Back Labor

One of the things women often ask prenatally is about whether the baby is “in the right position”. Although they are first asking whether the head is down versus breech, what they seem to be more concerned with is back labor. There are horror stories out there about 3 day back labors because the baby was in posterior position rather than anterior, that is, with the baby’s back to mom’s back instead of towards her belly. In anticipation of something they already perceive as a challenging unknown, this added potential weighs heavily.

In the Ob community, we have, in fact, anecdotally noticed that we are seeing more back labors and wonder why. Posterior lies are more common with a pelvis type called Android,
and account for roughly 10-15 % of  women’s pelvic types. The other 85% should be Gynecoid, and allow for optimum anterior positioning of the baby.

What else then could cause a back labor, and is there anything to do about it?

First, you may be wondering what is meant by back labor. It describes a labor where the woman experiences not only tightening of the uterus, the entire abdomen, and some residual low back pain, which is the common experience, but also what is described as relentless severe back pain. Comments such as “if it weren’t for this unending pain in my back, the labor would be manageable”, or “this can’t be normal” are often said.

This, as we said, is most common when the baby’s back is descending right against momma’s, all the way down and out.  Some ideas about ensuring against that type of descent revolve around maternal lifestyle and positioning. We have bucket, not bench, seats in our cars, which predispose to leaning back. We recline even at home, as rigid upright seating is  found less now in homes. We walk less. We have household help, either in person or with advanced design appliances, so we bend forward far less to do our chores. We are online more and often slouching or leaning back, laptop propped. The uterus holds a lovely waterglobe that floats a baby and is not immune to gravity. You lean back all the time, and the heaviest part of the babe, it’s buttocks, may float towards  your back. In labor, if you are the one with the unrelenting back pain, even in early labor, get on all fours and rock. It easily lets your labor partner apply pressure to your back, or heat, and it gravity feeds the baby forward. Also, if there is a birthing ball, use it when your knees get tired, because upright may help. If there is not a birthing ball, lay flat on one side for half hour, curled up, and then go to the other. This will allow the baby’s back to budge a bit. If it does, then when you are back on all fours,it will be able to swing forward. If the baby is anterior, none of these positions will negatively affect optimal positioning at all.

However, there is another overlooked reason for back pain, and that is something called compound presentation. Remember seeing that cute thumb sucking baby on your ultrasound? Or the one who has his hand up on his head or near his cheek? Not so cute when labor starts. They elbow you. And the labor is slower as the head tries to wiggle it’s way into the pelvis with a hand in the way…

This is a case where all the labor advice about squatting and being upright as the “best” thing may impede you.  If you are consistently upright and the back labor persists, please get on your side, flat, as described above. That way, you give a little wiggle room to the baby, and it only takes a couple millimeters space for a hand or elbow to adjust and flick out of the way of the head. When it does, the mom knows it. The pain changes and labor begins to progress more smoothly and rapidly.

Presume the best fetal positioning for birth is what will happen. After all, most of you have the pelvic type for it.  Optimize that chance by more exercise, as mentioned, and if you can swim, add that too, and do far less reclining. Have a smooth labor.

Written by Deb Gowen, CNM and featured in Expectant Mother’s Guide to Boston 2010 Volume 2