Current topiCs & opinions
Copyright © Royal Society for Public Health 2018 May 2018 Vol 138 no 3 l Perspectives in Public Health 147 SAGE Publications ISSN 1757-9139 DOI: 10.1177/1757913918763285
Current topiCs & opinions
For over 2000 years, Chinese women have practiced the traditional postpartum ritual called ‘doing the month’, during which new mothers follow specific regulations for one month following delivery. In this article, Guodong Ding and Ying Tian of Shanghai Jiao Tong University School of Medicine, Jing Yu of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and Angela Vinturache of the Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, discuss the need for greater understanding of this traditional practice in order to provide appropriate medical treatment and unite traditional and modern postpartum health.
pregnancy and childbirth are significant life events marked by the adherence to traditional customs in many cultures. such ancestral beliefs and customary practices are also present in Chinese culture, providing an important context for understanding the childbirth practices of Chinese women. For over 2000 years, many generations of Chinese women have practiced the traditional childbirth ritual called ‘doing the month’, also referred to as ‘zuoyuezi’.1 Despite modern society abandoning countless traditions due to either disconnection or perceived irrelevance to the westernised world, this specific postpartum practice has survived. since ‘zuoyuezi’ is still passed from generation to generation, integrated into almost every aspect of living, this traditional practice needs to be understood and considered when
dealing with postpartum women in order to provide culturally appropriate advice, respect diversity, avoid conflicts, and bridge the gap between traditional and modern postpartum health.
the traditional custom of ‘doing the month’ stipulates that women should be confined to their own home for one full month after giving birth to their baby. During the month of postpartum convalescence, the new mothers follow specific regulations to control their physical activity, diet, and emotions.2 in modern medicine, childbirth is a physiologic process that, for most part, does not require additional healthcare, while in traditional Chinese medicine, childbirth is associated with dramatic transformation of female energy and body. According to the dual principle of yin and yang in traditional Chinese medicine, pregnancy and childbirth are considered to exhaust women’s yang, leaving women in a transient functional imbalance status of having relatively more yin, much like illness.3 Yin originally meant ‘shady’ and is related to the phenomenon of cold, winter, and darkness; it symbolises femininity,
internality, inferiority, and negativity. Yang is translated as ‘sunny’ and is associated with heat, summer, and brightness; it
symbolises masculinity, externality, superiority, and positivity. the first postpartum month is believed to be a crucial time to bring yin and yang back to a balanced state and resume normality. As such, major ancestral practices promote maternal rest, preferably in bed; discouraging domestic duties and activities outside home; avoiding bathing, washing hair, and brushing teeth; and refraining from intake of ‘cold’ food for the first month postpartum.4 of note, in the context of traditional medicine, ‘cold’ and ‘hot’ suggest the inherent nature rather than the temperature of food. this specific set of practices is regarded as not only curative but also preventative.
Although many of the practices and rituals of ‘doing the month’ have been disproved by science or common sense, many Chinese women follow the ancestral rituals because they are part of their culture and traditional principles that guide everyday life. new mothers spend most of the time convalescing in bed, avoiding domestic duties and routines, including watching tV and reading books, because such activities are believed to be associated with diseases in later life, such as chronic back pain, joint pain, and poor eyesight.5 Confinement to the house with the windows closed and avoiding contact with the ‘cold’ (wind and water) are required to maintain body warmth because during childbirth, new mothers lose blood, which is considered to be ‘hot’ in nature. new mothers wear additional clothing, in particular hats and socks; and daily personal care, such as bathing, washing hair, and brushing teeth, is also restricted in order to prevent the body from being exposed to the ‘cold’. regarding dietary restrictions, new mothers avoid consuming ‘cold’ food and replenish their body with ‘hot’ food. Common ‘cold’ food that is restricted includes fruit and raw vegetables (e.g.
Cultural postpartum practices of ‘doing the month’ in China
763285 RSH0010.1177/1757913918763285Current topics & opinionsCurrent topics & opinions research-article2018
this traditional practice needs to be understood and considered when
dealing with postpartum women
148 Perspectives in Public Health l May 2018 Vol 138 no 3
Current topiCs & opinions
cabbage, turnips, orange, and watermelon), ice, ice cream, and duck.6 Commonly prescribed ‘hot’ food includes eggs, chicken, pig trotter or internal organs, ginger, and brown sugar. these food preferences are believed to compensate for the loss of blood at birth, prevent sore back muscles and poor circulation, and ensure that enough milk is produced for infant feeding.1,4 Furthermore, new mothers should maintain emotional stability during this period; crying or exposure to extreme emotions should be avoided. in addition, refraining from sexual intercourse is advocated because it could endanger and bring bad luck to the family.
Despite the fact that economic and social advances may have influenced the manner in which the rituals are performed, the rationale behind the traditional practice remains the same. indeed, there has been an increased renewal of this rite of passage among Chinese women giving birth and making the transition to motherhood, with a growing movement of ‘doing the month’ from the familial domain to the public domain.7 Yuesao (referred to as ‘month mums’) or home health workers are becoming increasingly popular in China, which is similar to postpartum doulas (birth companions) who are now widely employed by childrearing women in Western countries. in addition to these services that augment family support at home, an increasing number of medical zuoyuezi centres have been created, where postpartum women can receive both modern medical care and the benefit of traditional cultural practices.8 the first of these centres opened in Beijing in 1999 and in shanghai in 2003 and are becoming increasingly common throughout China.
several sociocultural factors may explain this phenomenon of modern Chinese women adhering to the traditional postpartum practices.1,4 First and most importantly, women are raised and educated to believe that adherence to this ritual is physiologically and psychologically beneficial and that the absence of it is
harmful, with potential long-term adverse effects on quality of life. this is based on the traditional Chinese belief system about health and illness causation and the maintenance of a balance of yin and yang in a woman’s body after childbirth. the influence of significant others from the family including the mother, mother-in-law, and grandmothers may be another factor that ensured intergenerational perpetuation of the traditional practices. Although some new mothers may not be personally aware or willing to follow the traditional practices at home, the power of opinion from significant others may persuade the women to at least give some semblance of adhering to the custom. past experiences of detrimental effects of not following the traditional practices from the extended family and relatives could have a motivating force in sustaining the customary practices. third, modernisation and the imposition of Western values have probably influenced new mothers’ social expectations and their understanding of puerperal health. nonetheless, moving away to urban centres and lack of family support led to resurfacing of this tradition in a new context of commercialisation and market for profit, ‘doing the month’ crossing over from a private affair into the public trade. the traditional postpartum practices are potent reminders of cultural beliefs regardless of where Chinese women live. not surprisingly, Chinese immigrant childbearing women continue to follow these traditional practices to some extent, and the cultural ritual is not influenced by maternal educational level, acculturation, or length of time in the host countries.9–11
industrialisation and changes in governance of healthcare in China encourage modern hospital and health centre–based healthcare for childbearing women. At the same time, there is a re-surfacing of the ancient practices such as ‘doing the month’ in an effort by
women to re-connect with their roots and maintain their cultural identity. these two dimensions of ‘doing the month’, the ceremonial cultural aspects and medical opinion, have led to discussion of controversies in the media, healthcare, and medical scientific circles. For instance, some studies have suggested that the traditional postpartum practices provide legitimate family support and protective actions for new mothers, relieving physical pain and reducing the severity of symptoms, overcoming stress, and preventing poor mental health and depression after delivery.3,12 However, other studies indicate that the postpartum ritual is not necessarily curative or protective. A study conducted in taiwan, China reported a high prevalence of postnatal depression (about 19%) among new mothers, despite the fact that the vast majority of them practiced the ritual.13 this prevalence is even higher than those reported in Western countries at 6.5%– 12.9%.14 Another study from rural China reported that the traditional practices did not decrease the risk of chronic pain for women 5–11 years after childbirth.15 Given the inconsistencies among existing studies and the complexities of the ritual in contemporary society, further studies are required to bridge the gap between traditional practices and current evidence about the effect of ‘doing the month’ practices upon women’s long-term
health and wellbeing. therefore, we emphasise the importance of allowing flexibility to fit and adjust the ritual into modern life, to enhance the
positive effect of traditional practices and reduce unnecessary conflict and stress.
Funding this report was supported by the national natural science Foundation of China (81402645). the authors declare that they have no actual or potential competing financial interests.
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we emphasise the importance of allowing
flexibility to fit and adjust the ritual into modern life
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