If you are pregnant and you are very uncomfortable, or you have had a difficult history of periods, conception, or birth, or if your baby is breech, posterior or lying sideways these will be important. Some positions, like lying sideways (transverse lie) and many breeches will need additional techniques specifically for when baby is not head down. These work for all positions but aren’t enough for some babies who are not head down.
If you are at the end of pregnancy with any of those indicators, you may want to do these every day for a few days in a row, in addition to scheduling a Chiropractic appointment.
Rebozo Sifting (Manteado)
The Rebozo is a long woven scarf that serves a number of purposes, including carrying babies, children, and groceries. Why sift? Rebozo sifting or Manteada relaxes muscles that the mother can’t relax herself. This relaxes the mother’s broad ligament before each attempt to reposition a baby. Manteada is beneficial for all pregnant women.
How is it done? Make a hammock to wrap and lift the belly to lift the weight of the baby off the mother’s spine while she is on her hands and knees. The helper stands behind the mother. The helper’s knees are slightly bent and their back is straight with elbows near their sides. They hold the scarf so that their wrists are straight, which protects the wrists from strain. Lift and check in with the mother… does this feel okay? When yes, then slowly rock the belly in the hammock you made. The scarf should not shift with the clothes — if it does, you aren’t lifting enough. The mother should be comfortable.
When the gentle rocking feels okay, speed it up. Now the important thing is you aren’t rocking in wide arcs, but rather very short movements. Just about an inch or 2 centimeters. Meaning, your left hand raises 1 inch while your right hand goes down, then your right hand goes up 1 inch while your left hand goes down. 1 inch (2 cm) is not much! A very short movement is all that is needed. Making tiny circles like the rods on an old-fashioned train wheel is even better. I make a “choo-choo” train sound, “chugga chugga,” under my breath to keep time. Stop slowly so you don’t make the mother uncomfortable – which means stop slowly to keep the mother’s trust! It’s better, too.
Don’t try to manipulate the baby’s position by a forceful flip at the end. Trust the release. When the baby finds room, the baby will move.
How long? Three minutes or until the helper’s arms are tired.
How frequent? When you can get it! Occasionally, if not possible daily. Also, use sifting to relax in early labor (between contractions). Use in pregnancy and in labor (between contractions).
Don’t do this if… Don’t do this fast if the mother has had spasms in her round ligaments. If she does feel pain when her doctor or midwife feels her lower belly for the baby’s head, then sift very slowly (and she’ll love it). But if she has had sharp pains in her lower front abdomen at times, this could bring on such a spasm. Do it slowly and often and the spasms will stop coming on (add magnesium if you would like to support those muscle fibers so they don’t spasm).
Don’t do this if there has been bleeding from the placenta or for unknown reasons from the vagina; or if the pregnant person doesn’t want to or if there is discomfort.
Variations: The person can also be standing with a trusted helper behind them, lifting their p belly with the Rebozo and jiggling it that way. This helper has to have more skill and thoughtfulness about the angle of pressure and about helping the woman to stand and lean back so she can relax. It helps if the helper stands against the wall.
I do know a pregnant woman who figured out a rebozo sifting system to do on her own. She had a very long scarf — probably 14 feet long — and she tied it around a chin-up bar. It made a loop almost to the floor. She got on her hands and knees and crawled through the loop so that the lower curve of the hanging scarf came under her belly. She let it be a hammock for her baby. She had tied it so it hung at just the right length to do so. Now she felt the scarf support her belly as it lifted her belly very slightly. She now jiggled in this hammock to relax her belly. I was surprised, but she said it worked well!
Of course, many women will not be able to enjoy the rebozo very often. Find a friend, even a pregnant friend, and take turns with each other. This is something fun to do with a doula as well as a partner.
Thanks: to Guadelupe Trueba, Elena Carrillo, and others for sharing the delights of the Rebozo with DONA International members and the world.
The Rebozo Sifting can also be done daily. The Forward-leaning Inversion may be done now in this series.
Standing Sacral Release (A fascial technique)
Why? This re-balances the tough membrane (fascia) that wraps the sacrum. Sometimes the sacrum has a “buckle” or “wrinkle” in it which twists the lower uterine segment in turn. This is likely to release the “wrinkle” and, in turn, untwist the lower uterine segment.
Who does this? A fascial therapist, or a Chiropractor who knows fascial release. Some doulas have even used this because its a good comfort measure for lower backache in pregnancy or labor. It’s non-invasive and gentle. Partners can learn it and do it regularly.
How? This technique is easy to do when you slow down and tune into the connection. But it is hard to explain through words and pictures.
The mother stands facing a wall. She puts her hands or forearms against the wall. Her head does not rest on the wall unless she really wants it to, and then that’s part of the release. The helper stands to her side, facing either side the helper prefers. The dominant hand probably should go towards the mother’s back.
The helper so lightly touches the mother that they have to pay attention or contact is broken. The weight of contact is the weight of a nickel (or shilling?). The helper’s less dominant hand is on the mother’s lower abdomen – to start with. The helper’s more dominant hand is turned, fingers down, and the “ball” or base of the thumb is gently resting on the “buckle” of the sacrum. Finding the buckle takes a couple light passes from the top of the sacrum toward the tailbone. When the base of the palm feels resistance of a subtle “ledge” of something under the woman’s skin, that’s the “buckle.” The “force” (however lightly given) is towards the direction of the sacrum, off into the air, not towards the mother. Remember — the fingers point down, but away from the body. The hand waits there, lightly (the weight of a nickle) until the buckle suddenly is gone and the hand slides suddenly off into the air.
Both the mother and the helper have their knees slightly bent. This helps each of them respond better to one another and the subtle movements going on in the technique. The mother may feel like bending her knees quite a bit more and moving in response to her shifting fascia. This may be easy to resist, so the mother may be encouraged to listen to her body and move to make herself even more comfortable. The helper attempts to “follow” her, maintaining such a light pressure and perhaps moving the hand to follow the point of tension which sometimes leaves the sacrum to go somewhere else, for instance, the hip or knee, or lower back, etc.
One of you will know when you are done. The mother because she feels the release, the helper because he or she has run out of time, I suppose. Helpers shouldn’t worry that they don’t know what they are doing. They don’t really. But the fascia does. Follow the fascia!
How long? Time varies. The first time or two might take 2 -20 minutes or longer. Each person is different. 2-5 minutes becomes typical after the first time or two.
How frequent? Doing this a few times in pregnancy and once in early labor is helpful. Do this after a long car ride to help avoid breech. Daily, if the partner can do it, when the baby is breech or persistently posterior.
Do this when… Pregnancy is uncomfortable or the baby is in a less than ideal position (breech, posterior, transverse). Do this when engagement doesn’t occur by 38 weeks, or when labor is long and descent is delayed. Do this when labor is uncomfortable, especially in the back.
Don’t use this if…. the mother can’t stand up. Use the abdominal release (diaphragmatic release) instead.
Thanks: to Dr. Carol Phillips, DC, in Annapolis, MD, for teaching us the benefits of the Standing Sacral Release and to Deb McLaughlin, CST, in Duluth, MN, for bringing it to our doula trainings.
Diaphragmatic Release or Abdominal Release
Why? Relaxes the broad and round ligaments helping the pelvis to come into balance.
Who does this? A fascial release therapist or craniosacral therapist can teach this and you can learn to do this as a couple or with a doula or friend.
How? The mother semi-sits on a couch with a helper kneeling on the floor. The mother can be comfortable, breathing freely. The helper kneels or sits facing the side of the mother. The less dominant hand (with no rings!) is under the mother’s sacrum. She lays on the helper’s hand. The helper does not push or anything with this hand. This hand is passive. This hand can send warmth, love, and relaxation. Your intent is to hold space and complete a circle with your top hand.
The dominant hand rests lightly on the lower abdomen. The pinkie finger is near the symphasis, with fingers toward the hip that is opposite (furthest) from the helper. Gentle compression (the weight of a nickel again) is on the abdomen. The helper has to lift the weight of the upper arm and be mindful not to rest the weight of the arm on the mother.
The helper’s hands are soft, light, warm, and holding a good intent. Their slight compression (aided by the weight of the mother on the lower hand) allows the fascia to begin to release. The mother breathes deeply and slowly, as if falling asleep. But not forced. The baby will be quite active afterward. The release makes the broad ligament relax and that lets the baby move more freely. The baby notices this.
How long? It varies. Wait for the feeling of movement of the fascia in the front and the back of the mother.
How frequent? A few times in pregnancy and during early labor as indicated by pregnancy discomfort or fetal malposition.
Do this when… you’re a first-time mother; you have discomforts in pregnancy, including discomfort or pain when baby kicks (this may indicate a tight broad ligament); you have an anterior placenta (the exercise will help baby rotate past it more easily and reduce the chance of a posterior baby); when you have a consistent need for a chiropractor, in other words, you keep going but keep being out of alignment.
Thanks again to Dr. Carol Phillips, DC!
Pelvic Floor Release or Side-lying Release
Why? An imbalance in the pelvic floor twists the lower uterine segment (are you seeing how these body structures are all related?). This asymmetry can lead to malpositions such as a brow presentation, a posterior baby, or a breech. However, it is most often associated with the asynclitic baby, the one whose tipped head makes vaginal birth a challenge with long pushing stages and perhaps a switch to cesarean delivery.
Who does this? This can be learned from a fascial therapist or another professional who uses myofascial techniques, such as a chiropractor. The mother can even do it herself at home!
How? The woman lays on her side so that her shoulders are one above the other and she is not tilted! She can’t be leaning back to look up at you, for instance.
Her upper hip starts out directly above the other one. So her top leg is resting upon the lower leg. Her lower leg is straight as an arrow. Very straight. Her partner or her doula supports her shoulders so the top shoulder doesn’t tip forward. Face-to-face encouragement can be vital in labor and be the key to success! Don’t ask the laboring mother to do this without eye-to-eye contact and constant encouraging words! I’m serious!
The helper holds the anterior superior iliac crest… or the front of the hip bone. Press down about as much as you would to put a lid on a food container… firm but not a lot. Enough to notice, but not to make a statement.
The mother has to be so close to the edge of the firm, hard surface that she relies on you totally to hold her from tipping off! Be trustworthy!
As the helper pushes down and back on her hip bone, the mother lets her top leg fall into the air. It hangs limp – you’ll have to coach her to let her leg go. Hold her firm so she believes she can do this without slipping off. Let her leg hang freely — it should not touch the floor or you! Wait a minute or two. In labor, wait through and between three contractions (two if she seems like she’d never make it through three, you know her personality).
Then she lifts her leg back up. Someone might help her but it can’t be the helper, she (or he) is holding her hip and must continue to so the mom won’t fall. She can lay on her back a second, then she switches sides. Her head goes where her feet were, or she switches to the other side of a massage table. Repeat for the other leg. Be confident and inspire confidence in the mother.
How long? This is hard to answer, but most important is to do it on both sides!
How frequent? A time or two in pregnancy and then again in those labors that are long, delayed, or that have malpositions.
Do this for… asynclitism; posterior presentation; to enhance a vaginal breech (done before labor or in early labor); slow descent due to a first time mother’s strong pelvic floor (ballerinas and horseback riders, runners, etc.) Long previous labors or pushing stages. Hip pain. Preventative or to help along a labor.
Don’t do this if…. you have significant back injuries, like surgeries or spinal damage. You wouldn’t do it with a very large woman if you couldn’t hold her from falling forward off the table or hospital bed. There is no need to do this if labor is progressing well. It can be done during pushing stage if labor slows due to a “tight fit” or asynclitic head or there is reason to “make more room.”
Note: Make sure to explain to the mother first that this may be a somewhat uncomfortable technique (some pregnant women find it more comfortable than not! Others find it challenging when a head is in the pelvis). Explain that it is vitally important to do it on both sides so that more asymmetry isn’t caused by doing it on only one side – and really tipping the head to the side because it was only done on one side.
Ask the laboring mother before you start, to hold the position for 3 contractions on one side and 3 contractions on the other side. Let the mother pick which side to start on. She will pick the more comfortable side first and that’s fine.
This technique is awesome. It has helped many women avoid a cesarean (but not all). I would say it works wonders! After it’s done, the reduction in the pain women feel in labor is significant!
Again, thanks to Dr. Carol Phillips, DC, for teaching me this one at a long birth. That willing birthing woman was suddenly so relaxed that she dozed at 8 cm and began pushing her baby out so quietly the midwife almost didn’t turn around from her charting at the counter to catch the baby! Later, I’ve used it at many a labor with an asynclitic baby. It’s not always dramatic, but almost always resumes progress. This shows that a lot of slow progress isn’t the bony pelvis as much as the tension of the pelvic floor. It’s worth a try!