As your due date gets closer, your baby will start getting into position for the big day. The ideal spot for them is head-down with their back against your tummy, this is called the anterior position. It’s the most common position and usually means labour moves along more smoothly.
But sometimes, babies have other plans. Some get into a back-to-back position, also known as the occipito-posterior (OP) position, or sometimes called “sunny side up.” This means baby is still head-down (which is good!), but their back is against your back, so they’re facing your belly instead of your spine.
This isn’t dangerous, but it can make things a bit more uncomfortable. You might feel more pressure in your lower back and labour can take longer or feel stop-start. But here’s the reassuring part: even though studies show up to a third (around 30%) of babies are back-to-back when labour begins, most don’t stay that way. According to research and the NCT, only 5–8% are still in that position at birth, and over 60% rotate naturally during labour and are born vaginally without any major issues.
So, while a back-to-back baby might mean a bit more patience (and back rubs), it’s usually just another variation of normal and there’s lots you can do to help things along.
How can tou tell if your baby is back-to-back?
It’s not always easy to know for sure if your baby is in the back-to-back position before labour starts but there are some signs that may suggest it. Many mums with a back-to-back baby notice:
Persistent, intense lower back pain (“back labour”): This isn’t your typical pregnancy ache, it’s a deep, grinding pain during contractions that might not go away between them. It happens because baby’s skull presses directly against your spine and tailbone.
Slow or irregular contractions: Labour may feel drawn out, with contractions that seem less rhythmic or effective, common in OP labours.
Baby’s movements concentrated across the front of your belly: Instead of the usual kicks around your sides, you might feel more wriggling in one area because baby is spine-to-spine with you.
A dip or hollow in your abdomen: Some mums notice a scooped shape in the middle of their bump, due to baby’s body positioning though this is more noticeable later in pregnancy.
Diagnosis via ultrasound or clinical exam: Clinicians may feel baby’s spine aligned with your spine during a vaginal check or confirm it with ultrasound, transabdominal or transperineal scans are much more accurate than a manual exam.
What happens during labour with a back-to-back baby?
Most babies in a back-to-back position will eventually rotate during labour to face your back, which is the ideal anterior position. This usually happens as they descend through the birth canal, essentially doing a 180-degree turn. It might take a bit longer, and sometimes they don’t turn at all. When that happens, baby may be born face-up.
If the position doesn’t change, labour can be longer and more intense, particularly with back pain. In some cases, interventions like an episiotomy, forceps, or ventouse (vacuum) assistance may be needed. If labour stalls or becomes too difficult, a caesarean might be considered.
Why are some babies in a back-to-back position?
There are a few possible reasons your baby might settle in this way. One is the shape of your pelvis, certain types like the anthropoid (narrow and oval) or android (heart-shaped) pelvis can make it more likely.
Your posture and movement habits also play a role. If you spend long periods sitting with your pelvis tilted backwards, such as in a slouched or reclined position, gravity can encourage your baby’s heaviest part (their head) to swing around to the back. That’s why some babies end up facing your spine.
How can I help my baby move into a better position?
Many midwives recommend practicing optimal fetal positioning (OFP) in the weeks before labour to encourage your baby to settle into the ideal anterior position. While there’s limited scientific proof that these movements guarantee success, many parents find them helpful for comfort and potentially aiding baby’s rotation.
Tips for before and during labour:
Hands-and-knees position: Spend about 10 minutes twice a day on all fours. This helps baby move away from your spine and can relieve back pain.
Sit with pelvis tilted forward: When sitting, keep your knees lower than your hips to open up the pelvis. Use a cushion if your chair or car seat causes your bottom to sink or your knees to rise.
Take frequent breaks if sitting for long periods: Avoid deep sofas or chairs that push your knees up and tilt your pelvis backward.
Use wedge cushions in the car or at work: This helps maintain a forward pelvic tilt while seated.
Practice the “butterfly” yoga pose: Sit upright with the soles of your feet together and knees apart, which encourages pelvic openness.
Sleep on your side: Avoid lying flat on your back to reduce pressure on your spine and promote good blood flow.
Avoid positions that close your pelvis: Such as deep squats, crossing your legs, reclining fully, or propping your feet up on chairs.
During labour:
Move around often: Change positions, walk, sway your hips, or rock your pelvis to help baby rotate.
Lean forward during contractions: Use a birth ball, beanbag, or your partner for support.
Try lunges and pelvic rocking: Standing or kneeling lunges, as well as rocking on a birthing ball, can help create space for baby to turn.
Use all-fours and knees-to-chest positions: These can relieve pressure on your back and encourage baby to move away from your spine.
Be cautious with early epidurals: While pain relief is important, early use may limit your ability to move and could increase the chance of baby remaining in the posterior position or needing assisted delivery.
Back to back baby position FAQs
What if my baby isn’t back-to-back but I have an anterior placenta?
An anterior placenta means the placenta is attached to the front of your uterus. It’s usually nothing to worry about and still provides your baby with everything they need.
However, it can make it harder to feel baby’s movements or hear their heartbeat clearly during routine checks. In some cases, the placenta may lie low and partially block the cervix, a condition called placenta previa. If that happens, a caesarean may be necessary.
Your midwife or doctor will monitor this closely with ultrasound scans if needed. Most anterior placenta cases resolve without complications.
Will a back-to-back baby require a cesarean?
Not necessarily. While the occipito-posterior (OP) position can lead to longer or more challenging labours, the majority of babies rotate during labour. According to the NHS and studies cited by the Journal of Obstetrics and Gynaecology, around 60–80% of back-to-back babies turn to an anterior position during labour and are born vaginally without intervention.
Why is labour more painful with a back-to-back baby?
The increased pain, often called "back labour", occurs because your baby’s skull presses directly against your lower spine. This can cause intense, persistent backache, especially between contractions, as opposed to the more typical wave-like contraction pain felt in the front of the abdomen.
Can I tell when my baby turns?
Some women do notice a distinct shift. It might feel like a sudden change in pressure, a strong movement, or even a “pop” sensation. Others may simply feel relief from back pain. However, not everyone can detect the rotation, and some babies turn just moments before birth.
Are there risks if my baby remains back-to-back?
es, there can be. Labour might be longer, more painful, and slower to progress. You may also be more likely to need assisted delivery methods such as forceps or ventouse (vacuum extraction). If these are unsuccessful or not advised, a caesarean section might be recommended, but it’s not a guaranteed outcome.
How can my partner help during labour with a back-to-back baby?
Partners can provide vital support by offering counter-pressure on the lower back during contractions, using a firm massage or tennis balls. They can also help you stay upright or change positions frequently, and provide reassurance and hydration. Emotional support plays a huge role in how manageable labour feels.
About the author
Bryony Firth-Bernard graduated from the University of Gloucestershire and went on to work as a reporter at Heart Radio West. She worked as a digital writer for Mother&Baby and Yours.co.uk before moving on to work for a fitness brand.