I'm just going to say it, no pun intended — back labor is a real pain.
The ideal position for baby to be in during labor is occiput anterior (OA), meaning her head is facing down in the pelvis. If she's in the occiput posterior position (OP), her head is facing up — and the hard part of her head is on your sacrum. Ouch.
Instead of feeling contractions in your lower abdomen, as with intense menstrual cramps, you'll feel them in your lower back. If this keeps up for more than just a few contractions, your baby may be OP or otherwise not fully OA. Alternatively, sometimes back labor is caused by the size of baby's head.
The good news is that there are many positions and comfort measures for back labor that can help you feel better while also opening your pelvis to give your baby more room to turn in, getting into a better position for birth.
Hopefully, you won't experience back labor, but if you do, here are some things I've seen work wonders for moms I've supported during labor. Be sure to check with your doctor or midwife before trying these positions or comfort measures, especially if you have any physical limitations or are sensitive to cold or heat.
The birth ball is my favorite tool, and not just as a doula. I used a birth ball during labor with both of my own kids, and I credit it with helping labor progress as well as with relieving my aching back. Many hospitals have birth balls readily available, or you can bring your own exercise ball if you have one — it's basically the same thing. Try sitting on the birth ball with your legs open — you'll be in a squatting position that will give baby room to rotate into a better position for delivery. You'll also take pressure off your low back and get some pain relief. Another option: You can stand with a birth ball positioned behind you on a wall — what a great, big massage tool!
Massage and counterpressure
Speaking of massage, many moms find counterpressure to be a great relief for back labor. You can pack massage tools in your labor bag, but a tennis ball, a rolling pin or your partner's hands will do the trick just fine.
The double hip squeeze
While you are sitting or kneeling on a birth ball, or even straddling a chair, your partner or doula can place his or her hands gently on your hips. During contractions, he or she can push in and up, releasing pressure from your low back. Many moms find this immensely comfortable.
Heat and cold
Placing a heat pack or ice pack on your low back is an added comfort measure that can be used with most labor positions. Be sure to place a barrier between the pack and your skin (for example, wrap the pack in a towel) and ask your partner to test it on his or her own skin first.
Use gravity to your — and your baby's — advantage
Unless there's a reason why your doctor or midwife advises you to stay in bed, upright positions for labor are great to try, especially if you have back labor. Try walking, sitting in a chair (be sure to open your legs), squatting with support or laboring on your hands and knees. If you're at home, kneel on all fours on the floor (you may want to put a blanket or yoga mat down if the floor is hard), with your knees hip width apart. If it feels natural to rock your pelvis or move back and forth, do it! This position is good for the first stage of labor as well as the second stage, when you're pushing. Some moms even give birth while kneeling.