In the weeks leading up to the birth, your baby will be getting into position ready to make their way into the world. The most optimal position for your baby to be in as labour starts is generally head-first (also known as cephalic or vertex presentation), with the back of their head towards the front of your tummy (anterior position). But this isn't always the case. A variation of the cephalic presentation is with the back of the head towards mum's back (occipito-posterior). This position is more commonly referred as "back to back".
How often are babies 'back-to-back'?
It is estimated that about one in ten babies are back-to-back when labour starts.
Most back-to-back babies are born vaginally, but this position can sometimes make labour longer and more challenging.
How will I know if my baby is back-to-back?
Here are the two main signs that can indicate that your baby is back-to-back at the beginning of labour:
Backache, as your baby's skull and spine are pushing against your spine
Slower progress or a stop and start pattern
How can I help baby rotate?
Most back-to-back babies turn to the anterior position during labour. However, it is important to remember that it can take time. Here are a few positions that you can try to help baby turn quicker by creating more space in your pelvis.
On your hands and knees
Pelvic rocking and pelvic tilts – create a fun playlist that will make you want to dance!
Lunging
Forward leaning inversions
Side release or exaggerated lateral positions
You can find more information and guidance on these positions on the Spinning Babies' website: https://www.spinningbabies.com/pregnancy-birth/techniques .
Important note: your baby might decide they don't want to turn around after all, which means they'll come out face-up. This is ok and you can still have a beautiful physiological birth (see amazing photos by Monet Nicole at the bottom of the page).
How to manage the sensations and make my back-to-back labour more comfortable?
Here are a few things that you can do to feel more comfortable during a back-to-back labour:
Hypnobirthing - use the up breathing and visualisations techniques to increase comfort and feel more in control.
Water - take a shower or have a bath to relieve discomfort and tensions. Water (and deep-breathing) will also boost your beta-endorphins (endogenous opioid / natural pain relief).
Cold / heat packs
Counter pressure / lower back massage from birth partner.
Movement – as well as helping baby move; swaying, dancing, or ‘bouncing’ on your birth ball will help relieving discomfort.
Sterile water injection – speak to your care provider about this option which is sometimes offered to manage strong back pain.
Can I try to avoid it?
Sometimes babies are back-to-back because of the shape of mum's pelvis, however some evidence suggests that the way you sit and move during the last weeks of pregnancy can also impact baby’s position for birth.
Longer periods sitting or reclining on soft furniture can result in the back of baby's head (the heaviest part) to move to the back due to gravity, and they'll end up lying against your spine.
So here is what I recommend:
Try to adopt more upright and forward positions during the last weeks of pregnancy – no more slouching on the sofa while watching TV or sitting at your desk. This is a great time to start using your birth ball too!
When you’re sitting, make sure that your hips are always higher than your knees. Check that your birth ball is the right size for your height.
Make sure to keep going with your daily physical activity. Walking, swimming, and yoga are particularly good to help baby move into an ‘optimal’ position.
If your days involve a fair amount of driving, use a wedge cushion in the car, so your pelvis is tilted forwards.
Sleep on your side, not on your back.
A couple more things worth noting:
Like with any birth, it will be essential for you to fully tune-in to your body’s cues and to stay active throughout if you wish to give yourself the best chance to welcome your baby without requiring interventions. However, some back-to-back babies will require that little bit of extra help, and this is ok too. Just make sure that you are given all the benefits and risks if you are being offered an intervention.
The language used when referring to back-to-back babies is often negative and sometimes even scary. I highly recommend for you to search for positive back-to-back birth stories to reframe your expectations.
Many back-to-back births are smooth and fairly short. A lot of Mamas experience beautiful physiological births with their back-to-back babies. Believe me, there is plenty of good reasons to approach your birth with the same sense of calm and anticipation! Trust that your body and your baby will know best.
