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Asian Post-natal Practice of the Confinement Month

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What is the Confinement Month?

The confinement month is an Asian practice whereby new Mums are confined to the home for a period of one month after the delivery of their babies. This period is for the new mother to recover from the ordeal of childbirth and to help her restore her body after 9 months of nourishing her infant in her womb. She is cared for by a confinement lady (also called a "pui-yuet") who will cook, clean and help her look after the baby.

The Logic Behind the Confinement Practice

There is a Chinese belief that everything in life requires balance between the Yin and the Yang in order for harmony to exist. If an imbalance occurs, then ill will befall the individual. Illnesses are also considered to be the result of an imbalance of the Yin and Yang within the body. Although pregnancy is not an illness, it is believed to create an imbalance within the body that must be corrected post-natally or the mother will suffer the consequences in her later life.

The following is an explanation of Chinese concept of Yin and Yang, from "Asian Mothers Western Birth 2ed: Pregnancy, Childbirth and Childrearing : the Asian Experience in... By Pranee Liamputtong Rice"

According to the theory, health is the outcome of humoral equilibrium; illness due to an imbalance of either hot of cold humours in the body, and to a lesser degree, to imbalances of "wet" and "dry" humours and to "wind" or air. The diagnosis of an illness identifies the imbalance of hot or cold and treatment involves steps to correct this - hence a hot illness (such as measles) is treated with foods that are regarded as cold (including many fruits and vegetables), whilst a cold illness (respiratory infections are frequently so classified) is treated with hot foods and drinks, which are often high in energy and/or fats or sugars (depending on the area, these may include chicken, ginger, black pepper and coffee). Medication may also be classified as hot or cold, as determined by the imputed effect of the food or medicine on the body.

Physiological events such as pregnancy and parturition also disrupt humoural balance, and require careful dietary and other behavioural precautions to maintain good health during that period and to prevent later illness. The body is said to be "hot" in pregnancy, although in some cases the first trimester is regarded as "cold" (Manderson and Mathews, 1985), and the humoral balances change as the pregnancy progresses.

Although the body is hot during pregnancy, the subsequent delivery of the baby causes the body to lose its heat, therefore a post-natal mother needs to be protected from the cold in her confinement month. She is given "hot" foods, like ginger and wine, to replace the body's heat. Practices such as wearing socks and house slippers, longs and not bathing are all attempts to prevent the body from losing extra heat. The irony, I discovered, was that I was always sweating after my delivery so I couldn't understand how anyone could fear that I might get cold.

Another article about confinement practices on Urban Baby called "'Doing the month': Ancient tradition meets modern motherhood - by Anne Williams" provides some great insight behind some of the reasons for certain confinement practices. Here is an excerpt:

Where did confinement come from, and how do mothers safely honour a tradition whose basis was formed long before modern medicine?

Zuo Yuezi

The Chinese tradition of Zuo Yuezi (Cho Yuet in Cantonese) dictates that for 40 days from the birth of their children, mothers must stay inside and avoid bathing, washing their hair or brushing their teeth. They must cover their heads to prevent chills, keep the windows closed, and remain in bed for as long as possible.

Zuo Yuezi - which loosely translates into doing the month - also requires mothers to avoid all forms of stress, including crying, shouting and talking for an entire cycle of the moon. While ‘doing the month,' mothers can't eat ‘cold' foods such as cool drinks, ice cream, fruits or vegetables. Instead, they must load up on ‘hot' foods like boiled eggs and chicken and fish soup. Along with the tradition is a famous Chinese postpartum ‘decoction' known as Shenghua Tang - an herbal cleansing and purifying remedy.

Origins in Chinese Medicine Medical writings about Zuo Yuezi can be traced to the Qing Dynasty (1644 - 1911). According to Yi-Li Wu, associate professor of history at Albion College in Michigan, early Chinese medical writings described conditions such as eclampsia, maternal tetanus and other postpartum diseases that are still deadly today if left untreated.

Essentially, ‘doing the month' was a primitive form of quarantine to prevent postpartum complications. If you analyze Zuo Yuezi in an early medical context, many of the practices made sense. The avoidance of bathing and teeth-brushing was a way to prevent water-borne illness; staying indoors helped women and babies avoid exposure to communicable diseases, and covering the head protected new mothers from catching a ‘chill'.

Food-wise, the proteins and iron found in eggs, meat and fish provided mothers with strength and muscle repair. Rest and heavy consumption of hot soup helped prevent dehydration, kept moms warm and was believed to promote the production of breast milk. Most importantly, the legendary herbal decoction of Shenghua Tang was thought to purify the female body and help slow vaginal bleeding.

The Power of Superstition

‘Doing the month' wasn't only a product of Chinese medicine. Without scientific explanations for the phenomena of the times, many ancient cultures developed devout beliefs in the supernatural.

For example, some of the fear of leaving home in the first month after birth had to do with evil spirits seeking to steal babies. More common was the belief that spirits and pregnant women were out to steal breast milk. Out of these superstitions came the avoidance of expectant mothers and strangers during Zuo Yuezi.

Baby snatchers were the reason that the Chinese did not give first-born children their official names until ‘doing the month' was over. Instead, a newborn was given a little name or nickname to trick the evil spirits. Many parents continued to use the nickname throughout their children's lives.

Zuo Yuezi Today

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Whether or not you believe in Chinese medicine or superstitions surrounding ‘doing the month,' there is no doubt that belief plays a significant role in one's feeling of health and well-being.

Clearly a lot of these reasons behind the confinement are now obsolete since we don't have to fear contaminated water supplies, nor would we be concerned about catching a "chill", especially if you live in a tropical country. Although I think that the fallacy that you can catch a "chill" from cold weather should be acknowledged.

In this current day, the advantage of having a confinement lady is the R&R afforded to the new mother since the confinement lady is responsible for taking care of the household matters. Instead of worrying about cooking, cleaning and looking after the baby, she can put her feet up and be pampered while her stitches heal.

The Confinement Pratice

After pregnancy, the mother's uterus has expanded from the size of a pear to the size of a large winter melon. The main function of the confinement period, therefore, is to nurture the new mother's body back to its prenatal form. The belief is that if the mother does not take care during this time, she will be predisposing herself to ailments that will surface later on in life.

Historically, it has always been the duty of the mother-in-law (MIL) to take care of the new mother. Part of the reason a MIL would be keen for her daughter-in-law (DIL) to recover quickly was so that she could conceive again and possibly add another name to the ancestral line. There is also a traditional belief that new mothers were not allowed to come into contact with their own parents because of the "stale blood" and "evil wind" inside their bodies which would bring bad luck to her family. I found this rather ironic because if that were the case, then wouldn't she also bring bad luck to her in laws?

In some instances, families will employ a "pui-yuet" (meaning companion for a month) or confinement lady to look after the new mother and baby. Pui-yuets are usually middle-aged women who have a great deal of knowledge on postnatal matters through her own experiences.

There are a number of strict confinement rules that are supposed to be adhered to by the new mother. I have noticed a lot of variations in these rules in the current day, but some common ones include: not being allowed to wash your hair during the confinement period and having to take sponge baths, and not being allowed to read or watch television because it would strain your eyes. A strict diet was enforced to help you remove the "stale blood" and "wind" from your system. You have to endure body binding and must rest as and when the pui-yuet commanded. You and your husband are also banned from having sex for 100 days after birth. There are a lot more rules, and these merely scratch the surface.

For more details on confinement practices, there's a good article from Nursing Center: "Postpartum Beliefs and Practices Among Non-Western Cultures". Unfortunately there is no explanation between the good and the bad of each practice.

Getting the Most Out of the Confinement Month

The confinement month is a very old practice that dates back a long way. As such, experienced confinement ladies are also very traditional in their practices and beliefs. Before engaging a confinement lady to help out, you should be aware that there are certain unspoken rules and expectations. Being aware of these rules will help you get the best out of your confinement month and maintain peace within the household.

  • A pui-yuet is only responsible for the mother and baby. Any work outside of those responsibilities are not part of her duty. That means, she isn't required to do any housework except wash the clothes that belong to the mother and baby, and the dishes that were used by the mother and baby. That also means she doesn't have to cook for the father, wash his clothes or anything else that belongs to the father. Some pui-yuets will do housework if you are willing to pay them extra. If you get a pui-yuet who is willing to take care of household matters without extra charge, count yourself lucky!
  • A pui-yuet's responsibilities does not include her own meals. Some pui yuets will overlook this point but the more picky ones will expect their meals to be provided for them. Some picky ones will also expect more money if they are required to cook for themselves.
  • A pui-yuet is employed for 28 days. It commences on the day the baby is born and ends on the day of the baby's full moon. Even if mother and baby are still at the hospital and cannot be discharged, the one month count-down has begun and the pui-yuet's time is ticking. So if you're stuck in the hospital for a week, you will only have a pui-yuet for three weeks (unless you get her to help out in the hospital).
  • A pui-yuet that is hired for a month that includes Chinese New Year has to be paid double. It is like working through Christmas or New Year's. An additional red packet is also given for Chinese New Year itself.
  • At the end of the month, a red packet is given to the pui-yuet as a token of appreciation for her efforts (this is additional to the amount agreed upon for her services for the month). There is no stipulated amount - it works a little like a tip. The happier you are with her services the more you can put inside the red packet - usually $100 - $200. Unlike a tip, you still have to give her something even if you think her services are poor, you just give her less. I think a red packet containing $1 shouts volumes about what you thought of her services. The purpose of this red packet is to balance the services rendered. Even though you are paying the pui-yuet for the month, her help is still considered a favour to you and this red packet is intended to return the favour and level your dues.
  • According to the traditional hierarchy, the pui-yuet is only answerable to the MIL. This goes even if the person paying for the pui-yuet happens to be you or your hubby. It also applies to your mother. Pui-yuets are not required to listen to your mother because she is answerable only to your MIL. This is because of the old tradition where a daughter marries into a new family and is no longer considered part of her birth family, therefore, her mother has no authority over the pui-yuet. It was quite amusing to observe that when my MIL was standing watch over my pui-yuet as she changed my son's diaper, her normally calm and experienced manner with which she handled him was suddenly all thumbs. That spoke volumes about who the real person in charge was.
  • For whatever reason, if you discharge the pui-yuet early, she still has to be paid the full amount agreed upon unless it was a mutual agreement to part ways before the end of the month.

There are also a few additional points that a new mother ought to be aware of when she looks for a pui-yuet which have nothing to do with tradition. From my understanding, most pui-yuets are generally not in favour of breastfeeding so it is best to be clear on your desire to breastfeed during your preliminary discussions. Please do not end up like a friend of mine who lamented to me that the result of her inability to breastfeed was due to her pui-yuet who sabotaged her efforts.

It is speculated that pui-yuets do not encourage breastfeeding because of the increased night duty involved. Breastfed babies are thought to require more nighttime responsibilities such as frequent stirrings for night feeds and diaper changes. Don't quote me on this - it is just a theory.

Pui-yuets also have their own way of doing things so if you have a specific way you want your baby to be bathed or handled, it is best to get this cleared up front to avoid battles during the month when you will be in no condition to argue your point. It is unfortunate but pui-yuets tend to bully the new mother if there are any disagreements on how the baby should be handled. This is a time when a stern talk from your MIL will come in handy.

The best way to avoid an unpleasantness is to discuss everything and outline your expectations before agreeing to sign on the pui-yuet. Hash out any potential problems you can anticipate before the actual month takes place. If your mother or MIL is engaging the pui-yuet on your behalf, make sure you meet her before hand because you are the one who has to live with her. One month is a long time to be with someone you don't get along with.

In addition to managing your pui-yuet, it would also be wise to get clued-in on the sort of foods that will be prepared for you. Some of the recommended confinement foods are cooked with herbs which may be contraindicated in mothers who are breastfeeding. For more information on this topic, there is a good article on Breastfeeding.com, on the consumption of certain herbs and their effects on breastfeeding, although the list is not a comprehensive one. Whilst it is okay to consume some herbs in small quantities, certain herbs are not advised for breastfeeding mothers. It is advisable to be aware of what you are consuming and to err on the side of caution where doubt arises.

Other than that, you should enjoy your month of being waited on. Your confinement lady is there to pamper you, so enjoy it!