Student Midwives' Working Group member Wendy Bascal reports on a interesting study day she attended where she learnt a traditional Mexican technique involving a shawl or scarf known as a rebozo.
Last month I was privileged to speak at the RCM Annual Student Midwives Conference in Brighton. I chose to speak on rebozo technique after attending a fabulous study day organised by independent midwife, Liz Nightingale, who is part of IMUK. Independent midwife Caroline Blamey, who facilitated the day, had learned the techniques from Angelina Martinez Miranda, a third generation traditional Mexican midwife. This cascade of learning is extremely useful in midwifery as it allows knowledge to be widely dispersed. It is important to stress that these skills require practice. Angelina watched her mother and grandmother many times in the care of pregnant and labouring women. As with other midwifery skills, midwives and students should seek supervision from those more experienced, building confidence as they do so. For that reason, attending a ‘hands-on’ study day is essential with this technique. I hope this description whets your appetite for finding out more!
Throughout the world for generations, women have used a shawl or scarf to wrap around their baby to carry him/her, without the need for a pram. In South America and in particular in Mexico, this long, strong colourful piece of material is known as a rebozo. Craftsmen and women still make these today following traditional methods.
Traditional midwives have learned to adapt the rebozo for therapeutic use throughout the antenatal period, during labour and postnatally. Incorporating advice on nutrition and a healthy lifestyle, the midwife would teach the partner how to massage his wife, and use the rebozo to aid relaxation and meditation. Backache or ligament discomfort can be alleviated using rebozo techniques. To encourage optimal fetal positioning (OFP), exercises would be given for the mother to practise in late pregnancy. The rebozo itself can be used specifically to turn malpresentation/malpositioned babies during pregnancy and even during labour.
In labour, the rebozo can be an effective tool for alleviating pain/tension and to assist the mother in maintaining positions such as squatting. Postnatally the midwife can use the rebozo to profound effect on the mother’s emotional state.
I have utilised some of these techniques successfully in my own practice during my training and I hope to incorporate more now that I am qualified. The rebozo is simply a tool, but it requires the midwife’s philosophy of practice to be individualised and for her to promote wellbeing to the mother and baby.
While there is an abundance of anecdotal evidence from midwives supporting the use of these techniques within midwifery practice, sadly research studies are non-existent. I therefore looked at the evidence for non-pharmacological pain relief, OFP and upright postures in labour. A recent Cochrane review found that women had a significant reduction in back pain following use of ‘hands and knees position’ (Hunter et al, 2007). However with no differences in baby’s position at birth or the number of operative deliveries, the review concluded that there was insufficient evidence to recommend this intervention. Nevertheless the review emphasised that women should be encouraged to find comfortable positions. Another way of looking at this is that in the absence of evidence of harm to mother or baby from OFP, midwives should incorporate this into their antenatal education (Anderson, 1999).
There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.
But whatever position a woman adopts and whatever training we have had to assist the woman to give birth in that position, we should ensure our eyes are wide open to the possibilities of other techniques that have been passed down from generation to generation of midwives and traditional birth attendants.
References and resources
Anderson T. (1999) Hands/knees posture in late pregnancy or labour for malposition (lateral or posterior) of the presenting part. Practising Midwife 2
Hunter S, Hofmeyer G, Kulier R. (2007) Hands/knees posture in late pregnancy or labour for fetal malposition (lateral or posterior) (Cochrane Review). In: The Cochrane Library
, Issue 4. Chichester, UK: John Wiley and Sons, Ltd.
RCM. (2008) Evidence based guidelines for midwifery-led care in labour. Persistent lateral and posterior fetal position at the onset of labour. RCM: London.