Back labor is excruciating. It is to be avoided, if possible. The back labor I am referring to is the pain of labor felt more in the lower back than in the belly of the mother, and is caused by a baby coming down the birth canal face up.
First a bit of terminology. “Anterior” means toward the front, specifically the front of the mother. “Posterior” means toward the back. The “occiput” is the back of the head. In obstetrics we describe a baby’s position during labor as Occiput Anterior (OA) or Occiput Posterior (OP). Most mothers have OA babies, which are easier to deliver.
In the picture you can see the mother’s bones are colored orange. The baby proceeding down and out in an occiput anterior position more naturally conforms to the passage. The unfortunate baby in the occiput posterior position has to squeeze the protruding occiput past the inward point of his mother’s spine. This puts immense pressure on her bones, causing pain.
Usually the baby spins around before emerging. Rarely, babies do not spin and are born looking in the same direction as their mother. This is especially unusual in a first time mother. Sometimes, if a baby does not spin, it simply does not emerge, and a Cesarean section is required.
What can a mother do to prevent the occiput posterior presentation? Sometimes nothing. Sometimes this happens because of the mismatch of baby’s head shape to mother’s pelvis shape. Sometimes the spinning capacity of the baby is limited by its umbilical cord. But there are two actions I advise my mothers to prevent some cases.
First, lean forward in your daily activities. We women are descended from generations of women who successfully gave birth vaginally and who spent their days bending over repeatedly to tend the hearth, wash the clothes in the river, churn the butter, plant the rice, etc. Only with the advent of modern technology did women begin to spend most of their day leaning back. Now women lean back when they watch tv, drive their cars, or work at their desks. Gravity pulls on the body of the baby, swinging it forward if mother is leaning forward, or backward if she is leaning back. So remember your grandmother, and lean forward. You can also do hands and knees cat arches several times a day, to pull baby up out of the pelvis where gravity can do the work of swinging baby’s back forward.
A second action a woman can take to deal with an OP presentation, is to ask that her healthcare provider not break her water. Having an intact amniotic sack helps lubricate and cushion baby’s head to encourage it to rotate. “Let’s break your water to get things moving,” sounds so innocent, even helpful, but with an OP presentation, this could be a mistake.
Penny Simkin and Ruth Ancheta, two doulas, wrote a wonderful book in 1994 and revised several times since called, The Labor Progress Handbook. This has been used by doulas, midwives and a few wise physicians in the years since for its natural ideas for the management of OP babies. In their book, the use of movement and positioning, massage, and equipment such as birthing balls are described to encourage babies to turn and descend. Methods for dealing with the pain of an OP presentation are also described, including pressure on the tops of the hipbones, pressure on the tailbone, TENS (electrical stimulation), and the administration of sterile water papules. The purpose of these methods is to avoid an epidural, which then places the woman in bed for the duration, eliminating the possibility of doing all the aforementioned maneuvers to spin the baby.
With a determined mother, a committed team, and experts in the Simkin/Ancheta techniques, OP babies can be born vaginally and healthy more often than they are. Obstetric residency programs do not routinely teach the moves, the positions, and the massage, use of sterile water papules and TENS for labor. This is unfortunate.