Counter-pressure is a common pain relief technique for labor. It's recommended in many natural childbirth classes and it does, in fact bring relief. It also brings a lot of jokes about exhausted daddies pushing on mommy's back – and it brings a lot horror stories about the painful labors it's used in.
So just what is it used for? It's recommended when you have back labor.
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 pain in this area of your body – your tailbone, your sacrum, and the lower part of your spine.
This pain is almost always associated with 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.
The only purpose of counter-pressure 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 counter-pressure. Some doulas carry tennis balls in their birth bags to rub into the sacrum and give counter-pressure.
The problem isn't that it relieves pain. The problem is that's the only thing it does!
The purpose of labor and birthing is not to relieve pain. It's to get your baby out! That's where there's a problem with counter-pressure. It doesn't help move your baby down and out. In fact, it may cause your baby to take longer to turn and be born.
Let me point out that counter-pressure does bring relief, and it can buy you rest time. If you've really been working hard, or your baby is a persistent posterior and you're feeling worn out, go through a few contractions with counter-pressure. Rest between, enjoy the lessened intensity while someone applies pressure to your sacrum. Once you're feeling more in control it's time to try other techniques.
Most babies will turn during labor. Babies want to turn anterior. There are some babies born “sunny side up,” but most will turn on their own during labor unless hindered by medications (the epidural is infamous for posterior babies).
Your goal during birthing it to help your baby do the turning he / she needs to. If you can convince baby to turn before labor, that's the ideal. Posture may play a role in that – don't lean back in chairs if you can help it. 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.
During labor you can use some of the same techniques – sitting on a birth ball or hands-and-knees positions can encourage baby to turn. If you're able to 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 a standing position where you rock and sway your hips.
Your birth partner isn't left out. He or she can support you in a standing position (you may want to avoid squats until 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.
Walking and hip spiraling / dancing, or sitting on a birth ball and spiraling your hips, are both great ways for you to move intense contractions. You're still encouraging your baby to turn and move down through your pelvis.
These proactive movements not only help you handle those heavy contractions while baby is posterior, they help you get your baby to turn and prepare for a straightforward journey into your arms.
Photo by shawngrazzi