THE back labor thread

[Marisa]

How do you help women experiencing back labor??

I did search here, but didn't come up with much, so I thought I'd start a new thread.

I haven't had anyone with really bad back labor, but a few with some fleeting back pain.

I've done:
back massage
pressure on one hip while she was lying on her side

Umm...you can see why I've started this thread.

[DL]

I've had great success with the double hip squeeze! Most of my moms have LOVED it! I've also used heat and/or counter pressure on her lower back. I've heard that pointing a hand-held shower head (very warm water) where she's feeling a lot of pain helps, too. I look forward to reading what everyone else has to say!

[RosyDoula]

So far I haven't had any mothers with back pain. I know you can have back pain and not have a posterior labor (though I've only heard of it happening one time irl), but with my clients part of their "homework" is to do bellymapping so I know if baby is posterior or not and recommend they do exercises/positions to flip him around. I'm all about prevention. I personally don't want to go through a posterior labor - and neither do my clients.

[DL]

Quote:

Originally Posted by RosyDoula So far I haven't had any mothers with back pain. I know you can have back pain and not have a posterior labor (though I've only heard of it happening one time irl), but with my clients part of their "homework" is to do bellymapping so I know if baby is posterior or not and recommend they do exercises/positions to flip him around. I'm all about prevention. I personally don't want to go through a posterior labor - and neither do my clients.

Although I haven't given belly mapping as "homework" (good idea, btw! ), I also emphasize OFP with my clients, trying to prevent those OP births. Unlike RosyDoula, however, I have had two mommas that did have back labor even though their babies were anterior. By using the double hip squeeze, warmth, shower/hot tub, both of those moms continued to have unmedicated, natural births!

[RosyDoula]

Comfort and Turning Techniques

"Short women, women who aren't flexible, women who've had accidents, women who have weak back muscles and some of the women with posterior babies or babies who have one of their arms up in late labor. Some women in of each of these categories are likely to get some back pain in labor." Good to keep in mind.

Leaning Forward: Many women, especially those with back labor, find it most relaxing to lean forward during contractions.
Hands and knees position: Can help relieve back pain and helps a posterior baby rotate, makes it possible to sway and rock.
Pelvic tilts: "These simple exercises also help to minimize the pressure on your spine."
Counterpressure: "By using your hands (or a tennis ball) and pushing, usually at or just above the sacrum, this will help put counter pressure where mom is feeling the most pain. She may also tell you to move higher or lower, but the most frequent request is more pressure. In my years of experience in providing labor support I don't think I've ever been told I've applied too much pressure."
Double hip squeeze: Like Lori mentioned. "Have the mother move into whichever variation of the hands and knees position she finds most comfortable. Begin by gently placing your hands on her hip bones to find proper placement, then slide your hands onto her back while keeping them on the large hipbones. Keep one hand on each bone and your thumbs pointed toward the spine forming a "W". Push the hipbones "in and up" towards the mothers body, and at the same time towards the mothers shoulders as if you needed to press on the bones and slide them up her back."
The belly lift: "Have the woman stand, or slight standing squat. As the contraction starts, she brings her hands around her belly and pulls up (on the butt) of baby until the back pain goes. If labor is long a helper can do this from behind. It sounds simple, and is along the same lines as much of what we use with hands/knees, duck walk, backward on a chair, etc. The theory is to change to vector (direction of force) of pressure of the presenting part."
Knee-chest position: "When on hands and knees, stick your bottom (butt) in the air, to tip the baby back up out of your pelvis so that there is more room for him to turn around."
Rebozo techniques: "Have the mother rest over a birth ball with her knees on a pillow on the floor. The doula lifts the weight of the baby up, and relieves Julie's back from the weight of her womb. With short, sifting movements, jiggle the lifted belly. She starts slow and speeds up to the speed of sifting flour. She makes very short wrist movements, nothing jolting. This isn't to force a baby to move, it is to relax the involuntary muscles and broad ligament supporting the womb. Then the baby can move more freely and get into a better position or make better progress descending down the pelvis. Another way a rebozo is used in labor is to lift a large uterus to angle the baby more directly on the cervix. Much like a pregnancy belt, the rebozo is wrapped around the mother's lower abdomen. One mother got the idea to tie the ends around her neck. Another mother would have her helper lift the ends of the rebozo during a contraction to improve the baby's angle."
Chunging: "I read an article some years ago written by an American obstetrician who had traveled the back country of China, far from civilization. He observed that when a woman was having a long and difficult labor, the midwives would "Chung" the mother. "Chung" means that two or three women would shake the laboring woman very vigorously all over. The obstetrician said it worked every time."
Trendelenburg position for rotating an OP baby: "I tried it first years ago to get the FHR to come up (bradycardia) and two times in a row, the baby rotated and delivered pretty quick. So I started thinking, that it probably gets the baby's head "unstuck" from the birth canal and helps it rotate easier. It works!! I still turn them from side to side in the trend. position. Most of them can tolerate it better than knee-chest, and it seems to work better. We have a big wedge at the birthing center and put it under the mattress of the bed. Or you can use a bean bag."
Walcher's Position/Arched Back/Lordosis: "For a posterior baby, place a trochanter roll on the bed beneath the place on the spine that corresponds to the iliac crest. The angle of the pelvis increases, therefore increasing hyperextension of the fetal head. This is uncomfortable for the fetus, so he assumes a more comfortable anterior position. Alternate with side lying position at 15 minute intervals (removing the roll) until rotation is complete. This method can be used at any stage of labor."
Sterile Water Papules: "These are four sterile water injections given around the sacrum, base of the spine. There are no medications in the injections and they can be done by a doctor, nurse, midwife, or anesthesiologist. The pain from the injection is stinging and lasts about 60 seconds. The area should not be rubbed because the blister of water that will form, much like when you have a TB test, is part of the process." Many women report remarkable pain relief from this simple procedure. It can be very beneficial for those wishing to avoid epidural anesthesia and can be used in conjunction with IV medications, if desired, though many women find that they are not needed once this procedure has been done.
Heat: Like Lori mentioned "For a firm hotpack that holds heat for a considerable period of time, dampen a folded bath towel, fold it up in a Chux (waterproof bed pad) and heat in a microwave for approximately two minutes, turning after one minute. Wrap again in a soft dry towel or receiving blanket. This can be rolled or folded as needed and is especially useful for back labor."
Water: Like Lori mentioned (again) "Using the tub to immerse mom in can also be a great comfort in labor. This will help promote relaxation and comfort. Even in a tub different positions and comfort measures can be added. In the shower mom can assume the hands and knees allowing the shower to provide the counter pressure on her lower back. You can place towels on the floor of the shower to make it more comfortable or use a birth ball to lean over."

http://www.midwiferytoday.com/articles/paininback.asp
http://www.spinningbabies.com/

Also the Labor Progress Handbook talkd alot about these things. Very useful resource to have at a birth.

[RosyDoula]

Quote:

Originally Posted by Doula Lori Although I haven't given belly mapping as "homework" (good idea, btw! ), I also emphasize OFP with my clients, trying to prevent those OP births. Unlike RosyDoula, however, I have had two mommas that did have back labor even though their babies were anterior. By using the double hip squeeze, warmth, shower/hot tub, both of those moms continued to have unmedicated, natural births!

Awesome!

[DL]

Quote:

Originally Posted by RosyDoula Comfort and Turning Techniques "...or babies who have one of their arms up in late labor. Some women in of each of these categories are likely to get some back pain in labor." Good to keep in mind.

Yeah...Come to think of it, my last client had back labor with an anterior baby. Her baby was born with his hand and arm up by his head (his hand was on his cheek). Very cute to see, but more difficult on momma. Thanks for the post, RosyDoula!

[loveslabor]

As a momma with back labor, the biggest help to me was being on a birth ball leaning forward to try and get some of the pressure on my back, mixed with counterpressure to the lower back on either side of the spine (I think...it's a big blur, but I think I remember this helping more than anything else.)

Oh, yeah...and the shower beating down on my back while I was leaning forward was heaven too.

[truelife]

I have only ever had backlabor. #1 was 45 hours of him being ROA, Posterior, and then LOA until he was born. Double hip squeezes and showers were what worked for me. The MW, MW apprentice, husband and best friends were taking turns two at a time pushing on my hips as hard as they could b/c that was the only way it really helped.

#2 was in the perfect position the entire pregnancy, had chiropractic care the whole time, was EXTREMELY mindful of OFP/posture and had a 3 hour labor with intense back labor. Being in the birth tub was amazing! Contractions were on top of eachother but the water and sacrum releases were what made all of the difference.

I could not tell you what a "real" contraction feels like but the best tool I learned from my chiropractor was how to do a sacrum release. I showed my MW and DH and that's what they did during my second labor.

Here is how to do it - if I don't explain it well please forgive me and ask away (and if I'm sharing something that everyone knows how to do then I will hide in shame- LOL)

Run the palm of your hand all the way down to the end of the mom's spine until the pads (right below fingers) are at the bottom of the sacrum and your palm is vertically up the spine. Press with your PALM until you can feel the sacrum move on your pad. Mom should be "dancing" or "houlaing" as you do this. This is her body's natural way of shifting everything. Usually the baby gets very active during this time.

You can practice this on anyone but without the Relaxin there will not be near the movement from the sacrum.

[MothertheMother]

The Birth Partner also has a chapter devoted to back pain in labor if you are looking for another resource.

[Gentlebirthmama]

First, off I agree that prenatally is the time to help OP babies turn to OA.
The mom's position has a LOT to do with whether a baby is OP or not...not always, but I think it makes a big difference.
During classes we talk at great length about OP babies and good posture for the mom.
No sitting in recliners, slouching, etc. Tailor sitting on the floor, pelvic rocks throughout the day, sitting on floor in the frog position, anything but leaning back. This makes a nice little hammock for baby to get into facing OP...leaning forward makes it less comfy for OP babies to stay that way, and barring any other reasons like cord issues, etc. baby should turn OA. I also show them how to tell if baby is OP...look at moms stomach...if it is flat around the umbilicus, OP. If she has a nicely rounded belly button, OA.

One of my first doula clients had an OP baby that stubbornly refused to turn before labor...so during labor I had her stomping/squat...her dh and I helped her stomp, wide legged, up a flight of stairs in between ctx, then she knelt down (h&K) on the stairs during a ctx, w/dh doing the double hip squeeze. I got in front of her and encouraged her to moan and groan thru ctx. to help relax her belly more. About 30min. before baby was born, the mom know longer was overly uncomfortable during a ctx...she said, he turned...she didn't have any back labor. Baby came out OA.

[hoosierdoula]

Quote:

Originally Posted by truelife ...the best tool I learned from my chiropractor was how to do a sacrum release. I showed my MW and DH and that's what they did during my second labor. Here is how to do it - if I don't explain it well please forgive me and ask away (and if I'm sharing something that everyone knows how to do then I will hide in shame- LOL) Run the palm of your hand all the way down to the end of the mom's spine until the pads (right below fingers) are at the bottom of the sacrum and your palm is vertically up the spine. Press with your PALM until you can feel the sacrum move on your pad. Mom should be "dancing" or "houlaing" as you do this. This is her body's natural way of shifting everything. Usually the baby gets very active during this time. You can practice this on anyone but without the Relaxin there will not be near the movement from the sacrum.

This is a great description, and sounds like a wonderful technique! Are there any risks to this? If I were to try this on a mom, could I potentially cause any back injuries?

[Luv2bemommy]

I havent helped a mom with back labor but I have expirenced it with each of my pregnancies (3 times!) so far! What helped the MOST was movement, NOT staying in bed. I adore the birthing ball, it was a life saver for me with my last labor. I also love the hot rice sock, it's fantastic! My dh tried to help me out and massage and put pressure on my back but it didn't help me any so I guess that varies from mama to mama..

[RosyDoula]

Also if the mother is on the fetal monitor - a nurse told me contractions will piggyback if baby is OP. One labor I attended the mother got an epidural and baby turned OP (surprise surprise) so we got her on hands and knees over a birth ball and put a glove full of ice where baby was and had the father talk to baby on the other - it worked!

[b'earth angel]

The first official doula client I had had back labor. Even though it was my first time I could tell baby was sunny side up. The doctor didn't even realize it.
I met her at the hospital so I didnt' have any prenatals w/her. All I could do was counter pressure on her back. I was the only one to do it for her and by the time baby was born, my arms were in spasms. We tried to do hands and knees, which was working splendidly, until the nurse came in and ordered her to stop. "We can't keep the monitor on the baby's heart beat like this". So they did and internal monitor, by that time, mom wasn't interested in trying it anymore.
Standing up, leaning over, and some heat helped her also.
I wish I had know more of these nifty little tricks back then to help her with. I hadn't even had my training yet, just reading books. So thanks for all of the good tips ladies!