By Claudia N. Benavides, PT

Pregnancy can be a beautiful and amazing experience but not free of fears and concerns. A month before birth you may be busy trying to finish your last days at work, preparing the baby’s room, and maybe trying to take care of the soon-to-be big brother/sister. At the same time, you may try to keep yourself physically active and healthy, following prenatal classes or exercises prescribed by your pelvic floor physiotherapist. By week 35 you will be advised to have at least one labour and delivery preparation session with your pelvic floor physiotherapist. This session includes strategies to control pain between and during contractions. Your pelvic health physiotherapist can assist you with non-pharmacological pain relief techniques including breathing, positioning, exercises, and if appropriate, the use of a rebozo.

What is a Rebozo?

A rebozo (also known as ayete or mamatl)  is a cotton, wool, or silk shawl made and used in indigenous Latin-American cultures to cover their heads, shoulders, chest, and back as a coat; it is also used to wrap a child and carry it. Rebozo is sacred in its culture, and as explained by indigenous midwives, it's an intervention that requires appropriate and comprehensive education. The use of a rebozo is associated with a variety of potential benefits, such as improved comfort, relaxation, and posture. However, there are also certain risks associated with using a rebozo. It is important to seek advice from your pelvic health physiotherapist, doula, and/or midwife if you are considering using a rebozo. It is also important to mention how the commercialization of the rebozo has led to the erasure of its cultural significance and has caused it to become a symbol of cultural appropriation. This has resulted in the rebozo being viewed as a trend, rather than an important part of the Indigenous culture. In order to address the issue of rebozo cultural appropriation it is important to recognize the importance of the rebozo to the Indigenous culture. In this respect, the World Health Organization has helped promote traditional medicine in its context, supporting these practices but also acknowledging that scientific research is needed to provide additional evidence of its safety and efficacy.

Rebozo in Pelvic Health Physiotherapy

The rebozo is used to provide support and comfort to the patient, and it can also be used to gently stretch and massage the body. Your pelvic floor physiotherapist may also use the rebozo to create traction and apply pressure to specific areas of the body, which can help to reduce pain and improve joint mobility. After your pelvic health assessment and according to your treatment plan, your physiotherapist may prescribe and teach you how to use the rebozo for pelvic girdle pain and for labour support.

Pelvic Girdle Pain

As previously explained in this blog (https://www.proactiveph.com/blog/pregnancy-related-pelvic-girdle-pain-2/) Pelvic girdle pain is a specific type of low back pain that is experienced between the top of the pelvis and the bottom of the glutes, particularly around the sacroiliac joints on either side of the sacrum at the base of the spine.  Additionally, pain or discomfort can be present at the symphysis pubis joint (pubic bone) at the front of the pelvis. Doña Irene Sotelo and Naolí Vinaver are Mexican midwives who have transmitted their knowledge in workshops around the world. They use the Rebozo in moms with pelvic girdle pain alleviating pelvic joint pain and the associated ligament irritation. This can be done with your pelvic floor physiotherapist, who may also prescribe specific exercises for this type of pain.

Labour, delivery and the fourth trimester

During labour, the rebozo can be performed with the mom standing, on four points, or lying on their side or back, allowing total freedom of movement. This can be reviewed with your pelvic floor physiotherapist, but it needs to be practiced at home before you go into labour to make sure you know what to do. It's also important during labour to check with your OB, midwife, or doula and follow their instructions/ recommendations.

During labour and the “fourth” trimester, the rebozo helps by:

- Relieving discomfort typical of pregnancy, called "sobada", can help activate the parasympathetic nervous system with smooth and rhythmic movements, relaxing uterine ligaments and abdominal muscles.
- As a measure of support and comfort during labor.
- Repositions the baby that is in a bad position, known as "blanket" (done by your midwife or doula).
- Used in the postpartum - "closure".
- Excellent tool for carrying the baby that we know stimulates bonding and early parenting.
- Promotes lactation.

If you are an expecting birth parent and have questions or want to be proactive and prepare for labour and delivery book a pelvic floor physiotherapy assessment today.

References:

A transcription of the rebozo workshop given by Doña Irene Sotelo and Naolí Vinaver  https://www.midwiferytoday.com/mt-articles/the-rebozo/

Course notes, Pelvic Health Solutions- Labour & Delivery: Maternal Support through Comfort Measures and Pelvic Biomechanics

El Rebozo en el parto http://www.mauleduc.cl/material/2.-%20El%20Rebozo%20en%20el%20Parto.pdf

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