What is Confinement? The Chinese Postpartum Recovery Practice of Confinement – Zuo Yue Zi (The Postpartum Wellness Show: Ep.7)

Selamat Datang and Welcome to the Postpartum Wellness Show!

and I’m Dr Kristal Lau, your host and postpartum wellness consultant

In this show, I share insights and knowledge around approaching your postpartum journey through culture, traditions, and modern postpartum care using my combined experiences as a physician with scientific and public health background, an author, a foreign-born US military spouse, and a mom of 2.

Join me in this exploration of motherhood, wellness, and heritage where you will learn how to thrive in your postpartum journey and beyond.

Welcome back to another episode of the Postpartum Wellness Show.

I'm going to be doing a mini series for the next few episodes around the topic of introduction to the postpartum Confinement practice.

Today's episode, we're going to talk about what is confinement, a little bit about the principles behind the rules that many of us follow during the confinement practice.

A lot of the information in this miniseries is explained in my book Postpartum 30, and I'll be reading a little bit from here as well as we go through today's episode.

So we'll start from the top on what is confinement? What is postpartum confinement practice? What is Zuo Yue Zi? What is sitting the month? What is pantang; taboo? 

A lot of these terms carry a similar meaning. It means to rest after giving birth for a specific period of time. And mothers who perform this postpartum recovery practice is encouraged to follow a set of rules, which are in place to optimize her recovery, encourage rest, and to help her body start returning to how things were before she got pregnant.

But why is there such a variety in terms used to describe this postpartum recovery period? Plain and simple: Different cultures, different languages, and different families end up using different terms that are passed down.

For example, in Malaysia, a lot of the times when a woman gets pregnant, her friends, family, would ask, "so are you going to be doing confinement?" Or for the husband, his friends might ask him, "is your wife going to do confinement?"

For us in that part of the world, when someone brings up the word confinement, the immediate association is to postpartum recovery. But I know that in the West, when we say confinement, the word is associated with jail time, imprisonment.

For a lot of us in the East, we continue to use the word confinement to talk about postpartum recovery because that's the closest English translation, so to speak, from the word Zuo Yue Zi. Because that is essentially what it is.

The mother and the newborn are confined to the home for a period of time where they're not allowed to leave the house. They're not allowed to go out to see people, and preferably not allowed to have visitors as well because this is a sacred time for mom to recover and for her to get used to life with a newborn.

For myself, especially, I am not fluent in Mandarin. I cannot read or write. I can speak a certain amount of Mandarin. Not only that, my parents don't speak fluent Mandarin and they're not literate in Mandarin either.

So the words that have been passed around in my family, among the women, passed down to us is the word Confinement. And I will continue to do so with my children. I will continue to use this word among my peers. And when I talk about this practice.

This practice is directly linked to traditional Chinese medicine principles. All of these rules and strictness in the practice doesn't just come from nowhere or is just an old wives' tale that's passed down. This practice is rooted in traditional Chinese medicine, which underlies a lot of health philosophies and practices in the East.

So that brings me to the next topic. What are the common principles behind the Chinese postpartum confinement? 

In general, a lot of traditional Chinese medicine, TCM principles, are based on prevention and restoration. And with specific relation to after childbirth, to the postpartum recovery period, a lot of the prevention is to avoid cold and dampness and wind from going into the body. The restorative part of TCM in the confinement practice is to restore the Qi and the Blood and to bring more warmth within the body and promote the healing and recovery.

This is why a huge, huge chunk of the confinement practice revolves around nutrition. You will be eating all sorts of stews, soups, freshly cooked food, steamed food, but very rarely fried foods because as I've been told growing up, fried foods are very "heaty".

That's a different concept from warmth. But just know that nutrition in confinement, very warmth based, very meat-based because they want protein to promote the recovery after you've lost so much blood and you've lost so much energy.

And at the same time as a new mom to a newborn, you are immediately breastfeeding, for those of you who choose to breastfeed. That takes up so much energy by itself. So the nourishment part really enforces eating a lot of those types of foods.

However, the caveat in the 21st century is we know and understand that having enough fiber in our food intake, which means vegetables and fruits, is very important not only for recovery but to keep yourself hydrated and to prevent constipation when you're recovering.

Those of you who have given birth and gone through that recovery stage. I know you can appreciate when I say you absolutely want to avoid constipation during this time. It is not fun, especially if you've had some perineal injuries and stitches or tears, and especially if you've had a c-section.

I don't know if this is an honor, but I have had the honor of experiencing a vaginal birth with my first, and then had an emergency C-section with my second child. So I have both sides of the birthing experience to compare, prevention of constipation is an absolute must for both experiences.

So in today's advice, a lot of TCM doctors will encourage mothers to, please eat your vegetables, please eat your fruits. And the reason this disparity in advice from back then and now is unfortunately a lot of vegetables and fruits are considered Cold foods, which they say is not good for the healing. Back again to that restorative concept of promoting warmth in the body.

However, I will encourage you to talk to your TCM doctors or a TCM pharmacist, someone who understands the Hot and Cold, Yin and Yang nature of these foods, especially if you're in the West because a lot of things that you may find online or in other recipe books, those ingredients may be very Asian and depending on where you live, you may not find these ingredients in your local grocery store, or even the Asian grocer may not stock those types of ingredients.

So definitely have a chat to your TCM providers about what foods in the Western grocer falls under Hot, Warm, Yin, and Yang. And then you can create your menu from there and start preparing your food that way.

Now, the other confinement practice that helps with restoring the body after childbirth is rest and work restrictions. Because the body's already so spent and so tired from the whole process of pregnancy and childbirth, it is time now to rest and limit doing work, which means housework, laundry, chores, even cooking.

For prevention and avoiding cold, dampness, and wind from getting in the body, the type of confinement practices you come across are hygiene rules and restrictions and socializing restrictions. So the hygiene part, those of you who are familiar with confinement, no showering, bathing for 30 days or however long it is that your family practices the confinement. And no hair washing if, if you do shower, no hair washing is the next most important rule.

The TCM principle of recommending avoiding that during the recovery period is because, and this is something that my TCM doctor contact educated me about, is during childbirth, a lot of your channels are open and they start to close when you're going through the confinement recovery period.

That is why the recommendation to not expose a recovering mother to water, to cold temperatures, to cold environments is important because the channels are so open that you risk the cold and dampness and wind going in and getting trapped in the body during that time.

And the last confinement practice of socialization restrictions. That helps with preventing the weak body from being exposed to more states of disruption and imbalance. This is based on the TCM principle that overly strong emotions upset an internal balance leading to poor recovery, poor health, which is why a lot of the advice is, "It's okay." "Just ignore those feelings." "It'll pass." "You'll be fine." "Just focus on the positive things."

But this is where I have my gripes with that. Postpartum is so chaotic. We don't really get to choose because the hormones are gonna drive us. The hormones are gonna shift us up and down, into all sorts of different emotional gears throughout the six to eight weeks or even longer, depending on how long you take to recover.

So strong emotions are definitely going to happen during the confinement period and all the mental health advances that we know today encourages us to not ignore those feelings, to address them and have healthy and safe outlets for them.

This is why in my book, I have a whole chapter on postpartum emotions and how to tackle those with respect to a traditional and cultural practice. I do have a passion for this topic because I have gone through postpartum depression myself, and I did feel like a very bad person, a bad Asian, to be blunt, that, oh, "did I not complete or perform my confinement practice properly?" "That's why I developed postpartum depression?"

Because the idea is that if I do this properly, I should be fine. So there's a whole journey to that, which I'll share in another episode. But the idea of socialization restrictions is to prevent moms from being exposed to triggers that could trigger strong emotions.

So there's that for today. I hope you enjoyed this brief introduction into what confinement is, what the principles behind it.

In the next episode, I'm going to cover a little bit of the historical side of the confinement practice. This part I had tremendous fun reading up on and picking up little bits and pieces for the book, and I'm going to also cover the benefits of following a traditional practice and the challenges of performing a traditional confinement practice as opposed to having something more modern.

So stay tuned for more!