We aren’t preparing women for the excruciating pain of back labor
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I thought I’d know a contraction when I felt one. I want other moms to know that’s not always the case.
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Nobody told me back labor was a thing. Not really, anyway. Not until I was 20 weeks pregnant, sitting across from a friend at a small Chinese restaurant, asking her to walk me through her labor, detail by detail.
It was the back pain, she said in words too colorful to repeat here, that really took her by surprise. The rest, I didn’t let myself hear, blissfully attempting to manifest an easier fate.
Her description—what I let myself absorb of it, anyway—wasn’t far from the clinical one. Just rawer.
What is back labor?
“Back labor is a term used to describe intense pain in the lower back during labor,” says Brandye Wilson-Manigat, MD, a board-certified OB-GYN. “It is thought to occur when the baby’s position places increased pressure on the mother’s sacrum, tailbone and surrounding tissues during contractions, making the pain much more noticeable in the lower back than in the abdomen.”
“Some women describe it as constant pressure, while others notice sharp pain that worsens with each contraction,” Dr. Wilson-Manigat continues. “Pain is subjective, but many women who experience back labor describe it as significantly more intense or difficult to cope with than traditional labor.”
I’d find out what she meant soon enough. Fast-forward to week 37, and I woke from a nightmare about back pain, only to realize it was real and inescapable. I was certain labor had started, and just as certain this was the back labor I’d been warned about. At the hospital, my pain was so intense I still can’t fully explain or remember it. I asked a nurse if that’s what this was. She answered kindly but simply: “It could be!”
I was sent home to rest. The baby was fine, and the pain, for the moment, came and went. But it returned the next night, harder and with vomiting, sending us straight back to the hospital. I writhed in the backseat, cursing at my husband to drive faster, drawing worried—or at the very least, confused—looks from anyone who caught a glimpse into our car.
This time, though, there was a new development: the baby’s heart rate had become a concern, too. My care team watched the monitor as contractions came and went. I felt nothing when they hit. It was the back pain that refused to relent, arriving on its own schedule, until it didn’t feel like something happening to my body so much as something happening around me.
I’d never had a baby before, but I thought I got the gist from the movies: water breaks, contractions arrive, and pushing ensues. When the moment finally came to push, though, I couldn’t tell you what a contraction had actually felt like. Had I missed it entirely? Was that the back pain, all along? And would anyone ever be able to tell me, with any real certainty, what had happened to my body and why?
Why do some women have intense back labor?
Doctors, as it turns out, can’t always say for sure why some women experience back pain. Position’s a factor, but it’s not the only one. “Back labor can be a clue that the baby’s skull (the occiput) rests against the back (posterior) of the mother’s pelvis, but it is not a definitive sign,” Dr. Wilson-Manigat explains. A lot of factors behind back pain are beyond anyone’s control: the shape or size of the mother’s pelvis, a baby simply too big for the space it’s given, or any condition that keeps a baby from rotating into position.
Which raises the question I kept coming back to in that hospital bed: If back labor is this common and this confusing, why had I never really heard of it before that lunch?
Dr. Wilson-Manigat’s answer is simple: it’s not what most people experience, so it’s not what most people talk about. It also gets folded into the broader conversation around labor pain, since many coping strategies overlap. In other words, it isn’t a separate type of labor, just a different way of experiencing the same one.
Was that the answer I wanted? No. I wanted someone to tell me, definitively, what was happening to my body. I wanted to tell the story with some authority, instead of the slightly unconfident, confused version I’ve been telling since, the one that boils down to “back pain, and back pain only,” and somehow doesn’t do the situation justice.
So here’s what I wish I’d let myself hear back at that Chinese restaurant, before any of this started: back labor is uncommon enough to catch you off guard, but common enough that it deserves a mention. You deserve to know, going in, that it’s possible. But if it happens, know that it ends, the way all of it eventually does. And what’s waiting on the other side is worth it.
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