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Why new mothers in China go into postpartum confinement

Why new mothers in China go into postpartum confinement

In China, some new mothers choose to confine themselves after birth. This cultural practice is known as “zuo yuezi,” which translates to “sitting the month” in Mandarin. But, before you start fantasizing about curling up with your bundle of joy without getting off the couch for 30 days straight, keep in mind that zuo yuezi requires the following: no showers, brushing teeth, cold drinks (not even a glass water), or eating fruits or vegetables. It’s also recommended to stay in bed underneath plenty of blankets and wear warm clothing, even in hot temperatures. These are just a few of many zuo yuezi restrictions.

We’re not pulling this from an 18th century novel or headline about house arrest: real Chinese women “sit the month” in their own homes, often relying on relatives or nannies to care for themselves and their child while recuperating in this fashion. In China, cities have luxury confinement centers that cost $500 per day and offer 24-hour nurse and nutritionist support to help mothers follow the rules and care for their babies. The South China Morning Post wrote about the existence and evolution of zuo yuezi this past June.

What’s the history and reasoning here?
Zuo yuezi is rooted in traditional Chinese medicine. These seemingly strict, unusual rules around what new moms can and can’t eat, drink, wear, and do, stem from the fact that large amounts of fluid and blood are often lost during childbirth. As you may already know, the concept of “yin and yang” is prominent in Chinese culture and medicine. Yin and yang is the philosophy that harmony exists when complementary, opposing forces are in balance — like hot (yang) and cold (yin), masculine (yang) and feminine (yin), fire (yang) and water (yin), or light (yang) and dark (yin).

When warm blood and bodily fluids are lost during labor and delivery, the mother’s body is left in an extreme state of yin (cold). Therefore, the confinement period rebalances the body by encouraging heat and avoiding cold. This explains the avoidance of “cooling” foods and the need to stay wrapped in robes and blankets. (It’s also why Kate Middleton sparked controversy on Chinese social media when she appeared outdoors in a short, breezy dress just hours after giving birth.) If this balance between hot and cold isn’t restored in the body, Chinese doctors and medical texts warn of illness and a host of other health problems for the mother.

The evidence for zuoyuezi
Medical experts in the United States recommend resting after labor and delivery to encourage physical recovery and allow plenty of time to bond with the newest addition to the family. For example, Stanford Children’s Hospital advises that new mothers should be relieved of all responsibilities other than feeding the baby and taking care of themselves. This includes sleep, alone time, minimal guests, and getting outside for just a few minutes each day.

There are obvious emotional and physical benefits to sitting the month, including getting plenty of rest and feeling like a part of one’s culture. But some aspects of zuo yuezi seem extreme, like not bathing or even stepping foot outdoors. However, there is positive anecdotal evidence for the practice. Check out this woman’s encouraging story about practicing it after her fourth child, compared to her previous postpartum experiences when she didn’t abide by the custom. But does science have anything to say about the more extreme measures?

Helpful, harmful, or none of the above?
As you might have guessed, there aren’t many scientific studies devoted to sitting the month. This 2007 study observed and interviewed Chinese women in British Columbia who recently completed zuo yuezi. The researchers looked at all of the rules — from dietary to hygienic — to see if they were actually beneficial to the mother’s health. Here are a few examples of what they found: Consuming more “hot” food rich in protein (like stew, broth, and meat) was beneficial because it supported lactation and the healing of any tears or incisions from birth. Remaining inside the home, along with not showering or bathing, was shown to have no observable health effect — these practices weren’t harmful or beneficial. But the researchers noted that behaviors like not picking up the toothbrush for a month was harmful because it “allows for a buildup of plaque and bacteria that can cause tooth decay.”

Potential dangers
A 2011 study published in the Midwifery academic journal discovered that while zuo yuezi is accepted by Chinese mothers as a time of respite and physical recovery, “it is also burdensome to mothers, as cloistering indoors compromises both mother and baby’s exposure to the sun, resulting in vitamin D deficiency and rickets.” Speaking of dangerous risks like these, a CNN article from 2015 reported that a woman in Shanghai died of heat stroke after wrapping herself in blankets and refusing to turn on the air conditioning (despite high temperatures) while sitting the month. The article describes a similar tragedy, which involved a new mother who refused to physically move her body and later died of pulmonary artery thrombosis, a severe respiratory condition.

We’re always fascinated to learn about the varying postpartum traditions around the globe. For all of the new and future mamas out there, we always recommend checking in with your provider to discover the optimal postpartum routine for you. Whether your culture’s unique postpartum rituals or customs include baptism, eating specific foods, taking time away from work and your regular routine, spending time with family, or not leaving the comfort of your bed, as long as mom and babe are safe and healthy, participating in your culture’s unique postpartum customs can be incredibly meaningful.