About the Author
Nicola has been a practicing Midwife for the last 21 years. Born in Cornwall, her career has taken her from Devon to the Australian Outback to inner city London and a few other places besides. She is a qualified Hypnobirth Practitioner and is currently training to be a Professional General Hypnotherapist. Nicola trained in the use of Rebozo scarf massage with Gail Tully, the American midwife, author of the Belly Mapping work book http://spinningbabies.com/product/belly-mapping-workbook/ .
Nicola is qualified to use Western medical acupuncture, moxibustion and aromatherapy in her midwifery practice and is also trained as a post-partum belly wrap artist, able to conduct Closing of the Bones spa treatments and blessing ways. Nicola also gained skills and formal training in numerous counselling techniques during her nine years working as a specialist Midwife in Drug and Alcohol Services; including techniques such as Compassionate Mindfulness and Motivational Interviewing Technique. If she’s not working as a Midwife, teaching a birth class or mentoring student Midwives, she can be found reading about, researching or writing about pregnancy, birth and breastfeeding and is acutely aware that this probably makes her a bona fide “Birth Geek.” (She has a very understanding husband and son.)
To find out about her classes for expectant parents and birth professionals visit her website: www.wayofthekoi.com
About this book
I don’t believe in mystifying things and one of the wonderful things about the Rebozo is that it is so simple; so why complicate it? With a few basic safety principles it can be learnt as a simple comfort measure within one evening. The three basic techniques included here are suitable for most women (see notes in each section). I have also included some bonus information about using the Rebozo for comfort after the birth as well as an introduction to using a Rebozo scarf for safe baby wearing.
Safety is a key feature of all my teachings. I often find that if people are advised of the safety and common sense considerations then they can quickly apply them and work out their own style and way of doing things. It is a teaching concept that is very liberating and empowering.
Rebozo scarf massage techniques for pregnancy and labour are growing in popularity in the UK as more and more people hear of them. They are simple to use and produce a dreamy, hypnotic and blissed-out feeling for the woman receiving the massage, increasing her comfort and oxytocin levels in labour (which can only be a good thing). The beauty of the techniques are not only their effectiveness but also their simplicity, yet many books and courses on the subject teach such a wide variety of techniques that it can be overwhelming and confusing for the average woman and her birth partner who really would benefit from just a few simple tools to promote her comfort.
This book provides a simple guide to using Rebozo scarf massage techniques for comfort in pregnancy and labour. It focuses on three of the best techniques and within one evening of practicing you can have a good enough understanding of them to be equipped to use them with good effect. Please read the safety notes before trying any of the techniques.
This book is required reading for birth professionals taking part in my short courses; Rebozo Practitioner workshop and Compassionate Postpartum Practitioner Training.
Introduction to the Rebozo and its contemporary use
The Robozo is a long, straight Mexican or Guatemalan scarf traditionally worn by women. It holds huge cultural significance and is considered an emblem of Mexican heritage. Although it is worn as a garment it is also traditionally used to carry babies and large bundles. It is used by traditional midwives to perform a rocking massage in pregnancy and labour called the Manteada. Frida Kahlo, the Mexican artist, is famously depicted wearing the Rebozo.
It feels important to begin this book by acknowledging the origins of the Rebozo. Its use as a pregnancy and birthing tool is currently gaining popularity within the UK birthing community; because of this huge and rapid increase in use, there is always a danger that it could be re-appropriated in a way that doesn’t necessarily demonstrate respect for the culture of origin. However, just because it originated in Mexico and Guatemala doesn’t mean that we can’t benefit from it in our part of the world. After all, consider the benefits to the world from the exchange of ideas and skills between cultures, without which we wouldn’t enjoy the benefits of acupuncture, yoga or Ayurvedic medicine for example.
The skilled traditional Midwives of Mexico and Guatemala are able to use the Rebozo scarf therapeutically to reposition mal-positioned babies (anything from breech positions to transverse or posterior positions). This book is a brief guide to using the Rebozo technique for comfort in pregnancy and labour and to encourage progress in labour only.
Choosing a Rebozo
You don’t have to splash out on an actual Mexican or Guatemalan Rebozo scarf—they can be very expensive. If you do decide to invest, be certain that you’re spending your money on a fairtrade Rebozo, ensuring the producers made a fair profit from their hard work. Otherwise you can use a length of mid-weight cotton with a small elastic effect in the length and on the bias; it should be at least 2 meters[* *]in length and about 70 cm wide. (1)
Notes on safety and comfort
If you are unsure whether any of these exercises are safe for you to use, please consult your Midwife or Doctor. This book does not replace the advice of a medical professional.
The three techniques that we are going to look at here are designed to increase comfort in pregnancy and birth. Although you can use them while semi-standing (leaning forward), women often choose to use them while positioned on all fours. If you have any conditions that will make these positions uncomfortable or dangerous, please do not attempt these techniques. Always ensure that you have something soft to kneel on (a yoga mat or cushions are ideal). You may wish to consider placing a rolled up towel behind the knees and/or under the ankles if you are going to remain in this position for any length of time.
[*● *]Let your Midwife know that you plan to use the Rebozo (including it in your birth plan is a good idea).
[*● *]Lean over a stable surface. For example, if you are using it in hospital and choose to lean over a hospital bed, ensure the brakes are on.
[*● *]Consider the comfort and safety of the person delivering the Rebozo massage. They should keep their back straight and knees loose. A taller birth partner will require a longer Rebozo scarf.
Do not use these techniques if:
[*● *]You are at risk of or have been diagnosed with placental abruption
[*● *]You have or are experiencing vaginal bleeding in pregnancy
[*● *]You have any underlying issues with blood clotting such as idiopathic cytopenia
[*● *]You are being “continuously monitored” with a CTG in labour
[*● *]You are expecting twins or multiple babies
[*● *]Significant pregnancy induced hypertension or are pre-eclamptic
[*● *]Experience postural drop with your blood pressure
[*● *]Are prone to dizzy fits or collapse
[*● *]You have an epidural in place
[*● *]You experience significant ligament pain or spasms in late pregnancy (ask to be referred to a physiotherapist if this happens to you!)
[*● *]A breech baby after your membranes (waters) have released
[*● *]You are experiencing hypermobility of your joints due to pregnancy or due to a pre-existing condition such as Ehlers-Danlos Syndrome
[*● *]Do not use the sifting technique if you have an anterior placenta (see your scan report and ask your midwife or doctor to confirm this)
[*● *]During labour if you are experiencing more than six uterine waves in ten minutes (Tachysystole[_)_]
(Please note this list is not exhaustive and if you have any doubts you should seek medical advice.)
*Before you start *
The birth partner should always check at the beginning of a massage that the woman is comfortable. Allow her to dictate the pressure applied and the speed and vigour of the motion. Speak to her softly to maintain her inward focus. You could agree before beginning how she can non-verbally communicate during treatment if she wishes to stop (for example waving her hand).
The simple techniques we will cover in this Easy guide are:
[*● *]Sifting the belly
[*● *]Hip Shimmy
[*● *]Bum Hug
When to use: In pregnancy and the first stage of labour (while the cervix is dilating)
Anatomy & Physiology
As pregnancy advances the weight of the baby and the womb (the placenta and water etc.) put a gradual strain on the whole system. The broad ligament runs across the front of the uterus like a wide band stretching to accommodate the growing uterus. All of the connective tissues are affected by the hormone Relaxin. Your body is clever: these changes ultimately mean that your pelvis and soft tissues are able to adapt and accommodate your baby as it passes gently through in birth. While these changes in your body take place, the Rebozo massage can feel incredibly soothing and supportive. This technique relaxes the pelvis, taking the weight off your pelvic floor and acts as a substitute for the broad ligament, relaxing and resting it for the duration of the massage. It relaxes the lower back and gives the baby a gentle cradling effect. It is very important that the massage is not stopped abruptly as the sudden sensation of the weight returning to the ligaments can be very uncomfortable for the woman.
The pregnant woman will need to get comfortable either on all fours or leaning forward comfortably over a stable surface. Most commonly women lean over their kitchen counter at home or over a birth ball. Utilise whatever you have to hand but ensure it is stable and not likely to slip out from under her (e.g. if in hospital ensure the bed brakes are on).
To start, pass one end of the Rebozo under her belly and grasp both ends so that it is cradling the belly like a hammock. Make sure that the Rebozo is laid flat with no uncomfortable wrinkles across the belly. The Rebozo is likely to have some natural folds in it but no bunched up wrinkles. The birth partner holds either end of the scarf firmly enough so that it won’t slip on the skin but not so tight that it might yank. The Mother should feel held, comforted and in control during treatment. Make sure the Rebozo is applied symmetrically so that the lengths grasped by the masseur are equal in length. The birth partner stands behind her or if she is on all fours they straddle her in a standing position (see picture). The birth partner should have their feet flat on the ground with their knees and shoulders relaxed. It is important to adopt a position that they are able to maintain without strain as they may be doing this for a while!
The Birth Partner may need to move their hands further down the cloth to ensure the correct tension and to ensure they are standing in a comfortable position. If the birth partner finds themselves having to stand on tip toe to get the right tension, this can be corrected by simply moving their hands further down the cloth. If the Birth Partner is tall they may need to use a longer Rebozo.
Check at the beginning of the massage that the woman is comfortable; her belly should hang free and relaxed with her knees apart. Allow her to dictate the pressure applied and the speed and vigour of the motion. Speak to her softly to maintain her inward focus. You could agree before beginning how she can non-verbally communicate during treatment if she wishes to stop (for example by waving her hand).
Once she indicates that she is comfortable and feels safe and you have achieved the optimal position for both the woman and the birth partner pull back and up gently but firmly on the Rebozo. Do not yank back—at this stage you are just taking the weight of the belly. Ask her to take a deep breath in through her nose and as she breathes out through a relaxed mouth, ask her to relax down into the scarf. This way, she is dictating the pressure which is applied to her belly. She should feel safe and comfortable. It is surprising how many women want the tension to be firmer than the birth partner thinks—but this is for her to dictate. Start off on the gentler side as it could be very unpleasant if the cloth is too tight. If she feels she can’t trust the process she will be unlikely to relax into it.
Begin to slowly rock the Rebozo from side to side in a sifting motion by first pulling on one side of the cloth and then the other—alternate these movements so that the belly is gently rocked from side to side. Be sure to maintain the tension so that the Rebozo doesn’t slip. You are aiming for a rhythmic, hypnotic movement by pulling alternately on the left and then the right ends of the Rebozo. Again, check in softly with the woman to ensure the vigour and speed of the sifting if relaxing for her. If the birth partner is the baby’s father or co-parent, I like to remind them that this is in fact the first time they will get to rock their baby gently.
When to use: During labour.
Anatomy & Physiology
This technique can provide a feeling of loosening up the pelvis and ligaments especially around the sacrum. Remember it’s the entire pelvis that opens to allow baby’s gentle passage, not just the muscles and soft tissue. If allowed to, an area of the pelvis and lower back called the Rhomboid of Michalis can move significantly to allow for baby’s passage. Sometimes a head-first baby may come down through the pelvis with its head in an asynclitic position, which means its head is cocked to one side a bit like they are listening at a key hole. The Hip Shimmy can make this feel more comfortable for the mother. Women often instinctively ask for things such as having their hips shaken or having pressure applied to particular parts of their pelvis in response to a baby’s positon. They often can’t explain their desires in a rational or conscious way and nor should they be asked to! If it feels good she should be supported to do it.
The woman should be supported to position herself comfortably on her hands and knees, it is likely to be more comfortable for her if she rests her arms on a pile of cushions, a sofa, bed or birth ball. Utilise whatever you have to hand but ensure it is stable and not likely to slip out from under her (e.g. if in hospital ensure the bed brakes are on). She may prefer to stand and lean over a high surface such as a kitchen work top; her belly should hang free and relaxed with her legs or knees apart. The birth partner kneels or stands behind her.
Place the Rebozo over and around the woman’s bottom, ensuring there are no wrinkles and that an equal length of fabric is on each side. Hold the Rebozo in place by bunching up both ends of the cloth firmly; your hands will be very close against her hips. You may need to adjust your hands further down the cloth and closer to her hips to ensure the correct tension and that the Rebozo is cupping her bottom firmly and won’t slip during the treatment.
The birth partner now vigorously shakes her hips on alternate sides. This releases tension and can feel really wonderful if the pelvis feels congested or locked. In yogic philosophy this is believed to release Kundalini energy, which is just what a birthing woman needs! Many women emit a low drone during this treatment although laughter is quite a common response too!
When to use: During labour
Anatomy & Physiology
As the baby moves down deep into the pelvis and all of the soft tissues and connective tissues adjust to accommodate this it can feel very comforting to have a soft supportive Rebozo running under your bum for you to push back into. Sitting on a birth ball can have a similar effect. It’s soft and supportive without closing down or squashing the pelvic opening, but at some point in labour, when the head is very deep within your pelvis, even that may not feel soft enough to sit on as you can feel as though you are sitting on baby’s head. That’s when having the comfort of the Rebozo reassuringly cradling your bum can be an exquisite sensation, supporting that whole area without putting any additional pressure on it.
The woman should be supported to position herself comfortably on her hands and knees; it is likely to be more comfortable for her if she rests her arms on a pile of cushions, a sofa, bed or birth ball. Utilise whatever you have to hand but ensure that it is stable and not likely to slip out from under her. Her belly should hang free and relaxed with her knees comfortably apart. The birth partner kneels at her head having looped the Rebozo around her bottom so that it cups it like a hammock. Ensure the Rebozo lies flat with no wrinkles and that an equal length of fabric is on each side. Keep the Rebozo in place by holding both ends of the cloth firmly. You may need to adjust the tension by pulling it back towards you slowly but firmly. The Rebozo should be cupping her bottom firmly and shouldn’t slip during the treatment.
The birth partner now gently pulls on alternate sides of the Rebozo, tipping the woman’s hips up in the direction of her ears and then back down alternately; one at a time in a rhythmic motion as the Rebozo is pulled and released. If the woman feels secure, she will sit back into the Rebozo and surrender herself to the rhythm.
After the Birth
All the Rebozo fun doesn’t have to stop once your baby is born!
Closing the Bones Spa Treatments
In some cultures (Mexican and Chinese for example), a ceremony is performed after the birth that focuses on the mother. In Chinese traditional medicine, birth is regarded as a yin (cold) experience, believing that heat is lost as the body opened to birth the baby (the body opens during birth regardless of how the baby is born—vaginally or by c-section). A ceremony is performed to “close” and warm the body. The idea of pampering and focusing on the mother in the postnatal period in this way is unusual within western culture; instead the focus shifts from the mother to the baby. I’m sure that many women would benefit greatly from honouring and nurturing their bodies in this way.
The basic elements of this type of ceremony can be incorporated into a spa-type experience for those of us who don’t have a cultural ceremonial framework. The basic elements include:
[*● *]A warming bath
[*● *]A massage with warming spice infused oils
[*● *]Wrapping the body in warm blankets, wraps or Rebozo
To find out about my bespoke postnatal spa treatments visit: www.wayofthekoi.com
There is an art to the postnatal belly wrap and it should ideally be carried out by someone who is specially trained to do it. If it is wrapped at the wrong tension it could exert too much pressure and cause the following:
[*● *]Too much pressure on the pelvic floor causing or worsening a prolapse
[*● *]Excessive bleeding
[*● *]Digestive problems
[*● *]Itching and rashes
[*● *]Complications following caesarean birth
However, just tying a Rebozo firmly around your postnatal belly can feel supportive and comforting.
Before we go any further into this subject I’d just like you to stop for a moment and consider why you might use a belly band or wrap. If you carry out a search of Google you will find most articles talk about using it to “get back into shape” after the birth of your baby; about getting a flat tummy, regaining your body shape or losing the “baby fat”. The first point to make here is that there is no scientific evidence to support these claims, although there is no shortage of anecdotal evidence.
The second point is that the urgent desire to regain a pre-pregnancy body shape is perpetuated by the western view of the sexualized female body. Is this the best way of showing compassion and respect for your body and all that it has just achieved in having a baby? Instead, following the birth of your baby I encourage women to take the time to nurture, respect and honour their body for having brought a new life (or lives!) into the world. Be gentle, kind and compassionate with yourself, please.
A firm and comforting Rebozo tied snuggly around your belly and hips should make you feel held, secure and nurtured. You should still be able to move around freely and position yourself comfortably when feeding your baby.
Hold the Rebozo across your belly with equal lengths in either hand. Pass the ends behind you and cross them over keeping the Rebozo at a firm but comfortable tension. Bring the ends back in front of you but tie them on one hip. This means that you don’t have a bulky knot in front of you which might restrict your movement. This should provide a comforting pressure on your hips and belly, but should be loose enough for you to still be able to sit or bend comfortably.
Following pregnancy and birth some women experience a parting of the abdominal muscles. This is called a ‘divarication of rectus abdominis muscles’[_ (DRAM) ]or ‘diastasis recti’[. _]In these cases a firmly tied Rebozo can be helpful. It should be tied with about the same tension as an elastic bandage would apply. It’s important that this condition is picked up and treated if necessary, because, in the long term if it goes uncorrected it can cause back pain and increase the risks of hernia later in life. All it means is that during pregnancy, while there was an increase in the levels of the hormones progesterone and relaxin, your abdominal muscles became over stretched and parted and this has left a weakness. Following the birth, your levels of circulating relaxin and progesterone will start to reduce allowing your muscles and ligaments to regain their tone.
Some women notice, as they lift their upper body to get out of bed or out of the bath, that a “ridge” appears running laterally down the midline of their abdomen. To check this for yourself lay yourself down flat on the bed and then gently lift your head or upper body (you are not doing crunches; just lifting your upper body gently!). If you do notice a ridge bulging up as you do this, lay back down again and press the midline area very gently with your fingers, you may feel a ”gap”. Check for the width of the gap. If it is less than 3 cm wide (about 1 to 2 fingers width) that is fine and it will likely resolve on its own. Keep an eye on it and mention it to your GP at you 6 week check if it’s still there by then.
If it is over 3 cm wide (more than 2 fingers width) or if it doesn’t resolve by the time you have your 6 week postnatal check with your GP, you should arrange a referral to a physiotherapist for treatment.
In the meantime here is a gentle exercise you can do to promote healing of a divarication.
[*● *]Lie on your back with both knees bent and let your tummy relax.
[*● *]Take a gentle but deep breath in through your nose. As you breathe out through a relaxed mouth, gently draw in the lower part of your abdomen (belly) back towards your spine. Tighten your pelvic floor at the same time. Do not move your back or pelvis, aim to just be drawing in the muscles of your belly. These muscles may feel weak to begin with so you may not be able to hold the “pulling in” for long at first. Build up gradually, aiming to hold the muscles for 5–10 seconds, while breathing normally.
[*● *]Repeat the exercise 5–10 times with a few seconds to rest in-between each one.
Avoid the following:
[*● *]sitting straight up when getting out of the bath or bed
[*● *]heavy lifting
[*● *]any strenuous exercises that cause your abdominal wall to bulge out
[*● *]sit ups/abdominal crunches
[*● *]holding your baby or older children on one hip (see ‘Carrying your baby’)
[*● *]intense coughing while your muscles are unsupported (this is when a supportive Rebozo is especially helpful)
To get out of bed safely first roll onto your side, drop your legs off the bed together and push up into a sitting position with your arms. Do the reverse to get back into bed. If your mattress is on the floor or if you sleep on a futon, roll onto your side, drop your knees off the bed together until you are on all fours and raise yourself gently up using your upper body strength too.
When lifting your baby, engage your abdominal muscles first by drawing them in and holding them, bend your knees and bring your baby into your chest when you lift. This keeps the weight of your baby close to your core and reduces the strain on your abdominal muscles and back.
Carrying your baby in a Rebozo or other cloth sling
Anyone who knows me professionally will not be surprised to see me opening this section with safety notes!
Carrying a newborn in any type of sling differs from carrying an older baby (over one month old) who will have better control over their neck and head muscles. A quick search of the internet shows us some beautiful images of women of indigenous cultures wearing their newborns in cloth slings, but it is worth bearing in mind that they have grown up immersed in these practices and are very competent at doing this safely. However, if you follow some basic safety principles, there is no reason why you shouldn’t be able to carry your baby in a Rebozo or other cloth sling safely and comfortably.
[*● *]Your newborn baby should be worn on your front where you can gaze at them; the general rule is that they should be close enough to kiss.
[*● *]Don’t carry them in a sling for prolonged periods
[*● *]Your newborn should not be ”slumped” in the sling. They should have their airway clear at all times with their chin off their chest.
[*● *]For most of the time a newborn should be carried upright with the majority of their weight being supported by their bottom. To nurse you can lay them down into a cradle position but once they have stopped actively breastfeeding return them to an upright positon.
[*● *]The sling should give them adequate support of their neck and head
[*● *]The sling should be made of an appropriate fabric for the weather/season. If you also wear a coat over your baby while in the sling make sure they don’t overheat; a light cotton sling would be adequate. Remember your baby will get heat from you as well as be insulated by your coat.
The benefits of baby-wearing are that babies tend to be more settled when they are worn. If your baby is having a particularly unsettled time for some reason (e.g. colic) then carrying them in a Rebozo or other sling can mean that they feel happier but you are also hands free and able to carry on doing the everyday things that you need to get done (like eat and drink!).
Your baby is in-tune with the rhythm of your breathing, the sound of your heartbeat and your voice as well as your movements when walking, bending, and reaching (or dancing!). For these reasons some refer to the sling as a “transitional womb”. “Kangaroo care” is a form of baby wearing that research has shown helps premature babies to gain weight faster and grow healthier than babies who are not worn in this way^ ^(2).
Wearing your baby is a wonderful tool for bonding, especially helpful for mothers who may be suffering with postnatal depression but also for fathers or same sex co-parents. The baby gets to be soothed by their voice (which baby may already associate with relaxation and feeling safe if you have done Way of the Koi Classes or KG Hypnobirthing). Your baby will feel and hear their parent’s heartbeat, feel their movements and experience their facial expressions. This helps the two of them to forge their own strong attachment.
This book is intended as a simple introduction to using the Rebozo scarf massage as a comfort measure in pregnancy, birth and beyond. There are plenty of resources out there if you want to delve deeper into the wonderful world of the Rebozo. I have listed some of the better ones below. It just remains for me to say: have fun with it! I hope that you found this book helpful. If you get the chance to give me some feedback I’d really appreciate it so that I can ensure the tools I create are hitting the spot and providing simple, compassion-based advice and information for pregnancy and birth.
To join one of my classes visit me at:
[*(1) *] The Rebozo Technique Unfolded. Workbook Rebozo Massage. Mirjam de Keijzer and Thea van Tuyl. (2010) ISBN: 978-90-811202-3-4
[*(2) *]“Current knowledge about skin-to-skin (kangaroo) care for pre-term infants”. J Perinatol. 1991 Sep;11(3):216-26.
[*● *]NHS 111: http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspx
[*● *]NHS choices: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx#close
rebozo scarf massage techniques for pregnancy and labour are growing in popularity in the uk as more and more people hear of them. they are simple to use and produce a dreamy, hypnotic and blissed-out feeling for the woman receiving the massage, increasing her comfort and oxytocin levels in labour (which can only be a good thing). The beauty of the techniques are not only their effectiveness but also their simplicity. this is the course companion book for anyone undertaking way of the koi rebozo training with a certified way of the koi birth worker.