What’s the deal with back labor?

whats the deal with back laborStorytelling is highly influential when it comes to birth. Most of what we believe about birth makes an impression on us because of two or three key stories we’ve heard. Our attempt to relate those stories to ourselves is a natural human instinct. If our parents have shared with us the stories of our own births, those often make the biggest impression, followed by those of our closest friends if they begin having babies first. What about you? What do you know about birth based on this form of community knowledge? One of the most prominent themes tends to be back labor, which might also be described as “malposition of the baby.” So, what’s the deal with back labor? Is it avoidable? Is it considered unusual or a complication? Depends on who you talk to.

As a childbirth educator and doula, I want my clients to gain some knowledge in this area without fearing it as an insurmountable challenge. There are ways to “treat” it during labor without having to make drastic changes to the birth plan. There are also times when babies may be unable to turn and a Cesarean birth is needed, and still other times when a baby doesn’t even need to turn and can come through the pelvis easily.

What I really want to emphasize with this post is that while a posterior baby during birth is not ideal, in general it is not abnormal. The most prominent cause of it seems to be a lifestyle spent sitting, especially at the computer and also while leaning back with our feet up. Putting our feet up is a great thing in pregnancy, but if we are having a healthy pregnancy, we should try think about it as more of an occasional indulgence rather than our default, especially during our late 2nd trimester and into the 3rd. Instead, try to sit in the “tailor sit” position more often while we’re watching TV or reading. This helps to naturally encourage our baby’s head to engage in the pelvis.

In general you want to encourage your baby’s heaviest part, which is the back of their head, to swing forward. So here are a few other helpful tips to prepare for birth and encourage our babies to rotate into this position where they are facing our backs (called anterior) rather than facing out (which is called posterior):

  • Place a wedge pillow behind our backs during long car rides and as we sit at desks and computers
  • From 36 weeks on, spend 15-20 minutes each night before bed in the hands & knees position while draped over a birth ball and/or wiggling your hips around
  • Increase fluid intake which can create more buoyancy in the womb
  • Consider wearing a pregnancy support belt throughout the day

These tips will not always avoid posterior positioning. Regular chiropractic with a trained (Webster technique) provider can also help. But ultimately remember that the birthing process (specifically contractions) are designed to rotate the baby. So even if you begin your birthing process with your baby in the posterior position, your baby will most likely rotate into your pelvis as he descends, particularly if you are able to choose mostly upright and forward leaning movements during your birth. Sitting on a birth ball and leaning over a bed and pillows or hands & knees on a bed or in a birth tub work well.

I have seen births where the birth giver preferred mostly upright but seated positions. This can be most comfortable during pressure that just won’t seem to release in the way we would hope. But unfortunately staying seated for a long time is not going to help the baby rotate. A “persistent posterior” baby might rotate well by having the birth giver do a forward-leaning inversion followed by a side-lying release and then some seated squats. (Toilet sitting works well.) It should be noted that some posterior babies will fit through well without rotating if the birthing parent has a roomy pelvis, but as noted above, there may also be a need for a Cesarean birth.

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