Confinement Practices, Practical or Irrational

Confinement practices range from the practical (having ginger in your food to rid the body of gas) to the downright unhygienic (not having a bath for a month). Should they be strictly adhered to or are they just a bunch of old wives' tales? There were a lot of confinement practices in the past which may not apply today. For example, mothers were told not to sit in an air-conditioned room. But if you think about it even the labour room is air-conditioned. What about the people living in Cameron Highlands or Beijing in the winter? Does it mean they have to move to a hotter country or location? These are some of the things that you have to think about - whether they are true or just myths. If you ask me I would say most of them are just myths. The most important aspects of the confinement period are your lifestyle and your rejuvenation. The first seven to 10 days is the crucial period. The confinement period is the time for the mother to rest and rejuvenate. In fact confinement practices don't just cover rest and nutrition; it also covers your lifestyle. In the old days most women worked on the farm, perhaps planting padi or working in the orchard. During confinement they actually had the time to rest. And those days you needed somebody to help you boil the water for your bath and also to bathe the baby. That's why they had a confinement nanny (pui yuet). In the past women needed a confinement nanny to help them do things like boil the water and do the washing but now you have a water heater, a washing machine and disposable diapers. So you don't need a confinement nanny anymore. Importantly, the confinement period has to be relaxing and a wonderful experience for the mother. It cannot be a matter of hiding yourself in the room and not being able to go out. That is not the right way to do it. Of course it's better to stay indoors but there is no solid evidence that if you go out there will be adverse effects. Look at the westerners - they go out after delivering their babies! One of the confinement practices that may conflict with the doctor's advice is the consumption of alcohol. When you talk about Chinese confinement one of the main ingredients in food preparation is wine. I don't believe the woman in confinement should take alcohol but she can take rice wine which has been boiled till the alcohol content is completely evaporated. Only then do you use it in food preparation. Drinking rice wine (without the alcohol) or what is sometimes called "confinement water" will help reduce the water retention in the woman. However, these days you don't even have to drink all this because there is R/O (Reverse Osmosis) water and you also have good filtration systems - so you don't need to have the confinement water, you can just take the R/O water. Another thing we don't encourage (which used to be done in the past) is the practice of buying raw herbs and boiling them because herbs by nature are toxic. So it is better to get processed herbs. Herbs are still important for rejuvenation but make sure you get the processed type in capsule or extract form. One cannot dismiss age-old practices totally, even in the modern era with advances in medical care and evidence-based medicine. A lot of the confinement practices (more than 60%) are related to foods and food directly contributes to nutrition, which is important to everyone, more so after childbirth. After childbirth, a woman may feel weak, and this is likely to be due to a sudden withdrawal of "feel good" hormones as well as anaemia due to the blood lost during labour. Also, the stomach and bowels which were initially compressed by the pregnant womb, now suddenly expands because of the sudden decrease in the size of the womb. These organs swell up with air and fluid, hence the sensation of bloatedness or "wind". If we can understand this, we can appreciate why the foods that are prepared (containing ginger or black pepper) for the mother in confinement appears to correct the problem. Confinement food and herbal food are also medication. They try to replace the hormones so that the woman feels better. But too much hormones is not good either. When you have just delivered, your womb is very big, your ovaries are very big, everything is large and if you take too much hormones sometimes it can result in problems like bleeding or if there are fibroids they can start to grow. My advice is that you can take everything that is prescribed but take it in moderation. I don't think there is any effect to the baby if the mother is still breastfeeding while taking the herbal medications. I don't think they will be toxic to the baby. Even the alcohol with a lot of herbs in it - it's fine to drink as well but the way to minimise the transfer to the baby is by drinking it late at night after you're done breastfeeding baby for the day. Then you sleep till morning and say about six hours later when it's time to feed baby again, the alcohol would have washed out of your system. If you are very concerned and baby is not yet sleeping for six hours then give one feed by the bottle. But I usually tell my patients not to worry, they can have the herbal preparation because the actual amount of alcohol that is released in the breast milk is very little. I believe one should be selective about confinement practices. Practices that are outright irrational cannot possibly be beneficial to the woman. For example, the prohibition on having a bath and washing the hair. It is illogical not to put hygiene as the top priority. Keeping one's body clean by having regular showers is more likely to contribute to a quick recovery. The other irrational practice is the avoidance of fruits or vegetables. These foods are a good source of vitamins and fibre which would help ensure good bowel habits and faster recovery. As for the advice not to touch water, if you are immersing yourself in iced water, then yes, it will cause temperature changes in you but if you are just washing your hands with cold water it wouldn't make much difference. So I think this belief that the woman shouldn't touch water is just an old wives' tale. There's another irrational practice that prohibits a woman from drinking water. There's no problem with drinking water. It may not be so appropriate to drink soft drinks because your tummy is already gassy. But if you drink plain water or warm water I don't see how there's anything wrong with that. When a woman tells me that she can't drink water and she's very dehydrated and constipated, I tell her to drink a lot of red dates water because red dates has a high iron content. Or she can drink milk. Otherwise (if she is not drinking water or milk) she would be constipated and then the milk won't come if she's trying to nurse baby. There's some rationale behind some of the confinement practices. For example, if you take ginger and black pepper to get rid of the wind - yes, it's very logical. But to restrict your fluid, to believe that you cannot drink water and cannot shower - those, I think, are not appropriate in this age. There's no truth to these unusual confinement practices.