Back Labor and What It Feels Like

Back labor is a common occurrence, often as an extension of back pain that occurred earlier in pregnancy or even before it. It happens during labor and delivery as pain is experienced in the lower back, hips, or thigh area. One in three people evaluated in a 2018 study felt severe pain in the lower back during labor.

Causes of back pain in pregnancy can range from underlying causes, such as a prior injury, to the increased pregnancy-related pressure on nerves. Some studies suggest sitting or standing positions in early stages of labor can help to reduce back labor pain. Let your healthcare provider know if your back pain seems unexpected, as it can occur with preterm labor.

Symptoms

Some of the back pain a person feels at full term may not be related to back labor. Rather, it could be the result of general aches and pains, which commonly occur from excess weight of the pregnancy straining the back muscles. Back labor usually involves symptoms such as:

• Intense pain and muscle soreness that may or may not subside between regular contractions
• Lower back pain that feels like painful spasms and may worsen with each subsequent contraction
• A continuous, severe pain in the lower back that worsens at the peak of a contraction
• Intense pain located in the lumbosacral region, which encompasses the lumbar (lower back) and the sacrum

Causes

In most cases, back labor pain is caused by the head of the fetus pressing down on the lower back. This is called the occiput posterior position. There's also some evidence to suggest that people who experience back pain with their menstrual cycle are more at risk of back labor pain.

The pain really can't be prevented, although childbirth preparation classes can help you to know what to expect and offer techniques for coping with the discomfort.

When to Call a Healthcare Provider

In general, you should contact your healthcare provider anytime you notice new symptoms during your pregnancy. Experiencing back pain for hours at full term can be an indication that labor is about to begin.

Here are signs that labor may have started and your healthcare provider should be notified:

• Regular, painful contractions occurring at least every five minutes and getting progressively stronger and closer together
• Bloody show (blood-tinged mucus coming from the vagina)
• Water breaking (or ruptured membranes, when the amniotic sac releases some of the fluid surrounding the baby)

Note, if you are having regular, painful contractions, accompanied by back pain, you will likely have back labor.

Complications of Back Labor

The optimal way for the fetal head to be positioned during labor is with the head down and facing the parent’s back. In the occiput posterior position, back labor pain may result.

This position can increase the risk of:

• Prolonged labor and need for pain medication or other pain management interventions
• Requiring a cesarean delivery (or C-section, an incision in the mother's abdomen to remove the baby)
• Needing an assisted vaginal delivery (such as a forceps delivery or vacuum-assisted birth)
• The need for an episiotomy (a small incision at the vaginal opening that helps with a difficult delivery)

Prevention of Back Labor

Before you go into labor, and with medical approval, you can try these prevention strategies:

• Practice doing pelvic tilt movements on the floor. You can find online instructions for exercises to prepare for pregnancy but talk with your healthcare provider to be sure they're safe for you.
• Avoid positions such as semi-reclining with your knees up (higher than the hips).
• Walk and move around often. Try doing lunge and squat exercises during pregnancy.
• Try using a hula hoop for exercise, or practice using a birthing ball.
• Sleep on your side with pillow supports.

During labor, you can try position and pressure changes, along with temperature (cold and hot) changes, like applying a warm rice-filled sock to the lower back or rolling pressure with a tennis ball.

Treatment

One study suggests that a sitting or standing position used during the first stage of labor caused an 80% reduction in continuous back pain. It also reduced back pain with contractions by 50%. 

A spinal block (epidural) may be considered for pain control in people with back labor. When the fetus is not in the optimal birthing position, known as occiput anterior, it can be more difficult for the fetus to descend through the birth canal.

One study showed that people with severe pain from back labor exhibited lower pain scores approximately 30 minutes after sterile water injections, one alternative for managing pain. This option may not be commonly available or used.

Summary

Back labor occurs when labor pain is felt in the back, and sometimes hips and thighs. It can occur with any pregnancy but may be more likely when the fetus is in the occiput posterior rather than occiput anterior position. The pain can occur for part of labor or through to the delivery.

The best way to prepare yourself for labor and its complications is to arm yourself with information beforehand. Exercises to improve fetal positioning and techniques to ease discomfort during pregnancy and labor can help. Talk with your healthcare provider about back labor relief.