Medically Reviewed by: Charlotte Hoskin, BSc (Hons) Midwifery studies
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 you 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.
How is a back-to-back position diagnosed during labour — are scans or physical exams typically used?
Charlotte Hoskin, consultant midwife at My Expert Midwife and Independent Prescriber, explains, "A back-to-back position is usually identified during labour through a physical examination."
She adds that midwives or doctors typically assess the baby's position by feeling through the abdomen (abdominal palpation) or during a vaginal examination, where specific landmarks on the baby's head help determine its orientation.
"Ultrasound scans are not typically used during labour for this purpose," she notes, "but they may occasionally be used earlier in pregnancy, particularly if there are concerns about the baby’s position or if labour is being induced."
Can posture or lifestyle during pregnancy influence the likelihood of a back-to-back position?
"You may hear that certain postures, like spending time on hands and knees or avoiding slouching, can help prevent your baby from settling into a back-to-back (occipito-posterior) position," says Charlotte. "While these suggestions are common, current evidence indicates that posture and lifestyle during pregnancy are unlikely to make a significant difference to your baby’s final position at the onset of labour."
She emphasises that a back-to-back position is not something anyone causes.
"It’s more often influenced by anatomical factors, such as the shape and type of your pelvis, rather than anything you have or haven’t done during pregnancy."
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:
Charlotte notes that many babies who begin labour in a back-to-back position will naturally rotate as labour progresses. However, she adds, "There are some techniques that may help encourage rotation, particularly if labour is prolonged or the mother is experiencing significant back pain. These should be tailored to individual circumstances, considering the mother’s comfort, the baby’s wellbeing, and how labour is progressing."
Here are some of her key suggestions:
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Stay mobile and upright: Walking, swaying, or using a birth ball can help the baby move into an optimal position.
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Try all-fours or knees-to-chest positions: Spending 10 minutes twice a day on hands and knees can relieve back pain and help the baby move away from the spine.
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Sit with your pelvis tilted forward: Keep knees lower than hips when sitting, use a cushion if needed.
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Avoid prolonged sitting: Especially on deep sofas or chairs that tilt the pelvis backward. Take frequent breaks.
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Use wedge cushions: Especially in cars or office chairs to maintain pelvic tilt.
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Practice gentle prenatal yoga: The butterfly pose (soles of feet together, knees apart) can help open the pelvis.
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Sleep on your side: Avoid lying flat on your back.
During labour:
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Change positions often: Changing positions frequently, encouraging upright and forward-leaning positions, like standing, squatting, sitting on a toilet, leaning over a birthing ball, or being on ‘all fours’ (hands and knees), can help create space in the pelvis and promote rotation. Use any position where your knees are higher than your hips - think 'knees to chest’!
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Staying mobile and using movement: Walking, gentle swaying, pelvic tilts, or rocking on a birth ball can support the baby in finding an optimal position.
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Use hydrotherapy: Using water, labouring in a birthing pool can help relieve pain and allows for easier movement and position changes whilst enabling the pelvis and knees to naturally open.
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Use comfort measures: Heat packs, TENS machines, baths, and massage for backache.
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Eat, drink and rest as you need to (make your birth partner do the same).
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Be mindful with epidurals: Experts advise caution with early epidural use, as it may limit movement and increase the likelihood of needing assisted delivery if the baby remains in a posterior position.
How might a back-to-back baby affect labour decisions?
Women with back-to-back babies may experience stronger lower back pain, which could prompt earlier contact with a midwife or hospital. "Early labour contractions may also be less regular or less intense,” says Charlotte, “so it can be harder to know when active labour has really begun. This might delay or complicate the decision about when to go to the hospital."
If labour is prolonged or discomfort becomes too intense, many women may choose to seek support or hospital-based pain relief earlier than expected.
What are the possible risks or outcomes if the baby remains in a back-to-back position?
Midwife Charlotte advises that if labour is not progressing well, or the baby remains in a persistent back-to-back position, midwives or obstetricians may consider several interventions:
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An obstetrician may attempt to manually rotate the baby during a vaginal examination.
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If the baby does not turn and assistance is needed, a forceps or ventouse (vacuum) delivery may be recommended, particularly during the second stage of labour.
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If labour becomes too prolonged or there are concerns about the wellbeing of the mother or baby, a caesarean section may be advised.
How might a back-to-back position affect decisions about when to go to the hospital or seek support?
Charlotte explains that many women experience strong lower back pain when their baby is in a back-to-back position. If the discomfort becomes difficult to manage at home, it may lead to an earlier call to a midwife or hospital for support or pain relief.
Early labour with a back-to-back baby can also present differently:
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Contractions may be less regular or intense, making it harder to recognise when active labour has truly begun, potentially delaying the decision to go to hospital.
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Labour may progress more slowly, leading some women to stay at home longer or contact their care team sooner for advice.
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Because of prolonged or intense discomfort, women may opt to access hospital-based pain relief earlier than they might with a baby in an optimal position.
Charlotte adds a reassuring reminder, "back-to-back is a variation of normal, not a position that needs to be 'fixed', if it was, human beings as a species would be very poor at giving birth and we are actually rather splendid at it!"
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 expert
Charlotte Hoskin has provided her expert advice and medically reviewed this article. Charlotte is a Consultant Midwife and Independent Prescriber at My Expert Midwife. Her career began with a fascination for pregnancy and birth, inspired by her experiences helping her family. With extensive experience in both hospital and community settings, Charlotte is dedicated to providing comprehensive care to pregnant women, including those with complex needs. She’s also a mum of two, with her birth experiences featured on Channel 4’s One Born Every Minute.
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.