Burning Questions 3: What is Back Labor?

Today's question comes from a wonderful former doula client of mine and she asks:

I wonder what is back labor and how much more painful it is than regular labor and how do you cope with it? Women have used back labor to “explain” getting an epidural and I just say ohhhhh yeah that sounds awful without knowing how bad it is. I mean, I had you doing a lot on my lower back and my back certainly hurt but I assume it wasn’t back labor? Thanks!
— Previous Doula Client
Spoiler alert: Being Submerged in Warm water is excellent relief from back labor

Spoiler alert: Being Submerged in Warm water is excellent relief from back labor

 Excellent question! In my experience, back labor adds an extra layer of intensity to the experience of labor. I've also talked to lots of mamas who chose to have an epidural (despite their plans for a natural or unmedicated birth) because they experienced a long period of back labor*. So let's talk about:

1) the difference between a more usual contraction pattern and back labor,
2) why the Fear, Tension, Pain cycle is especially important, and
3) the most effective tools for getting pain relief

Along the way, I'll also talk about how your birth setting and team can affect your ability to manage back labor.

"Normal" Labor versus Back Labor

Normal labor contractions will often wrap around from the abdomen to the lower back, especially at the peak. Women often report feeling pressure and/or aching in their lower back, sacrum and hips during surges as well. As labor progresses, that aching can intensify even between contractions. 

But with back labor, you will usually experience intense lower back pain or pressure even between contractions. This can be exhausting, because you don't feel like you get that break between surges that a normal labor pattern will provide. Not having enough support and/or not having freedom to move about can make it that much harder to handle your surges.

The Fear, Tension, Pain Cycle

Have you heard of the Fear, Tension, Pain cycle before? In a nutshell, it says that feeling afraid will lead to greater tension which leads to an increase in pain perception...which leads to fear, and so on. That's why emotional support, such as encouragement and help with relaxing, is extra important when dealing with back labor. By interrupting this cycle at any point, you experience less pain. Heightened feelings of fear is a common response to back labor in particular. And it makes sense; persistent back pain would usually be a signal to your brain that something was wrong, right? So without an understanding of what might be happening, as well as techniques that help ease your pain and adequate emotional support, back labor can throw off many birth plans!

Tools for Relief from Back Labor

Back labor is a classic sign suggesting that the baby is occiput posterior (OP). So if I'm with a woman experiencing back labor, I'll be thinking of ways to provide her with comfort - to interrupt the Fear, Tension, Pain cycle. For example, your doula or birth partner could do sacral counter pressure, firm lower back massage, and hip squeezing. (These are effective for dealing with the intensity of labor contractions in general. I use one or more of these techniques at most labors.)

But I'll also be thinking of things to do to encourage your baby to get in a better position, since this could actually bring an end to the back labor. Forward leaning positions, the Miles Circuit, rebozo sifting, side-lying pelvic floor release, and lunges can all help to encourage a more favorable occiput anterior (OA) position for baby. But these things may also increase the discomfort for a little while! Calm presence and high levels of emotional and physical support from your birth attendants are key during these activities. This is where someone who is really good under pressure can be so key. If your partner is overwhelmed by seeing you stressed out, scared, or in pain, a doula can be invaluable! A skilled doula can help you both feel calm, relaxed, and able to try techniques to ease the back labor.

Finally, one of the things that I find can provide the most relief from back labor is submerging yourself in a deep, warm pool of water if you are lucky enough to have access to one in your birth place. This is one reason that giving birth in a setting and with a provider supportive of water birth is great - even if you don't want to give birth in water, being able to submerge yourself in a deep pool of warm water is amazing pain relief.


Even with the very highest level of emotional support, skilled hands-on labor support, a slew of tricks and techniques, and a huge birth pool, I know that in some instances back labor is overwhelmingly intense and unmanageable. I don't know why this is true, but I know that it is. If you have experienced back labor and chosen to use epidural pain relief, whether that was what you wanted before labor began or not, I want you to know that I completely understand your choice, and I support you in your decision making. I don't think anyone can understand another person's labor and judge their decisions. I don't believe that anyone should suffer in labor and birth, and I'm incredibly thankful that epidurals exist!

Do you have a burning question you've been dying to hear a real, personal answer to about pregnancy, birth, breastfeeding, or bodies?  Please, spill! Help us all out by submitting your questions to be answered on the blog! Leave a comment on this post, send me an email at emily (at) mamamassagedoula (dot) com, or fill out my contact form here. All questions will be published with a pseudonym unless you give me explicit permission to use your name. I can't wait to hear from you!