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Why Counterpressure in Labor is Counterproductive

By Kristen Burgess

Using counterpressure in labor is a quick way to bring pain relief when needed! Most women know “back labor” can make contractions more painful and that counterpressure stops that. It’s a good tool, but it’s also important to understand why back labor happens and when other methods can bring relief and get labor moving more smoothly. Your baby’s position greatly impacts what you feel during the contractions. Using techniques that reposition your baby can speed labor up and make contractions less painful. I’ll discuss what causes back labor, the pros and cons of counterpressure, and other comfort measures to bring pain relief and optimal baby positioning. If you’re hoping for an un-medicated birth, I’ll cover tips to get the pain under control, get baby in a good position, and have the natural birth experience you’ve prepared for! 

What is Back Labor and Why Am I Having It?

Back labor is persistent pain in your back, specifically low in your back around and just above your tailbone. Your tailbone (technically called your coccyx) attaches to a bony plate at the back of your pelvis. This plate is your sacrum; above the plate is your spine. 

The sacrum forms the back of your pelvis and attaches to the rest of your pelvic bones by cartilage that softens during pregnancy (your pelvis isn’t rigid and your baby can move through it!). 

Back labor is felt as lower back pain—in your tailbone, your sacrum, and the lower part of your spine. This labor pain is often because of a posterior baby, which means your baby’s back is up against your back. The back of your baby’s head pushes against the tailbone and sacrum during contractions, causing back labor. You may hear this baby position referred to as occiput posterior. 

You may not feel a lot of pressure during early labor, when the baby is still higher in the pelvis. But as baby moves down during active labor and the back of his or her head puts intense pressure on the sacrum, back pain gets more pronounced.

Counterpressure Techniques for Quick Pain Relief 

The purpose of counterpressure in labor is to give pain relief. By pushing in hard on your sacrum, your birth partner helps to push back against baby’s head, lessening the pain that you feel. 

It’s effective, which is why there are stories of daddies exhausted from hours of counterpressure. Some doulas carry tennis balls in their birth bags to rub into the sacrum and give counterpressure. The amount of pressure you need to use may seem like a lot, but it will bring huge relief to her! 

This method is often very effective at controlling the pain of labor and birth. In fact, the problem isn’t that counterpressure relieves pain. The problem is that’s the only thing it does! While it’s a huge relief to stop that pain, it doesn’t address the cause of the back labor to begin with, which is baby’s position. 

This both lessens the pain and helps labor move forward smoothly (and maybe more quickly!).

Getting Lasting Relief (and a Smoother Birth) 

The purpose of labor and birthing is to get your baby out! Counterpressure in labor may cause your baby to take longer to turn and be born because it’s just pushing back against your baby rather than helping him or her to rotate. This leads to a long labor, or even a labor stall, which is not what you want! 

Counterpressure brings relief and can buy you rest time without using pain medication. If you’ve been working hard, feel severe pain, or your baby is a persistent posterior and you’re feeling worn out, go through a few contractions with counterpressure. 

Rest between, and enjoy the lessened intensity while someone applies pressure to your sacrum. Once you’re feeling more in control, your birth partners can add in additional techniques. These may lead to a shorter duration of labor! Good labor progress and an easier birth are both possible when you create more room in the pelvis. 

The Double Hip Squeeze 

The double hip squeeze provides pressure relief and can help open up the bottom of the pelvis. Have the mom get on hands and knees or lean forward over the birth ball/bed. She can also stand for this technique. Have her flex her hips. Use your fingers to find her hip bones, then move your hands toward the roundest part of her bum. Use the flat or heels of your hands to apply pressure in toward the center of her body. You can also do this with a helper, which makes it easier for the birth partner! Using the heel of your hands can be more effective than the flat if the mom wants a lot of pressure. If doing this with two birth partners, place one hand over your other as you push in. 

When mom is in a hands-and-knees position, the ischial tuberosities (sitz bones) can spread more easily, helping the baby rotate into an optimal position while relieving pressure for the mother. The mama’s forward-leaning position also encourages the baby to rotate. 

Alternate the double-hip squeeze with counterpressure if needed to help bring more relief to the mother. Together they can help significantly! 

Getting Your Baby Into a Good Position 

Your pelvis is perfect for birthing your baby and can open beautifully for your baby! Most babies will turn during labor. Babies want to turn anterior. Some babies are born “sunny-side-up,” but most will turn on their own during labor unless hindered by medications (evidence shows that the epidural, for example, causes babies to be posterior). 

Your goal during birthing is to help your baby do the turning he or she needs to. If you can convince your baby to turn before labor, that’s the ideal! 

Posture may play a role in that. While pregnant, don’t lean back in chairs too often. Sitting on a birth ball and leaning forward slightly (comfortably) at the hips is a good way to sit at your desk/table. Spending some time kneeling or on hands-and-knees daily will help too. Need to stretch out? Lie down on the couch on your left side, leaning slightly into your belly. 

During labor, you can use some of the same techniques —sitting on a birth ball or hands-and-knees positions can encourage the baby to turn. If you can get into a birth tub, you’ll find that your freedom of movement increases. You’ll naturally move to positions or move in ways that help your baby move down. Outside the tub, try standing where you rock and sway your hips. 

Your birth partner isn’t left out. He or she can support you standing (avoid squats until the baby has turned). Some techniques, such as the hip press or belly sifting (done with a rebozo or shawl) can create more room within your pelvis and get baby to turn. 

Belly sifting is best done with someone experienced to show you how to do it (your doula is a great resource!). 

Walking and hip spiraling/dancing, sitting on a birth ball, and spiraling your hips are great ways to move through intense contractions. You’re still encouraging your baby to turn and move down through your pelvis. 

Position Changes 

Moves from any of the above positions to another can open up room in your pelvis and help your baby move down. Position changes are especially important if you’ve been reclining back for a while. Getting up and moving to a better position can not only get your baby moving down, but also helps relieve pain. 

Good positions to try if you’re feeling back pain: Standing and swaying your hips. Walking. Hands-and-knees (ideally with a hip press). Sitting on a birth ball. Open knee-chest position.

The Open Knee-Chest Position 

This position is ideal for moving your baby. Here’s how to do it: Get down on hands and knees, then kneel. Make sure you’re stable in a kneeling position. Slowly lean down, crossing your arms to form a rest for your forehead. Lift your bum into the air. Have your support person put a folded blanket or mat under your knees to ease the pressure on them, if needed. 

This position isn’t the most comfortable or sustainable for a long period of time, but it is excellent to move baby back out of your pelvis. This can ease back labor and create room for your baby to rotate. This is a good position to use if you’re feeling back pressure or pain in early labor. Try and stay in this position for 30 minutes or so. 

Get up and move into a position that will help baby rotate, such as sitting on a birth ball while leaning forward into the bed. You can also sit up on the birth ball and rotate your hips. Or try slow dancing while leaning into your partner. 

Then get up and move into a position that will help baby rotate, such as sitting on a birth ball while leaning forward into the bed. You can also sit up on the birth ball and rotate your hips. Or try slow dancing while leaning into your partner. 

Slow Dancing 

Slow dancing, or other positions that give your hips lots of movement, can help you handle labor’s energy while encouraging your baby to spiral down into the pelvis in an optimal position. During my labors, I liked to lean on my bathroom counter, which is a low counter. I pressed my hands down firmly into the counter, about shoulder-width apart. That supported my weight so I could sway or spiral my hips back and forth. 

This was my favored position until I got into the birth tub with my last few babies. It helped me deal with the contractions (sometimes moaning/vocalizing too) while also moving my babies down. Labor progressed very quickly once I got in the tub! 

Water Birth Benefits 

If your birth coach can get into the birthing tub with you, applying counterpressure or doing a hip squeeze is possible. It’s more likely, however, that you’ll be in the tub yourself without that added technique. 

Warm water has been shown to help in labor all on its own, especially when you can immerse in a birth tub. Water birth is a great option for you and baby! You can have a tub if you’re having a home birth, and many birth center and hospital birthing rooms now offer a tub for labor (and sometimes hospital staff is open to water birth as well). 

Water helps provide even support and pressure around your body, taking away some of the weight and immediately canceling out some aches and labor pain. It’s such a great relief and many moms swear by it! Studies have shown that birthing in water can be as effective as pain medicine for many mamas. It won’t totally take the pain away, as an epidural might, but it relieves the discomfort of the contractions so that you can get into a rhythm and handle labor more easily. 

Having a birth tub available for labor has other benefits, like lowering blood pressure and giving you freedom of movement. Moving more easily can help you get your baby in a good position for birthing. In addition to lessening muscle tension, the warm water can help you soften and relax pelvic muscles, offering baby an easier time rotating. 

These proactive movements not only help you handle those heavy contractions while baby is posterior, they also help you get your baby to turn and prepare for a straightforward journey into your arms.