afterbirth

In most cultures, it is customary for new mothers to follow a set of confinement practices during the month after child birth. The main purpose of these practices is to ensure that both the mother and child recover fully from the trial of pregnancy, labour and childbirth. This confinement period is usually characterized by loads of rest, good food and “home quarantine”.

The days and weeks following childbirth – the postnatal period – is a critical phase in the lives of mothers and newborn babies. Major changes occur during this period which determine the well-being of mothers and newborns.

WHO recommendations on Postnatal care of the mother and newborn

From a practical point of view, it does make sense. During the six weeks following the birth, both the mother and child are undergoing major physiological changes to adapt to the new conditions and reach homeostasis.

The postpartum period has been termed the “fourth stage of labor”, and has three distinct but continuous phases.

The initial or acute period involves the first 6–12 hours postpartum. This is a time of rapid change with a potential for immediate crises such as postpartum hemorrhage, uterine inversion, amniotic fluid embolism, and eclampsia.

The second phase is the subacute postpartum period, which lasts 2–6 weeks. During this phase, the body is undergoing major changes in terms of hemodynamics, genitourinary recovery, metabolism, and emotional status. Nonetheless, the changes are less rapid than in the acute postpartum phase and the patient is generally capable of self-identifying problems. These may run the gamut from ordinary concerns about perineal discomfort to peripartum cardiomyopathy or severe postpartum depression.

The third phase is the delayed postpartum period, which can last up to 6 months (1). Changes during this phase are extremely gradual, and pathology is rare.

This is the time of restoration of muscle tone and connective tissue to the prepregnant state. Although change is subtle during this phase, it behooves caregivers to remember that a womanʼs body is nonetheless not fully restored to prepregnant physiology until about 6 months postdelivery.

In Western cultures, this is commonly referred to as “lying in”. However the practice has slowly died off due to changing expectations of new mothers.

The U.S. seems only to understand pregnancy as a distinct and fragile state. For the expectant, we issue reams of proscriptions—more than can reasonably be followed. We tell them what to eat and what not to eat. We ask that they visit the doctor regularly and that they not do any strenuous activity. We give them our seats on the bus. Finally, once they’ve actually undergone the physical trauma of it, their bodies thoroughly depleted, we beckon them most immediately to rejoin the rest of us. One New York mother summed up her recent postpartum experience this way: “You’re not hemorrhaging? OK, peace, see you later.”

The non-practice of confinement among the western societies has raised some debate within the Asian community. For example, the Duchess of Cambridge being seen in public with her newborn a day after the birth was a major talking point in Taiwan and China.

Although non-Western cultures have very differentiated confinement practices, there are some similarities. The emphasis on the healing properties of food, rest and maintaining the “hot-cold” (yin and yang) balance of the body is a recurrent trend in these practices.

One such belief is the necessity of maintaining a ‘hot-cold balance’ within the body and with the environment after the birth of a baby. Hot-cold conceptsof healthcare (also called humoral theories) are centuries old in the traditional cultures of Latin America, Asia, and Africa.

Most non-western cultures advocate the avoidance of all things cold – air conditioning, ice, showers. For the Chinese, this means a month of no showering, washing of hair, no going outdoors to avoid the wind and a diet rich in “hot” foods. “Hot” foods supposedly contain inner heat and will help with blood circulation and promote lactation. On the other hand “cold” foods, foods that physically cold or grow in cold places, are off the menu.

One surprising fact is that most new mothers in Asian countries still follow these practices. The confinement industry is doing brisk business, with confinement centers/maternity hotels charging up to $4,500 to $19,000 per month and confinement ladies commanding a salary between $1,500 to $2,000. Confinement centers have also sprung up across the states due to the demand and increasing migrant population.

Further reading:

Why Won’t This New Mom Wash Her Hair?
The fascinating postpartum customs of women from around the world.

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