Should you avoid bathing or leaving the house after childbirth, as Chinese tradition dictates?
Much of traditional Chinese postnatal confinement practice runs contrary to Western medicine. We ask health professionals from Chinese, Western and holistic backgrounds for their views on postnatal care
Imagine being told you are not allowed to wash your hair, have a cold drink, or leave the house for a month. This is not some bizarre form of house arrest; millions of Chinese women follow these restrictions each year as they observe the traditional Chinese practice of postnatal confinement known as zuo yue zi (cho yuet in Cantonese) or “sitting the month”.
Rooted in traditional Chinese medicinal beliefs, to sit the month is to follow a prescribed set of lifestyle and dietary guidelines designed to help a new mother recover from the stresses of childbirth.
Childbirth is considered synonymous with imbalance, as it involves a significant loss of blood, causing a new mother’s body to enter a state of yin. Cold food and drink must be cut from the diet, while bathing and exposure to wind is discouraged as the body is more susceptible to the cold.
The postnatal period is also treated as a crucial window of recovery for the mother, who is encouraged to rest throughout confinement. Cooking, household chores and care of the baby is passed on to hired help, in the form of a pui yuet confinement lady, alongside older family members, usually the mother and mother-in-law.
Showers and baths are off limits
Traditionally, new mothers were banned from washing themselves for the month after birth to limit further yin from entering their bodies. Even brushing one’s teeth is discouraged through this line of reasoning, due to the cold from tap water. For reasons of hygiene and practicality, however, these beliefs are rarely followed verbatim.
A common workaround to the no-bathing rule is to use only specially prepared hot water boiled with ginger to wash during the confinement period. Traditional Chinese medicine practitioner Yu Hsin Tzu, of Balance Health, a holistic health clinic in Hong Kong’s Central district, explains that the ginger water helps to “remove the cold” from the mother’s body. “It is perfectly all right to shower five days after birth, as long as the hair and body is dried immediately,” says Yu.
Hulda Thorey, director of the Annerley midwives clinic, also in Central, says: “There is no current support in the professional studies of midwifery for not bathing after birth. It is easy to understand that in the past, when heating, accommodation and the quality of water was much worse, that getting cold just after giving birth with breasts full of milk, was not a good idea.”
Dr Lucy Lord, senior partner at Central Health Medical Practice, in Central, says that dirty or contaminated water can be a problem in parts of China, which can lead to puerperal infection – a range of bacterial infections in the female reproductive tract contracted soon after childbirth. “This is less relevant in Hong Kong given the relative cleanliness of our water supply,” says Lord.
No cold food or drinks are allowed
The avoidance of “cold” food and drinks – including ice cream, bananas, watermelon, soy and mung bean products, chrysanthemum tea and any refrigerated water or juice – is again due to the imbalance of yin and yang in a woman’s body after delivery.
While prenatal dietary guidelines are more restrictive, a traditional Chinese postnatal diet is meant to nourish the mother and help replenish the nutrients lost through childbirth, while promoting the production of breast milk.
My grandmother, Chan Sin-yue, a mother of nine, recalls that the traditional Chinese stew of pig’s trotters and hard-boiled eggs braised in ginger and vinegar was brought to her home even during the Japanese occupation of Hong Kong, after she had given birth to her first child. “It didn’t matter that there was a war on our doorstep,” she says. “That’s how important consuming that stew was.”
Karen Chong, a registered dietitian at Matilda International Hospital on The Peak, says: “The stew provides good nourishment for postnatal women as it is very calorie dense and high in protein. Vinegar dissolves the calcium from the bone of the pork knuckle to make it available for absorption. However, the dish can be very high in fat and sugar. As an alternative, low-fat milk or high calcium soy milk can be consumed.”
Papaya fish soup is another common Chinese postnatal recipe, and Chong agrees that it is a good source of liquid and protein – two important nutrients for breast milk production. She also advises that if an oily fish such as salmon is used in the soup, it also provides DHA and EPA, two omega-3 fatty acids.
Rarely are these recipes found in cookbooks. “I learned about the nourishing stews and brews from my mother, mother-in-law and aunt,” says local first-time mother Esther Kwok. “I think it’s common for older female relatives to prepare these tonics for new mothers.”
The provision of traditional Chinese postnatal foods is also an important part of a pui yuet confinement lady’s role.
“A good knowledge of Chinese postnatal recipes and cooking them is just as important as looking after the baby for pui yuet ladies,” says Chrisie Wong, whose nanny agency DreamCare has around 100 confinement ladies registered. Wong says that this is a key difference between a pui yuet and a Western maternity nurse, as the latter rarely helps with cooking.
New mothers should not go outdoors or use air conditioning
Again, this stems from the belief that new mothers have an excess of yin in their bodies and are more susceptible to illness arising from exposure to the wind or cold. This is arguable in Hong Kong, with its high temperatures and humidity during the summer months.
“According to traditional Chinese medicine, a woman’s joints and pores have opened up after birth, so the body can get cold more easily, leading to back pain, headache, chills and cold sweat,” says Yu, who recommends mothers avoid draughts blowing on them directly, and maintain a room temperature of 25 to 26 degrees Celsius.
Yu does not actively encourage new mothers to stay indoors for the duration of the confinement period. “There is no harm if you go out for some fresh air from the first week, as long as you take care to keep warm,” she says.
Sudha Nair, a naturopath and yoga therapist at Balance Health, says: “Sun exposure is the best way to maintain adequate vitamin D levels for both mother and baby.”
Lactation consultant Yvonne Heavyside says: “Newborn babies are vulnerable and susceptible to germs and illnesses, particularly in Hong Kong.” Culture-specific challenges include exposure to coughing and sneezing, not to mention friendly well-wishers who feel entitled to touch, pinch and breathe all over newborn babies, she adds.
Physical exertion should be kept to an absolute minimum
New mothers are advised to cede household responsibilities, including baby care, cooking and cleaning, to their confinement ladies and their families, so their bodies are able to rest and heal during what my grandmother refers to as the “golden window of recovery”. The 30-day window after birth is used to regulate blood circulation, balance yin and yang, and potentially cure previous chronic diseases that the woman might have.
Yu explains that the traditional Chinese medicine concept behind the recovery month is divided into stages: “The first week is to restore uterine function and help with the discharge of lochia [blood, mucus, and uterine tissue]. The second week is about promoting metabolism and restoring physical strength. The third and fourth weeks are to regulate blood energy and improve physical conditioning.”
Maternity nurse Edith Lemardelee has worked with many local mothers as well as expatriate mothers looking to try Chinese-style confinement over the years, and says that she has no problem with the fact that much of the traditional Chinese behavioural restrictions are meant to allow the mother to rest.
“I have met mothers who can’t wait to go back to the gym or run around; sometimes that doesn’t work well with breastfeeding,” she says.
Lemardelee does caution against prolonged confinement for mothers at risk of postnatal depression. “When you find yourself confined in a flat with lots of people around, telling you what to do and what not to do, it’s very hard to stop the depression from setting in,” she says. Multiple clinical studies have demonstrated a positive correlation between an increased risk of postnatal depression and mothers practising enforced postnatal confinement.
However, Heavyside says: “Many women remaining at home during the confinement period are well looked after by family members. They are fed frequently, encouraged to rest and have little or no expectations placed on them other than to care for the baby.”
Exercise should be avoided at all costs
“Even within hours of the birth, a woman may resume doing gentle exercises to help rehabilitate the pelvic floor,” says Karin Ubbiali, a Pilates trainer at Flex Studio, a fitness club in Central and Wong Chuk Hang. “This includes general stretching and releasing movements, and deep abdominal breathing exercises to reconnect the abdominal muscles and open the chest. Pelvic tilts and simple pelvic stability exercises also help to realign the pelvis and spine.”
Panda Li, a physiotherapist at PhysioMotion: “Maintaining flexibility, especially in the upper body, also helps when dealing with a young baby.”
From a traditional Chinese perspective, exercise – however gentle – is not recommended immediately after birth. “Historically, women were advised to stay in bed for the whole 30 days after birth to allow time for the wound to fully heal,” says Yu. “Nowadays, getting out of bed is recommended for better blood circulation and a prompter recovery.”
Low- to moderate-intensity exercises such as brisk walking, low-impact workouts, Pilates, tai chi, yoga or swimming can be taken up at around six weeks, after the all-clear from an obstetrician, Li says, as long as the exercise intensity and duration is built up slowly.
So what should you do?
The guiding principles behind cho yuet are designed to help mothers recover after birth, but can also cause stress for an already overwhelmed mother dealing with the physical, mental and hormonal after-effects of childbirth. Just as Hong Kong is a cultural melting pot that combines East and West, the best approach for new mothers is one that takes into account their individual character, preferences and cultural practices.