While you are pregnant, many women will share their birth stories with you. Several of these stories may contain complaints about back labor. What is back labor?

The true definition of back labor is that a laboring mother feels intense pressure and contractions in the back, particularly the lower back near the tail bone or coccyx. This pressure, as seen in illustration at the left, is due to the back of the baby's head (or occiput) pushing on the coccyx so that is moves outward (posterior position or presentation). This, in turn, produces constant, often intense back pain.

Often, when there is a posterior presentation such as in the illustration, and the bag of waters is broken, contractions are enhanced and the baby will descend in the pelvis. These actions wedge the baby's head further, pressing more on the coccyx.

For the baby to get to the anterior presentation (as in illustration at right), the head and body must go through a long rotation of up to 180 degrees. If the head descends too deeply before rotation is accomplished, the inability of the baby to move through and descend through the remainder of the pelvis greatly increases, thus reducing the chances for successful vaginal delivery.

To help initiate a turn, the mother can assume a position on all fours (hands and knees). In this position, doing the pelvic rock or gently rocking the pelvis back and forth often initiates a turn approximately 85% of the time. A modification of the pelvic rock may be for the mother to lay over the birth ball (see color photo at left) with the top half of her body and then rock her pelvis. In this manner, she can alleviate any stress on the wrists and avoid aggrevating carpal tunnel syndrome. A passive pelvic rock may also be done. To perform a passive pelvic rock, position the mother comfortably, preferably on her left side (color photo, at right, shows model on her right side). Standing behind her, cup your left hand over the iliac crest and place your right hand on the sacrum. Moving your arms in a bicycle-type motion, rotate the pelvis with the strength of your hands and arms. Depending on your individual strength, you may need to show another support person how to do this so they can take over when you are tired. Success in rotation of the baby depends on many factors, so it make take a while before results are seen.

A variety of massage tools may be used to provide counter pressure and massaging relief. When selecting massage tools, consider what will feel good on the laboring mother's back as well as the hands of the person giving the massage!

Back labor, or the baby presenting in the occiput posterior position, can be very difficult with which to cope. Knowing in advance the positions, massage and exercises to relieve the pressure and possibly rotate the baby can make the situation less stressful for you and your baby.