance. This can take place at home, in the birth center, or in the hospital. The trick with using hydrotherapy is similar to that of the epidural medication, where it can slow things down if utilized earlier on in labor but can also maintain the status quo when used later on (or even speed things along by relaxing the body). So just like the injection, you’ll ideally want to use other techniques for comfort until the 5/6cm mark and then hop on in!
What not to do
Tense up: It can be a habit to scrunch inward when we’re bracing for or experiencing pain, but I promise you it will work against you in labor. Even when pushing. Tensing up not only traps the contraction inside of your body instead of letting it come and go as it is intended to do, but it also burns through your energy and heightens the sensation of pain. The goal is to remain fluid, loose, and flexible. Let the contraction build and wash away like a wave in the water, take a deep cleansing breath, and rest between. Stiffness will amplify the feelings of back labor, and make for a longer labor by essentially making it more difficult for baby to descend.
Lay flat on your back: Unless this position is calling you by your government name, it’s not going to be helpful right now. While this position can absolutely be tweaked to provide some comfort, it isn’t usually a birthing person’s first choice. If you happen to have already received an epidural and cannot be mobile, roll up a towel or use a sock over a tennis ball placed directly under your sacrum (think tailbone) to provide counter pressure to the area. Otherwise, get up on hands and knees or sway to allow that back access while allowing gravity to bring baby down. Tip: Utilizing gravity for a steady descent lowers the risk of tearing or episiotomy.
Listen, I know some parts of labor may not feel the greatest. But keep in mind that nothing labor throws out can ever be bigger than you. It is you. Ready? You got this!
*Getting in the water after your waters have broken is widely debated, while the risk of infection does go up when there is no longer an amniotic sac as a barrier for baby — there is also a risk of infection from cervical checks, internal fetal monitoring, forceps or vacuum deliveries, and other routine interventions. To limit the opportunity for bacteria to enter the body, taking a shower first can rinse off some of the sweat and dirt that accumulate during the day and provide a cleaner tub to soak in. Additionally, avoiding adding soaps or fragrances directly to the water can also limit this risk. Always discuss with your healthcare provider, trust your intuition, and follow the BRAIN decision making model.
