Back labor is most often caused by the baby presenting in a posterior position. This means that the baby’s spine and the hardest part of the head are against the mother’s spine; this can cause intense lower back pain and pressure, during and possibly between contractions, and sometimes even during pregnancy. Since the baby’s head is not as well-applied to the cervix, this position sometimes delays the onset of labor, or leads to hours or days of what are known as “turning contractions” or prodromal labor (aka false labor). It may also lengthen the dilation and/or pushing phases of labor significantly.
A skilled care-provider will often detect this variation of the baby’s position before labor, but other times it is not discovered until labor has begun. Sometimes slow labor due to posterior presentation leads to a diagnosis of “failure to progress” or “cephalopelvic disproportion” since a larger diameter of the baby’s head is working to fit through the pelvis. The baby may rotate to an easier position during labor; about 5% of posterior babies do not rotate and are born in a face-forward position, often called “sunny-side up”.
The best way to handle posterior presentation is through prevention. It is usually much easier to rotate the baby before labor has begun. During pregnancy, regardless of your baby’s position, sit in upright or forward-leaning positions, such as on a birth/exercise ball, leaning on a straight-back chair that has been turned backwards, or cross-legged on the floor (“tailor sitting”). A back support called the Nada Chair can help you sit this way comfortably for longer periods of time. When standing or walking, avoid the “sway-back” silhouette by tucking your pelvis forward. Avoid reclining on a couch or chair and leaning on your tailbone; this can cause your baby to assume a posterior position. You can do the cat/cow yoga exercise, also know as the pelvic rock; on hands and knees, first arch your back up and tuck your head down, then bring your head up and make your back straight.
Gravity can help you avoid or change posterior position; when you are on hands and knees, since your baby’s spine and head are the heaviest parts they often sink toward to floor and into an anterior position. You can also lean forward over a birth ball if you cannot lean on your wrists or arms. Midwife Jean Sutton suggests using a Swedish chair. These are backless, with a place for you to tuck your legs under.
Some babies remain posterior when the mother sleeps in the same position each night. Try sleeping on your side, top leg bent and drawn up with pillows under the knee. Don’t recline to rest. Lie on your side or sit on a birth ball, leaning forward into something soft. If your baby’s head has already engaged (moved deep into the pelvis) you might try kneeling with your face and chest on the bed – the knee/chest position – to help the baby move up a little before you start the other exercises. This may give the baby a little more room to turn around. After this, try climbing stairs. In addition, always visualize your baby’s back facing the forward part of your uterus, and ask your baby to help.
Some women have successfully rotated posterior babies by using moxabustion (burning mugwort, the same technique used for breech turning; ask your midwife or doula for help). The homeopathic remedy pulsatilla may also help; ask a homeopathist or herbalist.
During labor, all of the above suggestions can help your baby rotate and be born more easily. Showering or bathing in a tub may help relieve back labor. If in the shower, direct the jets to your lower back; in a tub, the deeper the better. Massage and counterpressure can help. Ask someone to apply pressure with the heels of their hands on either side of your tailbone. In addition to all of your comfort measures, a midwife or doula may be able to use a rebozo – a long piece of fabric – to help the baby turn, or may use a technique called the “double hip squeeze” to help make room for your baby’s head. Spend time on hands and knees, maybe while swaying and circling your hips. Try climbing stairs or doing lunges with one foot up on a low chair, alternating sides (try the right side first). You can also use a technique called the abdominal lift. Place your hands under your belly down by your pubic bone and lift your abdomen with your hands. This is especially effective during a contraction – it can tuck your baby’s head into your pelvis. Try to avoid amniotomy (artificial rupture of membranes, or “breaking the bag of waters”) because this may fix the baby in a posterior position and make it more difficult for the baby to rotate.
Your birth partner, midwife and/or doula can really help with physical support and verbal encouragement (tell her how well she’s doing, and focus on the positive!). Be sure to eat and drink; if you are facing a long labor you will need the extra energy and fluids. Above all, relax your bottom and belly and rest between contractions. The most important thing you can do is focus on relaxing and releasing your baby, and your most effective tools are your sense of humor and good attitude.
In addition, there are other resources you can use to help your baby assume an optimal position. Midwife Gail Tully has developed a technique called Spinning Babies, with these and other suggestions – see www.spinningbabies.com. Books you may want to consult include Active Birth by Janet Balaskas, Optimal Foetal Positioning by Jean Sutton, and Penny Simkin’s Labor Progress Handbook.
Remember that if all of your efforts to help the baby rotate do not work, babies can and do come out anyway! Some babies may just need to be born this way. Relaxation, patience and persistence, and above all a courageous positive attitude will take you a long way. With support, encouragement, and trust in birth, you can do it.
By Vanessa Stephens
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