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CONFINEMENT PRACTICES AND MYTHS

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Confinement, part of the Asian culture, involves the prohibition of doing certain daily tasks and the restriction of certain food intake.

Confinement diet and practices

Confinement is a period for your body to recuperate and recover from childbirth. The idea of confinement is familiar to Asians but foreign to Westerners.

In the past when infant and maternal mortality rates were high, it was a practice to keep both baby and mother indoors during the period of confinement. This was meant to protect mother and baby from ill health.

By now, you may have been exposed to some of the practices or ideas from your parents. You may or may not agree with them but many of these have originated from our Asian culture and hence, possess no scientific basis at all. They range from the prohibition of doing certain daily tasks to the restriction of certain food intake — with the strong belief that these can provide adequate rest and replenishment during this period.

  CHINESE PRACTICES MALAY PRACTICES INDIAN PRACTICES
Confinement Period 30 days 44 days 40 days
Dietary Requirements
  • To purge out the “wind” in the body after delivery, promote “blood circulation”, strengthen the joints and promote milk supply.
  • To avoid “cooling” foods.

 

 
Traditionally, they use a lot of ginger, wines and sesame oils in their diet. Common dishes include pigs’ trotters cooked with ginger and vinegar, fish soup, chicken cooked in sesame oil and a traditional tonic brewed from 10 herbs. Fish soup boiled with papaya is believed to be beneficial for milk production. 
 
It is also recommended that plain water consumption be avoided during this period to reduce the risk of water retention. Instead, specially prepared drinks from a mixture of herbs and preserved dates are recommended.
During confinement a woman follows a special diet in which heating foods are encouraged and cooling foods avoided to restore the balance upset by the birth. 
 
Some Malay mothers who have just delivered often take a special drink called “jamu”. It is believed that the pores on the body are opened during labour and “jamu” has properties that can keep the body warm.
The Indians take garlic milk to prevent “wind”. Like the Chinese and Malays, “cooling” foods are avoided, especially tomatoes, cucumbers, coconut milk and mutton. 
 
Only chicken and shark fish cooked with herbs are allowed while other seafood is not allowed. 
 
Chilli is not allowed. 
 
Plenty of garlic fried without oil is encouraged. Cooking is done with gingelly oil.
 
Oral intake of herbs or D.O.M. is encouraged to keep the body warm. 
 
There is restriction on fluids/fruits/vegetable intake as well as cold drinks and food. 
Other Practices The basis for such practices is to protect the new mother from future ill health, restore her strength and to protect the family from ritual pollution. 
 
The Chinese believe in staying indoors throughout the confinement period to avoid outdoor pollution. Strenuous physical activities are discouraged to prevent further “muscle weakening”.
 
Some would hire a confinement nanny to help with the housework and caring for the baby. 
 
Other practices may include:
  • Not washing the body or hair during the month; especially avoiding contact with cold water.
  • Not going outside for the entire month (or at least avoid wind).
  • Not eating raw or “cooling” foods or foods cooked the previous day.
  • Eat chicken, especially chicken cooked in sesame oil; pork liver and kidney are also good; eat five or six meals daily and rinse the rice bowl with scalding water.
  • Avoid all wind, fans and air conditioning.
  • Avoid walking or moving about; the ideal is lying on the back in bed.
  • Do not go into another person’s home.
  • Do not get sick.
  • Do not read or cry.
  • Do not have sex.
  • Do not eat with family members.
  • Do not burn incense or visit a temple or altar.
Traditionally, childbirth is in the mother’s home attended by a bidan (Malay midwife) and the umbilical stump dusted with a mixture of spices. Fortunately, this has been replaced by hospital births that reduce complications and infection rates.
 
Both mother and child should be bathed immediately in heated water filled with herbs after birth. 
 
The mother will “keep warm” through various traditional methods. These may include sitting near to or lying above a heated source or warming the abdomen by applying a heated stone over it. 
 
During this confinement period, a female masseuse is engaged to help the mother regain her figure or at least to keep her extended tummy trim. The practice of tightly binding the tummy is called berbengkong, and is believed to help in maintaining the body shape. 
 
Sex is also strictly prohibited during the confinement period.
Indian mothers are also discouraged from leaving their homes during their confinement period.
 
Bathing is discouraged and if done, it should be performed with special herbal preparations and turmeric powder. 
 
Bathing is only allowed between 11 am and 2 pm when the temperature is at its highest. 
 
Daily body massages with oil are also encouraged. 
 
Other practices may include:
  • Not allowed to enter the prayer altar room.
  • Splashing of warm water on abdomen during bathing to expel clots from uterus.
  • Washing of hair is done on odd days i.e. day 3,5,7… during the first two weeks. Dry hair after washing with incense smoke.
  • Place incense smoke in between legs to dry episiotomy wound.
  • Binding of tummy with six feet cloth
  • Sex is strictly prohibited.

 

Let us now examine some of these myths in detail

MYTHS  MEDICAL PERSPECTIVE 
 “Now that my baby is born, I will lapse into depression.” It is true that most women experience a sad/depressed mood, beginning some days after the birth of the baby and continuing for varying lengths of time. These symptoms are termed the ‘baby or postnatal blues’ and are believed to be associated with hormonal changes following the birth of a child. Fortunately, it is of a relatively short-term duration (about two weeks) and most women recover from it. 
 
Depression is diagnosed only when these symptoms persist in a small proportion of women. It may be accompanied by suicidal or infanticide intent. Prompt psychiatric attention is imperative in such instances.
 “I am not allowed to bathe or touch water for fear of ‘wind’ entering the body.”
 
“I can only wash my hair with water in which ginger has been boiled in it.”
There is no basis to this at all. In fact, bathing regularly ensures a good personal hygiene and comfort level. It reduces the incidence of skin and wound infections. On a personal note, it certainly ensures that people around you would find it more bearable.
 “I must consume plenty of wines, sesame oils and traditional herbs to drive out the ‘wind’ ”. Again, there is no medical reasoning behind this recommendation. In moderation, there is no harm in consuming these substances. However, when taken in excessive amounts, it may affect you and your baby. Furthermore, there are various substances present in the herbs that we are not fully aware of. 
 
Alcohol and other organic substances might go into your breast milk, and when breastfeeding, these might be transferred to your baby. These substances may affect the liver and worsen jaundice of the newborn if it is already present.
 “I cannot drink plain water at all during confinement." Adequate fluid consumption is advised especially if the mother is breastfeeding. The kidneys will produce more urine in the next few weeks after the baby is born to remove the excess fluid that has accumulated during the course of the pregnancy.
 “I must not expose myself and the baby to any wind drafts or air-conditioner.”
 
“I must not leave my house for one month.”
For personal comfort, there is definitely no harm in switching on the air-conditioner or fan, as long as it makes you and your baby comfortable. It may even help prevent heat rash from developing in our hot and humid climate.
 “I must eat liver and meats only.” The confinement period is a time when physical changes that occurred in the last nine months will revert to the original state. It is also a period when nutritional demands on you are high, owing to the recent blood loss from the delivery and the demands of breastfeeding. 
 
The belief here is that the mother has been “cooled” by the delivery, and there is a need to eat “heating” foods such as meat. Many “confinement foods” have been devised to ensure that these nutritional demands and beliefs are met.
 
Whatever your beliefs are, it is important to take a well-balanced diet than specific food types to replenish the body’s stores. This is especially so during breastfeeding. If necessary, as in the case of vegetarians or vegans, iron or vitamin supplements may be taken to satisfy these nutritional demands.
 “I have been told not to read or cry.” The traditional belief is that it causes eye problems later in life and this has no scientific logic.
 
 “I cannot pray before an altar or enter a place of worship.”
 
“I cannot mingle with the rest of my family members or enter the kitchen.”
Many believe that the post partum discharge (lochia) is unclean and therefore, this practice prevents any spiritual contamination. Again, there is no scientific basis to it.
 “I heard that the Malay traditional practices are effective for regaining health.” There are six components to the traditional practices of postnatal care. These are:
  1. Tuku — daily massage over the abdomen with a ball-like metal object
  2. Mengurut badan — massaging by an experienced masseuse
  3. Barut — tight wrap around the woman’s waist
  4. Salai — lying on a warmed wooden apparatus
  5. Air akar kayu — tonic drinks made from medicinal plants
  6. Pantang makan dan minum — to prohibit oneself from eating or drinking certain food items
The main idea of the above is that specific massaging/ heat/ selective dieting helps to promote blood circulation and recovery; while the Barut helps to regain the woman’s figure. Dieting to the Malays, like what the Chinese believe, ensures the avoidance of “cooling foods” and the intake of “heating foods”. 
 
Although these practices have never been proven scientifically, it is possible that certain benefits can be derived from them. However, all these should be done in moderation to prevent burns and injuries from happening during these massages and therapies. After a cesarean section, these have to be delayed for a month to prevent the disruption of a healing wound.
 
As mentioned previously, it is still essential to have a well-balanced diet to ensure adequate nutrition during this recovery period.
 “Bathing should not be an issue.” This is prevalent in the Malay culture and is contrary to the Chinese practice. The water is warmed and herbs are added for a “heating effect”. As mentioned before, this is good for personal hygiene and is encouraged.
 “I cannot have sex for forty days.” This is against the religious teachings of certain cultures, e.g. the Malays. 
 
From a medical perspective, it allows for the lochia to be over and the episiotomy wound to be completely healed and this may reduce the incidence of infections.


Video: Confinement Practices
 

Find out about confinement practices and some things that you should take note of during your confinement period.

 

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By Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John,
KK Women's and Children's Hospital

Sources:
The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.