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DISCLAIMER: The content of Dr Kristal Lau’s Postpartum Wellness Show does not replace medical advice from your health providers. Listening to this show does not establish a patient-doctor or client-provider relationship between you and Dr. Kristal Lau. Please see your health provider for any medical concerns or contact your local emergency line for any urgent matters.

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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, and today we're going to dive into part two of the miniseries on the confinement practice.

I'm going to talk about the historical aspect of confinement, whereabouts it all started, especially since a lot of the records that are available come from the Imperial Chinese times.

Because when you think about it, way back when, the only people who had the ability to document, who were literate were imperial doctors, Imperial physicians, officers, and scholars in those days.

So are you ready for a little bit of historical geeking out today?

Because I am, it's something I would have loved to do as a main job, if I hadn't gone down the way of medicine, I would've definitely loved to study history as a major.

My main reference for today's episode and for the History of Confinement practice in my book is from an article titled "Childbirth in Early Imperial China", where the article originally is in Mandarin written by Jen-Der Lee, and the English translation is done by a Dr. Sabine Wilms. This was published in 2005.

I will put the link in the show notes and in the YouTube description for those of you interested to delve into this. And also what's interesting about this article is they incorporated the herbal recipes for treating complications and postpartum care.

However, When it comes to any herbal medicines that you're looking for, I highly, highly recommend you consult a TCM doctor and also work with your health provider to ensure that whatever you're taking doesn't contraindicate or mix or have any adverse effects with your Western medications.

And also, if you're able look for medical doctors in your area who also include traditional Chinese medicine principles and practices in their Western clinical practice, integrative care, integrative medicine is what it's called. And I'll put the keywords that I've mentioned in the show notes so that you know what to look for if it's something you want to pursue. 

So let's get started with the historical side of things.

One thing that was really interesting to me was, "where did the notion of 30 days come from?"

Because that's something I grew up with. That's something I've always heard and been told about. My cousin who was pregnant before me, talked about her confinement for 30 days. Um, friends I've known and aunts and uncles like everyone around me in Malaysia. 30 days for the confinement practice is really standard, but where did that come from and has it always been that way?

And what I found out from reading this article is postpartum recovery really depends on the dynasty that was in power at the time and what the imperial doctor decreed at the time.

Does that sound familiar? Yes.

Because today, it's very similar to a lot of guidelines we have. It's very country specific, population specific, ethnic and community group specific. And things change depending on what's happening at the time. What are the needs of our population?

So according to this text, the postpartum period, where the postpartum confinement recovery is expected to happen, ranged from three days, seven days, 30 days, the whole month, 100 days, and up to half a year, or even as long as a year of resting after childbirth.

The reason for putting forth a specific timeframe for resting after childbirth is, and I quote from this article, "After undergoing childbirth, a woman's physical constitution was changed, and she could potentially suffer all sorts of symptoms for the rest of her life.", which is why there is such an emphasis on resting even till today. 

And there's why There are a ton of confinement centers in East Asia, a ton of agencies having confinement nannies for hire, and a ton of businesses involved in confinement food delivery, and confinement herb preparation.

Because resting and then tonifying and supplementing and boosting the woman after childbirth is absolutely crucial in her health and wellbeing. For what reason?

Very easily, we can think back in the ancient days, not just in East Asia, but pretty much in many cultures around the world, a woman's role is purely to produce an heir, mainly a male heir, a son to continue the line. This is one of the biggest reasons for a woman to be restored and rejuvenated so that she can continue to produce sons for the family that she's married into.

And thankfully that's changed today, but yet there are families who still really treasure sons over daughters. And we, we see that, in a lot of modern social issues when it comes to female infanticide.

So in the ancient Chinese days, there was absolutely an understanding for the need of a mother to rest after giving birth, and the need to nurture and nourish her to return her to good health after she's had her baby.

But what about the confinement practice itself? The concept of separating mom for the 30 days for that period of time? This is where it gets really interesting, and I'm going to read from the article because paraphrasing won't do it justice; 

"The practice of sending the woman off for the birth might have already existed in the spring and autumn period, 722 to 481 before the common era." Or also known as before Christ. 

"Before the delivery of her baby, she was forced to leave her regular daily life and enter a location that had been arranged specifically for her. The central idea behind her isolation was the inauspicious nature of childbirth."

This is where I'm going to pause and talk about how women in the ancient days, and even up till today, a lot of our biological functions, the natural happenings to our body, our periods, the menses, our hormonal cycles, pretty much everything to do with the female body, including childbirth and the products that comes with giving birth.

A lot of that has been viewed as dirty as unlucky, and it's not good for a woman to be around others when she's having her period or during childbirth because you are just going to bring bad luck to people around you. And it's interesting to see in this text that the evolution of sending the mother away to give birth evolved from a hut set up as far away as possible from the village and from her family. It evolved into delivery houses, and a lot of this existed in the Han Dynasty.

And interestingly, it says here that the wife of a government official could be lying and giving birth next to the wife of a butcher, where apparently the social class didn't always matter at some point in time in ancient China.

And this is another passage from the article that I want to read to you, which. Yes, it sounds very aggravating, very sexist and just completely unfair to mothers and women. So here's the passage;

"The people in the village shun women in childbirth, considering it inauspicious. And in order to make it auspicious, the woman enters the mountain and forest going far away, crossing rivers and marshes while nobody interacts with her, the family of the woman also avoids and abhors her graveyards, cottages, even roadsides she may enter only after having passed through the month. Aversion to her is this great."

But of course there were caveats to that.

The article does include explanations where in some families and in different villages, the way that they support or not support mothers and pregnant women. It differs.

There's also a section in this article that describes how fathers from different classes will participate in the childbirth process, where those who are richer and a higher social status because they've got armies of servants and people to help. It's a high chance they're probably lingering on the sidelines.

But for the regular people in the village, the husband is very likely the first one to rally everyone to help and to get things organized for his wife while she starts laboring.

But what's interesting is the evolution of that to the modern day confinement is at one point, and especially for my generation, when I was growing up, men and fathers were absolutely, absolutely excluded from the confinement practice, from the childbirth process. And there wasn't really much participation in terms of nurturing the mother after she's given birth, or participating in caring for the infant.

But thankfully, all that is changing and the guys themselves are participating in this change very actively.

To further expand on the notion that women in childbirth and the products of childbirth are polluted and therefore unlucky and inauspicious. There is this concept described in the article that I personally have heard of growing up and comments around me about how it's better to have sons instead of daughters. This is what the passage in the article reads.

So the people in the Han Dynasty considered it "inappropriate for a married woman to return to her natal family to give birth", so to go back to her own family to give birth. The quote goes on to say that "it is not appropriate to return home for the birth. The custom has it that it leads to people's downfall because women like to take their daughters and exchange them for other people's sons, therefore do not permit them to return home."

And so when women back in ancient China days did not go to a delivery house or a birthing house, and they could not go home to their family's home to give birth, it was customary from the Han Dynasty onwards to set up a special birth room either inside the house where they're currently living with their husband and their immediate family or outside the home.

Which is why after reading this article, The confinement practice is definitely something that has been there for centuries and it's so ingrained in the way Chinese people approach postpartum care, and it's passed down generation after generation. The concept of resting and not just resting, but away from other people.

Now, in my book, I do draw the link between the benefits of confinement, and actually being secluded and isolated away from other people. There are benefits in terms of prevention of germ transmission and infectious disease, especially during a time where both mom and baby are in such a vulnerable state because of so much that has happened during childbirth.

Both baby and mom need to recover. They need to grow stronger before their body's ready to fight all the regular germs that we have out there. So in that aspect it makes sense. It makes sense to confine and seclude the mom and the newborn away.

However, from what I've just read to you from the article preventing exposure to infectious diseases was absolutely not the reason for them to do a confinement practice away from everyone else. It was absolutely related to the cultural belief and the taboos and superstition around how dirty the childbirth process is.

And there you go, a little blast to the past about where the confinement practice originated from.

I personally feel it's really important for us to understand these things because it's such a huge cultural tradition and practice. And the state of the confinement industry in East Asia where business is absolutely booming for these centers and agencies that have confinement nannies for hire, and the concept is being adopted in the West.

It's very important for us to continue to respect where that tradition came from. It's only appropriate to pay homage to where these businesses drew their inspiration from.

And one thing that's really important to know is that in our modern day today, when you're approaching someone to care for you during your confinement, especially when it comes to ingesting the herbs for your recovery, please ensure that you talk to a traditional Chinese medicine doctor or a pharmacist or a herbalist who's also aware of any potential drug and herb interactions because a lot of us may have health conditions that are treated by western medicine, that have Western medication, and there is fast growing knowledge about drug herb interactions that are absolutely important for you to be aware of before you take them during the time where you're in recovery.

Thank you for listening to today's episode, and in the next one, I will be making the case for a modern confinement approach in our 21st century. I'll see you then.

In this blog post, we continue our exploration of the Chinese postpartum confinement practice, zuo yue zi. This time, we're diving into the historical aspects of confinement. We'll discover the origins of this tradition, and shed light on why it's such a significant cultural practice, particularly in East Asia.

The article I referenced for this blog post and episode is "Childbirth in Imperial China" written by Jen-Der Lee and translated by Dr. Sabine Wilms.

Source: Lee, J. (2006). "Childbirth in Early Imperial China". In Medicine for Women in Imperial China. Leiden, The Netherlands: Brill. https://doi.org/10.1163/9789047409922_006

The Role of Ancient Chinese Historians

To understand the origins of postpartum confinement, we need to consider the limitations of historical records. Many early accounts of this practice originate from Imperial China. This is because, in ancient times, the literate population was limited to imperial doctors, physicians, scholars, and officers.

This exclusive group held the power to document events and practices.

For the villagers, most knowledge and traditions are passed down by word of mouth. Stories and advice were shared over work, meals, and during significant life events such as marriage, childbirth, and death.

As we delve into the historical context of confinement, keep in mind that our knowledge is derived largely from these sources. It's a window into a world where cultural traditions, taboos, superstitions, and religious beliefs played a significant role in shaping postpartum practices.

The Origins of 30 Days of Confinement

Before we explore the origins of the 30-day confinement period that many of us are familiar with, it's essential to understand that postpartum recovery practices were far from standardized throughout history.

Postpartum recovery periods could vary significantly, depending on the Chinese dynasty in power and the decrees of the imperial doctors of the time.

In ancient China, these recovery periods could range from a mere three days to an entire year. Sometimes the confinement period was 7 days, 30 days, a month, or even 6 months after childbirth.

The reason for such varied recovery times was rooted in the belief and Chinese medicine principle that childbirth had a profound and lasting impact on a woman's physical health. The emphasis on rest and recovery was a response to the potential long-term health challenges that could arise post-childbirth.

The Cultural Significance of Confinement

The cultural significance of confinement practices, of zuo yue zi, goes beyond just rest and recovery. It's deeply intertwined with the belief that the process and products of childbirth (such as blood and lochia), and even menstruation, were considered dirty and unlucky.

This belief led to the practice of isolating women during these periods.

In ancient Chinese times, women were often banished from their regular daily lives and sent to specific locations for childbirth. This isolation was rooted in the superstition that the presence of a woman giving birth would bring bad luck to the people around her.

This practice evolved over time, from simple huts located far from villages to dedicated delivery or birthing houses.

Social Class and Childbirth

Surprisingly, social class didn't always play a significant role in where a woman gave birth. Historical records show that, at times, wives of government officials might give birth next to the wife of a butcher.

This suggests that, at least during certain periods, social status wasn't a primary factor in determining birthing arrangements.

However, as time passed and socioeconomic status became more pronounced, there were variations in how different families and villages supported or didn't support mothers during childbirth.

These variations highlight the complex nature of the postpartum confinement practice and how they were influenced by cultural, social, and economic factors.

Understanding and Respecting the Traditional and Cultural Significance of Confinement Practice

The deep cultural significance of postpartum confinement practices, of zuo yue zi, must be honoured. These traditions, although evolving, are still prevalent in many Asian families around the world.

In East Asia, businesses catering to confinement practices, such as confinement centers and agencies offering confinement nannies, are booming. But their focus and marketing goal is usually for profit and to capitalise on the luxury and pampering aspect of confinement.

But resting after giving birth and following certain confinement practices and taking herbal remedies is not just a luxurious and pampering experience. There are strong Chinese medicine and Asian cultural principles behind the confinement practice.

Modernising the confinement practice and turning it into a business should be done respectfully so that this traditional and cultural practice can continue to be passed down to and be appreciated by future generations.

Final Thoughts on the History of Confinement (Zuo Yue Zi)

As we conclude this journey through the history of postpartum confinement practices, it's clear that cultural traditions are deeply embedded in the way many of us with East Asian heritage approach postpartum care.

While the specific practices may evolve, it's essential to honour the origins of these traditions and the beliefs that have shaped them.

In our next episode, we'll make the case for a modern confinement approach in our 21st century world. We'll explore how these ancient practices can be adapted to meet the needs and challenges of the modern era.

IMPORTANT:

When seeking confinement care or considering the use of herbs and remedies, it's essential to consult with traditional Chinese medicine doctors, pharmacists, or herbalists, and with your modern health provider.

This consultation is especially important if you're taking Western medications, as drug-herb interactions can have consequences.


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About the Author

Physician and Postpartum Wellness Consultant. Author of 'Postpartum 30'. International Speaker. Mother of 2 girls and U.S. military spouse.

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