We are all no stranger to lockdowns because of the current pandemic, but while the experience was new for many of us, new mothers in Singapore have known for decades what lockdown life can be like. If you think being in a lockdown during COVID-19 was bad, imagine being trapped at home without bathing, without drinking plain water, and without air conditioning – for a whole month. These are just a few of the “extreme” and “shocking” practices that many Chinese mothers go through during postpartum confinement.
Postpartum confinement is a period of time when mothers and their babies are confined to their homes, to fully rest and recuperate after childbirth. It can last for 30 to 44 days, and during this period, mothers follow a set of traditional confinement practices, specific to each culture. These practices are believed to help in the acceleration of healing, as well as to prevent future sicknesses resulting from careless postpartum care. They are widely followed by Asian mothers, with many engaging in postpartum confinement services, such as confinement nannies (caregivers for the mother and baby during the confinement period), confinement food catering (food cooked specially for postpartum mothers), and confinement centres (lodging for both mother and baby).
Here in Singapore, these practices are widely followed by mothers. My Chinese mother was no exception. As a child, my mother would tell me about her postpartum confinement experiences, and would inevitably warn me about the “do’s” and “don’ts”, so that I would know how to avoid adverse consequences. When I was eight years old, she gave birth to my sister, and I got to witness her following these practices for myself. Although I only have a foggy memory of that time, due to the short attention span of a young child, I distinctly remember the strong fragrance of ginger and sesame oil that filled the whole house for almost the whole month as the confinement nanny cooked three meals for my mother daily.
My mother, on the other hand, still remembers her postpartum confinement experiences vividly – likely, I imagine, due to the high level of discomfort she faced as a result of the extremity of the practices. While she did not follow wholly traditional postpartum confinement practices, and only adapted practices that suited her lifestyle, she nevertheless suffered discomfort and inconvenience. I did not think much about it at that time, as I knew I had many more years ahead of me before I reached that stage in life where I’d even think about having children.
Recently, the topic of postpartum confinement practices came to my attention again, when I heard my mother relaying her stories to my younger sister. This time, being much older and having spent years in school arming myself with scientific knowledge and critical thinking skills, I questioned the validity of these practices and decided to fact check these odd-sounding traditions and their purposes. While I was not surprised that many of the confinement practices had no scientific evidence showing that they were effective, I was shocked that some of the commonly practiced ones could potentially be harmful to both mothers and babies.
Take, for example, the “No Bathing” rule. Mothers have to minimise their contact with plain water as much as possible during their confinement period and avoid bathing and washing hair. This comes from the belief that coming into contact with water would open up the skin pores and allow “wind” to enter the mothers’ bodies. In Traditional Chinese Medicine, “wind” has the characteristics of the Wind in nature, and is a major cause of illness. Due to the “lightness” of “wind”, it is associated with causing diseases in the upper parts of the body such as persistent headaches. “Wind” is also said to affect the joints, as it is mobile and moves throughout the body. Thus, many believe that if new mothers bathe, they will develop headaches and rheumatism in their later years.
However, there is no scientific evidence showing that avoiding contact with water prevents the onset of rheumatism. This myth could have originated from the northern parts of China many years ago, where people were poor, had no access to hot water, and had to use cold water to bathe. Coupled with the cold weather, this could have led to a higher probability of catching illnesses, especially when in compromised health. However, given the heat and humidity of Singapore and our access to hot water and electricity, this practice would therefore be no longer relevant for us today.
In fact, Gynaecologists and Obstetricians advise mothers to bathe regularly to maintain good personal hygiene and to stay comfortable. This would also prevent wound and episiotomy infection, and aid in the healing of wounds.
While my mother avoided washing her hair during her 40-day confinement period, she washed her hands and took baths in water boiled with Chinese herbs bought from TCM medical halls. These herbal baths were meant to promote blood circulation, expel “wind”, and relieve pain. However, many studies on the effectiveness of Chinese herbs showed no positive benefits. Furthermore, some Chinese herbal products have been found to contain toxins, heavy metals, and pesticides. Mothers are advised to exercise caution when using herbal products, especially since these substances can be passed to the baby through the mother’s breastmilk.
When I told my mother about this, she did not seem worried saying, “Look at me, I am perfectly fine, despite using and consuming so many herbs.” However, this would be an incorrect way of proving something to be true. Just because no noticeable negative effect has occurred, does not mean the practices are safe and effective in protecting mothers and their babies whom they nurse.
Drinking Plain Water: A Taboo
Besides avoiding contact with plain water, new mothers are told to avoid drinking plain water, too. My mother closely followed this practice, as she believed that the consumption of plain water caused water retention. This reason was also cited by Esther, a 19-year-old University student, when I asked her whether she would follow this practice in the future.
“I would avoid drinking plain water, because others have told me that it causes water retention. My mum experienced getting water retention after drinking plain water during her confinement period and it caused her face to swell” she recalls.
In TCM, plain water is believed to be “cooling”. “Cooling” foods and drinks are said to increase the yin (dark energy) in our bodies, which decreases body temperatures. As it is thought that the bodies of mothers who have just given birth are in a “cold” state, drinking plain water is strictly prohibited, to prevent the mother’s body temperature from decreasing.
However, from a medical perspective, it is important for mothers to drink plain water to stay hydrated. This is especially important for breastfeeding mothers, as doctors advise them to drink more water during this period. Additionally, the mother’s kidneys need to produce more urine during the first few weeks postpartum to get rid of the accumulated fluids that built up during pregnancy.
I explained this to Esther and asked her if she would still choose to avoid drinking plain water in the future. She told me that she would follow this practice “in moderation”, where she would only try drinking some water towards the end of the confinement period, because she believes there is still some truth that plain water causes water retention, given her mother experienced it in the past.
It is reasonable to say that many Singaporean women also follow these practices due to the Asian culture of valuing filial piety, where children are expected to obey their parents unconditionally. As such, while there is no scientific basis for most of the confinement practices, women may simply trust and obey their mothers, and follow the practices to err on the side of caution. They would not mind suffering the inconvenience for a short one month if it has the possibility of ensuring good health in their old age. This seemed to be true for Esther, who told me her parents would want her to follow the practices in the future, even if she did not want to.
Special Menu For Mothers
One huge aspect of confinement practices would be the food and drinks, where postpartum mothers are served a special diet. Postpartum mothers are believed to have a “cold” body constitution and thus, they would need to consume “heaty” foods (foods that increase the yang, also known as heat or bright energy, in their bodies) and avoid consumption of “cooling” foods to counter the “cold” body constitution and thereby warm up their bodies.
For a start, mothers commonly substitute plain water with ginger tea and red date (jujube) tea during their postpartum confinement period. This was a practice that my mother closely followed.
“I drank ginger tea and red date tea instead of plain water because they are herbal drinks that will warm the body. Red dates also improve blood circulation,” she told me. “As I drank them whenever I needed to, I didn’t face any dehydration during confinement,” she emphasised, upon hearing that doctors advised increasing the consumption of plain water during the first few weeks of postpartum.
There are studies which show ginger can warm the body, and ultimately we know that it is safe to be consumed. There are no studies to suggest that red dates warm the body, although red dates are reported to have a variety of other health benefits, such as anti-inflammatory and cardioprotective properties. Thus, while red dates do not serve the purpose of warming our bodies, red dates may still be beneficial, and there is no harm in consuming red date tea.
Alcohol is also commonly consumed as part of this special diet, as it is believed that alcohol has “heat” properties that can boost blood circulation and warm the body, similar to red date tea and ginger tea. Mothers can drink alcoholic beverages or consume dishes cooked in alcohol, such as stir-fried sesame chicken with alcohol. This is more problematic – the consumption of alcohol could be very harmful to babies, as it can be passed to babies through their mothers’ breast milk. While it is still uncertain to what degree a very small amount of alcohol (equivalent to half a glass of wine or one nip of spirit) adversely affects babies, higher levels of alcohol consumption could “impair the babies’ growth and development”. For example, babies’ livers and sleep patterns can be harmed by excessive consumption of alcohol.
Interestingly, while TCM believes alcohol can be used to “expel the cold” and improve blood circulation, it only encourages mothers to eat foods cooked with some alcohol.
“If alcohol is added early during the cooking process, most – if not all – of the alcohol will be evaporated and there would hardly be any alcohol [content] left”, my mother says. “But of course, this depends on the amount of alcohol added into the food, because the alcohol would obviously remain if a lot is being used. Mothers also usually wait a few hours before breastfeeding” she adds.
Studies show that the more alcohol the mother consumes, the longer the alcohol content will remain in the mothers’ breastmilk. However, it does appear to be safe for mothers to consume moderate amounts of alcohol, if they breastfeed their babies a few hours after consumption. Unfortunately, many of the confinement diet’s dishes and recipes have alcohol added to the foods at the end of the cooking process, which means most – if not all – of the alcohol content would remain in the dishes, which could cause harm to the babies.
There are certain foods that mothers avoid consuming during their confinement period as well. Mothers avoid eating “cooling” fruits and vegetables such as watermelons, bananas, radish, and bitter gourd during confinement. This means that mothers’ diets are limited to a narrow range of foods. On the other hand, “heaty” foods like plenty of meat, are on the menu for mothers as it is said that the high protein nourishment would help in nursing their babies. Mothers therefore do not consume a balanced diet loaded with a wide variety of fruits and vegetables, which are necessary to prevent constipation, a condition prevalent in the post-pregnancy period. Additionally, excessive meat intake is a risk factor for breast health. As such, Doctors recommend that mothers ought to have a well-balanced diet to meet all their nutritional needs.
Keeping Warm
Warming the body is a common thread that is found in many of these postpartum practices. As such, mothers are told to wear warm clothing and avoid winds, drafts, fans, and air conditioning, even in warm and humid Singapore. Again, this would be to prevent exposure to cool air and thus prevent “wind” from entering their bodies and causing health problems.
Xing Yi, a 20-year-old University student, told me that she would follow this practice in the future.
“On a normal day, my grandparents would encourage me to wear slippers at home to prevent the cold air from entering my body through my feet. So I think that my body would need to be kept warm during confinement too, especially since my body might be weaker,” she shares. “Also, I’m sure my family would ask me to keep warm when I have my confinement in the future,” she adds with a smile on her face.
However, from a medical viewpoint, postpartum mothers may sweat more at night due to hormonal changes, and this can affect their quality of life and sleep. Keeping warm would increase mothers’ level of discomfort as they perspire more. Hence, they are advised to stay cool and wear comfortable clothing instead.
When I told Xing Yi that keeping too warm might not be beneficial for mothers, she hesitated before deciding that she would still wear warm clothing but in air conditioning so she can be at a comfortable temperature and not sweat. My mother also followed this modified practice of dressing warmly and using air conditioning, albeit at a higher temperature.
I asked my mother, given that many of these confinement practices could do more harm than good, whether she would be happy if I decided not to follow them at all. “No”, she told me emphatically, explaining that such practices will reap long term health benefits, such as not sustaining chronic diseases like rheumatism. “I wouldn’t expect you to follow the traditional practices, but I would want you to follow the modified practices that I followed. Although it would be uncomfortable, the practices only need to be followed for a short period of time for the long term good. So, you can just bear with it,” she reasoned.
It appears then that these mothers cannot fully let go of the traditional confinement practices that they learnt about at a young age, and they would rather try adapting the traditional practices to align more with the scientific perspective than discarding them entirely. Likewise, people around the world who firmly hold on to various false beliefs don’t let go of them easily, just because science or experts say otherwise. In fact, they may not even be open to modifying their beliefs.
It is ironic that these postpartum confinement practices that are meant to protect mothers and their babies from harm, yet they can actually cause harm instead. This is worrying as many mothers who believe that they are protecting themselves are actually putting themselves and their babies at risk.
As a 20-year-old University student, I would not want to blindly engage in practices that have been proven to be potentially harmful. However, I have also been nurtured in an environment where I have been taught to value the experiences and advice of the older generations. As such, I have decided that in the future, I would follow the practices that would not result in harm, such as moderate consumption of ginger tea and dishes cooked with small amounts of alcohol. However, given that this would still mean not following many of the practices, I would probably be seen as the rebellious daughter, staging the first protest in my family against these unproven traditional methods – which would only add to my discomfort and potentially bring harm, too.
Postpartum confinement practices will likely be here to stay in Singapore for at least another generation, in the form of modified practices to fit into the lifestyles of modern women and the changing times. Given the ongoing COVID-19 pandemic, mothers who have just given birth would obviously need to take extra care of their health.
So, the next time we feel like complaining about the restrictions and measures implemented to curb the spread of COVID-19, we can be comforted by the fact that we are not experiencing more extreme measures that would further add to our discomfort and increase our risk of ill health.
