The truth about ‘back to back’ birth

*This article was originally published in April 2015. It is my most read article to date, frequently appearing at the top of my analytics. I’m re-sharing this on that basis*.

Before having children I had only ever heard a couple of references to ‘back to back birth‘. These were vague and pretty much just about where contractions are felt during a labour, where the baby is lying on the mother’s spine. Phrases like ‘back contractions’ and the description of the location of the pain being ‘all in the back’ were used.

I never gave it much thought.

I filed it away safely at the back of my mind along with the description of newborn poo and the fact that the car park machine at the hospital required several £1 coins.

I knew that in order to prevent a back to back delivery, I needed to get my baby into the ‘optimal’ birth position and well, I had been swimming; in the gym; taking aqua natal sessions and pregnancy yoga so I had this optimal birth position thing nailed right anyway?



Baby number 1

My first baby was two weeks late and following multiple sweeps and several goes at induction, labour spanned the best part of four days and resulted in a very tightly wedged back to back baby that had to be dragged out with forceps.

Baby number 2

A breeze in comparison to the first – not easy, as I would never describe giving birth as being easy, 9 days late and a sweep later he finally got moving and was born in water.

Baby number 3

Now, clearly I was hoping things would be getting easier, or at least that this would resemble baby 2’s arrival, more than baby 1’s. 12 days late and three sweeps later, nothing. Received a date for induction which seemed to frighten me into action. One very long, drawn out labour later, another tightly wedged back to back baby arrived, narrowly avoiding the need for forceps.

Baby number 4

I knew this would be the last baby, so was clearly once again hoping for the relaxed, hypnobirth in water. Baby had other ideas and decided to be 12 days late just like his brother. This time five sweeps and lots of trampolining didn’t move anything and I ended up being induced again. Another back to back baby started coming quickly and then got stuck and delayed things somewhat in the latter stages of labour, causing some concern, before eventually making an appearance, thankfully without the forceps.

I lost count of the number of people who told me after my first baby that they would all “fly out” or that I would only be in labour for 30 minutes. That’s just not how I have my babies clearly, they like to make me work hard for them.

I can tell you that a back to back labour is hard work. It can last a very long time and you can feel you make very little progress for all your hard work. A baby is in the ‘back to back’ or ‘occipito-posterior’ (OP) position when he/she is lying head down but instead of the back facing frontwards it faces the mother’s back. About 10% of labours involve babies in the ‘back to back’ position and in over half of these cases the baby will turn around naturally. None of mine did.

If you have a back to back baby you might be asked if you lounged on the sofa a lot, as this can cause the baby to go into that position. That couldn’t have been further from the truth with me, I’m not exactly a lounging on the sofa kind of person, quite the opposite. So not only will you be tackling a back to back birth, but you might also be fighting off disapproving and unwarranted comments.


A back to back baby might mean that the head does not engage fully; it might mean you have a longer early labour phase; you might have a longer pushing stage; you might feel the bulk of your pain in your back – for me it was in my back and the tops of my legs. Leaning forward helped hugely, as did having the TENS machine on my back, and firm pressure being applied to the base of my spine gave some relief as well.

With this type of birth you are more likely to tear, more likely to need an assisted delivery and more likely to have a birth that ends in in a c-section, BUT this is not always the case. I had an episiotomy with my first baby, only 5 stitches with my water birth, and then quite a substantial tear with both the following back to back births, but nothing that didn’t mend pretty quickly. Out of three back to back births, only one of them was assisted and I managed with Gas and Air with all of them.

It can be done, it doesn’t feel like it at the time, but it can be. It was without a doubt the most pain I have every experienced, and each time I said “never again”.

If you’ve been told your baby is back to back don’t panic. There is lots of time for the baby to turn before labour and if they don’t you can still do it. There were a few concerned looking faces during my last two births but I was so determined to get my babies out without forceps that I eventually started to shift them in the right direction.

Good luck and trust your body! It will all be worth it.

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  1. Two out of my five were back to back and I had natural deliveries with just gas and air and no stitches either. The pain was very different to my other three labours, it was all in my back and bum but still no more painful than the others really? I think that there is such a fear of back to back babies when actually, your body just does what it is supposed to!! Thanks for sharing! #sharewithme

  2. Oh just reading this makes me hold my breathe. I won’t say I can relate I have heard so much about back to back labor being the hardest and toughest labors. You are so strong and brave to go through it four times. Mother of steel I call you. While I think I am a big wimp and couldn’t handle that I had my babies both very quickly so I think the big man upstairs knew I was a wimp and helped. You really did work hard for your babies darling. 🙂 Impressive. Thank you so much for linking up to Share With Me blog hop. I hope to see you again this week for another great round. #sharewithme

      1. My daughter was born back to back it was a hard dilivery and I pained for my wife, my little girl was finally born after a hard labour but had a lot of bruising and 2 black eyes we also had to go back a few days later as she was jaundace I would never wish this on any other expectant mother child birth is hard enough without all the extra problems I tilt my hat to you after having 4 x

  3. Both my girls were back to back, with my first I had very poor midwife care and was kept on my back with feet up in stirrups!!! Pushing for over an hour before forceps delivery in theatre 🙁 but with second I was determined to have minimal intervention and got to hospital only an hour before delivery! 🙂 which was waterbirth with only small tear. It can be done without intervention but good midwifery care plays big part. Midwives at hospital I had my second were amazing! They also explained to me that some ladies just have pelvises that have back to back babies and also having a toned tummy can also encourage back to back baby! Far from lounging on sofa!! 😉

    1. Thanks for sharing your experience Anna – the stirrups are familiar as that happened with my first and third. You are right about the pelvis too I’m sure, I think mine were always going to be that way by preference lol. Sounds as if you had a much better experience second time around which is so great to hear 🙂

  4. My last baby was back to back with his hand and shoulder presenting first. I hadn’t even heard of it before till I was in labour and was getting contractions in my back.
    Let’s just say it was an interesting experience. I managed it naturally with gas and hair but after that experience said never again. Fair play to anyone that goes back for more. Interestingly though tearing I had the best post birth experience with him and feel I recovered quite quickly.
    It can be done with the right midwife helping you out.

  5. My last delivery was back to back and it was the worst. I thought something was wrong because there was no break in pain, just waves of even worse pain and it was all in a different place. I really want another baby but I’m too scared since the last delivery and it’s been 2 years!

  6. Easy labour ! No such thing – never knew if you ” lounged” you are more likely to have a back to back
    Great read

  7. My first baby was back to back. I was told I was fully dilated but baby was very high up and they were worried about a cord prolapse if my waters burst. After being put on a drip to speed things up she was born 6 hours after being told I was fully dilated weighing 9lb. I had gas and air and pethidine. Sadly I was rushed straight off to theatre after she was born. I had torn very badly. I even needed more surgery when she was a year old because of the scar tissue. I did ‘lounge’ a lot in late pregnancy as my back was in bits and I was signed off work weeks early. I was a lot bigger with my son but he was not back to back and I didn’t have the excruiating back pain in late pregnancy.

  8. I can concur back birthing is painful and needs good or experienced midwives. Mine was with my first and it’s a relentless pain, I opted for epidural but it slowed everything down and in the end gave birth with gas and air, that was the most pain free part!! Hoping it will be a normal delivery this time….!!

  9. All 3 of my babies were back to back (or face to pubes as one no nonsense midwife put it). Long hard labours definitely. No forceps or vacuum but a lovely episiotomy and plenty of stitches. Getting cut had been my worst fear but after 24 hours it was that or emergency c section. Quick snip and 3 minutes later my beautiful bruised 7lb 11 son shot out. Years later when I was getting coil fitted my GP remarked that I have a tilted womb which probably explained the back to back births. Only advice…poo before you push! Oh and the other 2 were 8lb 12 and 9lb 4 (the babies, not the poos)! ?

  10. Very interesting reading this as I had a back to back birth with my first but it wasn’t until she came out face up that the midwives realised. She was a bit bashed and I tore a bit. It was a long painful birth I think it helped that she was only small 5 1bs. I still had no idea exactly what had happened, so fortunately I had no worries about my next 2 pregnancies as no one discussed it with me at all. my second was quicker but a bit traumatic as his shoulders got stuck (he is 30 now but still struggles to get non stretchy tops over his head and fasten shirts at the neck). The third was in a hurry so only 2 hours from waking up to giving birth but cord around his neck and I went into shock ( that was the only time in his life that he has ever been in a hurry to do anything). Even though it was 32 years ago that I gave birth to my daughter it helps knowing a bit more about it. So thanks to everyone for their experiences.

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