Parenting: Pregnancy

Most women have heard of back labor. But what exactly is it and how can the pain be eased?

Dr. Glade B. Curtis, OB/GYN and author of Your Pregnancy Week by Week defines back labor as pain during the last few weeks of pregnancy or during labor that is experienced in the lower back or on the back of the hips. "Back labor is caused by the baby being in the posterior position," he says. "A baby in this position moves through the birth canal with his or her face towards the ceiling instead of pointed down at the ground. Delivery works better with the baby looking down and extending the head as it comes out."

In general, labor pains involve the abdomen (uterus) and the pain is caused by the contraction or tightening of the uterus. "It's possible to have back labor come and go as the baby negotiates the birth canal changing position and pressing on different areas of the pelvis and birth canal," Dr. Curtis says. "Back labor can seem alarming to some women because the pain is in a different location then expected."

Sandra Rees-Bowen of Ferndale, Wash. knows what back labor feels like. "During delivery I couldn't move without vomiting and I was in extreme pain," she says. "The pain seemed to radiate from my back around to my belly."

Rees-Bowen had decided on natural birth and she tried Lamaze breathing, but that didn't ease her pain. She credits her doula (a supportive companion trained to provide labor support to birthing women and their families) with helping her relax. "Husbands are wonderful and definitely needed, but they (and my husband told me this himself) feel rather useless when the contractions begin," Rees-Bowen says. "A doula can keep you focused during contractions, and use things like massage and aromatherapy to help you relax."

Some women find that changing position helps ease back labor. "Labor and delivery nurses will often have the laboring patient get on her hands and knees in bed or roll to one side or another," Dr. Curtis says. Phyllis Ring of New Hampshire was physically ready to deliver her daughter after 10 hours of labor, but she went through another 10 hours of back labor (sometimes on hands and knees) working to turn her daughter around. "My daughter and I still talk about the birth story and joke that we're both hard-working women," she says.

Of course, every woman's labor and delivery is different, but Dr. Curtis offers several tips for easing back labor pain:

• Try laboring on hands and knees. This position eases pressure on the back.
• Ask someone to massage the painful area of the back.
• Apply heat to the painful area.
• Try soaking in a hot tub.
• Request pain medications such as I.V. Demerol or ask for an epidural.

Lynne Anderson found massage helpful during her back labor. "My husband is a massage therapist, and he was able to massage my lumbar muscles and provide counter pressure against the force of the contractions," she says. Although she found walking difficult during contractions it also helped ease the pain.

Back labor isn't miserable for everyone. Teresa Smith of Texas feels that her back labor delivery was easier than delivering her second child. During her second delivery, which was induced, she ended up with a Cesarean delivery because the umbilical cord was wrapped around her son's neck and he was stuck in the birth canal. "My induced labor seemed worse because the contractions didn't build gradually, and with my back labor delivery the pain disappeared immediately after the baby was born," she says.

Doctors sometimes try to turn babies in the posterior position around, but it isn't always necessary. "Some babies will deliver in the posterior position (face up) or turn on their own," Dr. Curtis says.

When it's necessary to turn the baby, doctors use a vacuum cup, forceps or their hand. Turning babies can be very successful, but when a baby can't be turned and labor fails to progress, a Cesarean is necessary.

It's difficult to tell in advance if a woman will experience back labor. "Some patients experience back labor every time they are in labor ... but I don't think you can predict it in a patient having their first child," Dr. Curtis says. "Pregnant women who have experienced back labor should prepare for it, and if something helped in a pervious labor, they should try it again."

Finally, women should be aware that not all back pain indicates true back labor. "Lower back pain and pressure is very normal in the later weeks of pregnancy and in labor," Dr. Curtis says. "Many patients will interpret this to be back labor and perhaps become concerned about it unnecessarily."

It is possible to minimize back labor pain. Women should think about using massage, heat or another method listed above to ease back labor pain just in case they experience it. Luckily, labor is temporary, soon replaced by the pleasure of cradling an infant.