Tender Hands Doula Service

This is an article on Back Labor I wrote for the CAPPA Quarterly.  It was published in July 2009.  You may read the entire issue and other issues at: www.cappa.net/quarterly.php

The Challenge of Back Labor

By Erin Shreve, CLD

“I thought I would DIE.” “It was the worse pain I have ever had.” “My back was killing me.” “The epidural was the best thing that happened.” Yes, back labor is very painful, but there some very good ways to help the mother work with it, so she can continue to handle her labor well.

Back labor is often the result of a posterior presentation of the baby. If the baby can be helped to rotate into a better position, the mom will get relief from the discomfort and labor will progress better. Some of the techniques for helping women with back labor can seem pretty strange, and it may take trying several different ones before relief is obtained. If it is suspected the baby is posterior early in labor, it is helpful to try to get the baby to rotate before using techniques that use gravity, so the baby is in a better position before entering the pelvis. A favorite one for most laboring women is the birth ball. The mother can use the ball for support while on her hands and knees, which encourages the baby to rotate into the anterior position. The support of the ball enables the mother to be able to stay on her hands and knees longer, giving the baby time to turn. The ball is also very comfortable to sit on, and the mom can do some pelvic rocking and swaying through the contractions and the ball gives the perineum gentle support. The upright position allows gravity to assist in fetal descent, and makes a nice change from walking. The baby can be monitored while the mother is on the ball.

Hot compresses, hot water bottles, or using a heated rice sock on the lower back can help relieve the discomfort of back pain. Be careful to not get the compresses or socks too hot. It may feel so good, the mother may not notice if it is too hot. Some women prefer cold to heat. A shower or warm bath can also be relaxing. The water helps distract the mom from the pain and helps relax tense muscles.

Back pressure is always wanted when back labor is very painful, but South Carolina midwife Susan Smart recommends not putting a lot of pressure directly on the sacrum for fear that pressing inwards will limit the inner pelvic space. She suggests applying pressure outwards on the bones to the sides of the sacrum providing pressure and opening. Double hip presses are an excellent technique to ease the pain. It is nice to be able to switch off doing these with the Dad or other birth partners, as it can become tiring for the one doing it.

Doing lunges or taking stairs two at a time can also encourage the baby to change and move down. Slow dancing with Dad is a sweet way to work through some contractions. In The Nurturing Touch at Birth Paulina Perez recommends doing the “Doula Hula”! While being supported by her labor support person, the mother rotates her hips in a complete circle without breaking the movement.

Sometimes it can help to have the mom gently lift her tummy just above the pubis. This can help the baby into a better angle to enter the pelvis. A variation would be to have mom get in a knee chest position or to lean over the birth ball on all fours and sway her hips. These techniques can help the baby change position by backing the baby out of the pelvis and when the mom is more upright again, reenter at a better angle.

One time tested method to assist mothers is simply walking. Walking is beneficial in labor to almost all mothers, not just those experiencing back labor. Along with the walking, the mother can try stomping and squatting, which is just what the name implies: stomping and squatting!! The mother stomps around when she feels the contraction beginning and at the peak, squats down. The birth partner can assist the mother up and down or the mother can use the rails on the wall, if walking in a hospital where there are support rails along the hall walls.

Another interesting technique is referred to as “flopping”. To do this to help turn a baby, the mother gets on her hands and knees and stays there through a contraction, rocking her hips and arching her back. After the contraction, the mother FLOPS to the left or right and lays there through the next contraction. Then she gets back up on her hands and knees for the next contraction, once more rocking her hips and arching her back. Then she flops to the other side and rests through the next contraction, repeating the steps during the next contractions. The flopping encourages the baby to rotate and descend. If a woman has an epidural, it is still possible to flop, if she has help to get on her hands and knees. In a narrow hospital bed, the mom needs to move all the way to the left or right so she will have room to stay on the bed. Have assistants stand on the sides of the bed to help the mom and make sure she doesn’t fall. At home, the mother’s bed is usually wide enough so that she won’t flop off. J

There are many good resources to learn more about back labor and other techniques to help. A Nurturing Touch at Birth by Polly Perez, and The Birth Partner by Penny Simpkin are two excellent books, and www.spinningbabies.com is a web site with a lot of helpful information. Every woman has different needs and a technique which gives one woman relief, may not help another, so try another!

Gary providing massage for Amber to help reduce the discomfort of back labor Amber holding onto Gary during a contraction