During labor, it's normal to feel some discomfort in your back, especially as baby descends low enough to shift your sacrum and coccyx as they pass through the pelvis. This is not the same as back labor. Back labor is when the back of baby's head is lined up with Mom's spine. It often feels like the contraction starts in the back and wraps around, or it can feel like the contraction is only happening in the back. It's intense and can make for a longer labor. Here are  some suggestions for back labor. 

The first thing is to try to convince baby to shift from a posterior position. Things you can try are:

• Do 3 rounds of the Miles circuit.
• Use a Rebozo to encourage baby to turn.

If trying those things don't encourage baby to shift, here are ideas to manage back labor:

• Run the shower on your lower back
• Use the birth pool.  If you don't have a birth pool and your tub is large, you can use that instead.
• Roll tennis balls on either side of the lower spine during contractions
• Do the double hip squeeze
• Apply gentle pressure to the sacral area. Be mindful that pressure on the sacrum will limit the sacrum's ability to move which may slow baby's descent.
• Use a TENS unit on the lower back
• Try a heating pad on the lower back.
• Sit backwards on the toilet. You can use pillows on the tank to have a soft place to rest your head and upper body between contractions.
• Try sitting and gently bouncing on a birth ball.

Back labor is intense, but staying relaxed and trying the ideas I've shared can help you navigate labor with a baby in the posterior position.

Prodomal (meaning precursor) labor, also known as false labor is something that many Moms experience. Prodromal labor contractions are stronger than Braxton-Hicks contractions. They can be quite strong, similar to active labor, however prodromal contractions do not increase in intensity or frequency. While it is considered more common for third and subsequent births, it does happen with first and second births.

Take advantage of it! Prodromal labor is a great chance to practice:

• relaxing through a contraction
• ignoring contractions
• coping techniques so you can learn which ones might be the most helpful
• going about your day while your uterus does its thing
• eating  and drinking during labor
• the mindset you will need for labor

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Things to know about prodromal labor

• you can't force prodromal labor to become active labor
• it lets the uterus practice and strengthen for active labor
• it can help the cervix to move into an anterior or more forward position
• it can help the cervix to efface or thin
• it doesn't tell us when labor will start or when baby will be born
• it might help baby settle into a good position for birth

While it can be frustrating to have contractions that hang around for hours without turning into labor, it's not wasted work. It's a sign that the body is preparing for labor. It's one step closer to meeting your baby and that is a good thing. 

When labor has done its work and dilation is complete, pushing is the next phase to get baby born.

While you wouldn't think of pushing as a topic with differing opinions, it is. Do you start pushing as soon as dilation is complete? Do you wait until the fetal ejection reflex kicks in and your body is pushing? Is coached pushing the best? Do you hold your breath while pushing? Do you add effort to your body's pushing? How long should you push? These are just a few of the questions that have differing answers. Adding to the confusion is that there is no one correct answer that applies to every birth. 

I've been at births where Mom is told she's completed dilation so now she needs to push. I've been at births where Mom has completed dilation and takes a nap before pushing. I've been at births where Mom is complete, but needs a good snack before she has the energy to push. I've been at births where Mom has the urge to push, but is only at 5 or 6 cm dilation. I've also been at births where Mom has the urge to push but is told she has an anterior lip. The urge to push does not always mean it's time to push. 

In the home birth setting, I prefer for clients to wait for the fetal ejection reflex. I feel this leads to more effective pushing which means less time pushing. Sometimes this may mean there's a "rest and be thankful" phase where labor appears to slow down. I think this resting phase is beneficial to let Mom build up some energy for pushing. I also think it's a perfectly normal part of physiological birth.  

Sometimes in a home birth setting, a Mom will need some coaching to direct pushing where it needs to go.  I watch for this and will offer coaching if I think it is going to be beneficial. I am not a fan of asking a client to hold their breath while I slowly count to 10 . Sometimes holding breath for a few seconds while pushing can help with understanding of where to direct pushing efforts. I prefer Mom to breath as the body needs to make sure there is plenty of oxygen going to baby. If I coach a client with pushing, usually after a few pushes they need encouragement more than coaching. 

As baby starts to crown, I will remind clients not to add any effort to pushing in order to protect tissues. This also lets baby have time to adjust and do what they need to do tonavigate the pelvis. It can be perfectly normal for a pause between head being born and the rest of the birth. This pause lets baby turn his or her shoulders so they can come through the pelvis. 

I trust birth so I do not feel pushing has to be managed. I do not feel that pushing has to be rushed. I want to allow the time both Mom and baby need to work together in the pushing phase to have a safe, healthy birth. 

The modern lifestyle isn't always conducive to getting baby into a good position.  A lot of jobs involve sitting for long periods of time. Our cars, and seating arrangements at home often encourage a more laid back or reclined seating position. We may sit at home for extended periods of time watching TV or using the computer. We have labor saving devices to clean our floors such as a Roomba, eliminating the need to do much movement to clean, eliminating the need to get down on hands and knees to clean. These are all great things, but not so helpful in pregnancy to encourage baby to be in a good position for labor and birth.

Being up and moving, as well as sitting upright instead of reclined are just a few ways to encourage baby to settle into an optimal position when labor starts. 

​Other things you can do include:

• Curb walking
• Walking
• Swimming
• Sitting on a birth ball
• Pelvic rocks for 10 minutes, 2 to 3 times a day
• Taking the stairs
• Scrubbing floors on your hands and knees
• Bear walking
• Sitting in a straight back chair instead of the recliner
• Chiropractic adjustments using the Webster technique

Things to avoid include:

• sitting with your knees higher than your hips
• Recliners
• Crossing your legs

Being up and moving is the best thing you can do to encourage baby to settle into a good position at the start of labor. Having baby in a good position will help labor to be efficient and might shorten the length of labor.


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One of the most important skills I have as a midwife is being flexible.  I think this is an important skill for clients too.  

A lot of work and preparation goes into planning and preparing for a home birth.  Shopping for and setting up the nursery are such fun as you anticipate birth.  Lining up pet sitters, or child care for your little ones, getting a car set and stocking up on diapers are all part of being ready for baby's arrival.

Taking a childbirth education class, finding a doula, deciding if you want a birth photographer, deciding if you want to use a birth pool or not, reading books and watching videos about breastfeeding are some of the things I encourage clients to do to be prepared for labor, and the immediate postpartum.

Sometimes though, even though you have gotten all the things, have all the help lined up and have everything ready, plans will change at the very last moment.  I operate from the principle of the Boy Scout Motto: Be Prepared.  Being prepared means having a basic birth plan written out, and having a bag packed and ready to go with the essentials you will need for a birth at the hospital.  Being prepared means having the car seat installed and ready to use, as well as giving the petter sitter and child care providers a heads up that you might be calling on them soon.

There are many reasons plans can change.  Baby's heart rate may tell me that we need more help than we have at home.  Mom may not respond to the tools I have to stop bleeding if it's too much.  Mom may decide she wants pain relief.  Mom may start running a temperature, or her blood pressure may become higher than is safe for a home birth.  These are just some of the reasons plans may need to change.

When plans change from home birth to hospital birth, I like to let the hospital know we are coming and why.  I also like to send them pertinent records, and lab results so they have time to look them over and be familiar with past care before Mom arrives. I will go to the hospital with Mom and Dad if they want.  Because of hospital rules on how many people can be with Mom, sometimes parents want the doula or a family member to go instead.  If that is the case, I will be available by phone. My assistant will stay behind to do a thorough clean up. Once Mom is home from the hospital,  I will do postpartum care if Mom wants me to. 

While it is stressful to change plans, sometimes we need to change them. To lower the stress for everyone,  I try to hold space for my client and family to adjust to the idea that birth will now happen in a hospital, and I work to have a smooth transition to the hospital setting. In the end, I want families to feel heard, respected and cared for regardless of where birth ends up happening.