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February 9, 2010

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A month of sitting

AFTER childbirth, TCM prescribes a strict 30-day regimen for postpartum recovery known as yue zi (sitting for a month) involving total rest and nutritious food. Once it was like imprisonment with your mother-in-law, but today it's more relaxed. Zhang Qian reports.

Mizuhara Chie, 40 years old, is 21 weeks pregnant. Apart from reading books about pregnancy and child care, this mother-to-be has started studying the ancient tradition of zuo yue zi, postpartum recovery in the first month after giving birth.

She disregards the ancient prohibitions against bathing, brushing teeth, washing hair, touching water, eating fruits and vegetables, and reading (today it would be TV and computers).

But she plans to retain its essence of total rest, no drafts, no stress, no picking up baby (someone else hands it to her, lest she permanently injure her back) and rich dietary reinforcement, no cold (temperature or yin energy) foods.

Maybe, too, she will cover her head, to be on the safe side, so no pathogenic yin (cold) energy can invade her very vulnerable system.

Strict zuo yue zi, literally "sitting for a month," involves total bedrest, never going outdoors, and eating nourishing mostly yang (hot energy) foods to regain health and energy.

According to traditional Chinese medicine, this period lasts for one month, a moon cycle, hence the name yue zi (month).

Ancient wisdom and old wives' tales

Some Chinese hospitals and private clinics are offering recovery education and services for mothers-to be. There are even expensive, hotel-like yue zi retreats.

Shanghai Mother and Baby Health Promoting Center attached to Shanghai First Maternity and Infant Hospital provides special services for the new mothers throughout the whole pregnant period and after childbirth.

There is special body massage for the mothers to promote milk secretion, which is usually recommended at the 12th hour after natural delivery or 48th hour after Caesarean birth.

Most women stay home, however, and hire an ayi skilled in mother and child care.

Many young mothers these days shower and attend to personal hygiene before conservative mother or mother-in-law come to visit. But these days modern TCM strongly recommends good hygiene and gentle exercise.

During childbirth a woman loses a lot of blood and yang (hot) energy, so postpartum she is deficient in yang energy and has too much yin (cold), according to TCM.

Yue zi is a crucially important period for a woman's health ¨? make or break, it is said ¨? and most of the older generation firmly believes that numerous prohibitions must be observed, certain foods must be eaten, some avoided.

Most women do get lots of bed rest, avoid drafts (invasion of pathogenic cold energy) and eat lots of eggs (nutritious and symbolic since they just gave birth), chicken, meat and fish soups. Brown sugar and ginger are musts.

It is said to be a time for tuo tai huan gu (taking out the fetus and changing the bones), meaning a complete change for a woman.

Traditions say that a good yue zi helps a woman achieve good health, though she may have been weak or ill before pregnancy, while a bad yue zi can destroy her health, no matter how healthy she used to be.

There are reasons behind all the prohibitions: bathing and getting chilled can cause permanent problems for women, including all kinds of hygiene and contact with water. The reason: They are vulnerable.

Hair washing is said to cause headaches, and brushing teeth is said to loosen teeth. Any bathing is said to leave the body vulnerable to chill and pathogenic cold that can damage the entire system. Reading or watching TV strains the eyes permanently, crying permanently undermines vision.

"It was like a month of imprisonment," says Luning Wang, a 56-year-old woman recalling her yue zi. She still remembers peeking at the most popular TV series "The Bund" in her yue zi more than 20 years ago.

Many dismiss the "old wives' tales."

"How can you endure not bathing or moving around for a month," says Yang Meng, a 28-year-old reporter who gave birth to a son last November. She says she ignored most rules, except for good rest and nourishing food.

There are still some believers, however, and some women try to compel their daughters-in-law to comply.

Some modern mothers, like Mizuhara, believe in the old ways in spite of overseas experience. She and her family moved to Japan when she was in her teens. She always has followed TCM practices.

She works for a Japanese company and frequently flies between Shanghai and Japan. When she found herself pregnant in Shanghai about five months ago, she decided to stay until the baby was born.

"I want to be in perfect health both during pregnancy and after giving birth," says Mizuhara, "I can only get the best yue zi care in China. So I decided to stay."

There is no such detailed guidance about yue zi in Japan, according to Mizuhara. In Japan, women don't make a big deal out of yue zi, she says. They get a lot of rest and eat nourishing food, but it's okay to be up and about and return to work as soon as possible ¨? shocking to Mizuhara.

"I believe all those prohibitions exist for a reason, and they have been tested by time," says Mizuhara, "I would rather believe in their effectiveness than risk my own health."

Mizuhara says her younger sister had problems because she failed to observe yue zi. She insisted on picking up her tiny baby herself and nursing ¨? she didn't let an ayi bring the infant to her. TCM believes even that tiny weight can damage a woman's skeleton for life. Now the woman suffers frequent backaches, Mizuhara says.

Since she is an older mother at 40 years old, she wants to be very careful, but she does plan to bathe.

Selina Xie, 38, from Singapore, just delivered her second child in Shanghai last week. She is fully prepared for her a strict yue zi.

She bought hair-washing powder that can keep hair relatively clean without water. She has an ayi rub her with a warm towel, instead of taking a bath.

She also follows a strict diet, and the ayi prepares all meals.

The tradition of yue zi is still well-known among Chinese in Singapore. Most of Xie's friends observe it closely, though many of them bathe. Xie says she recovered very well from the birth of her first child by strictly following yue zi.

"It is so tiring to go through the pregnancy and delivery," says Xie. "You are vulnerable at the moment and, of course, need good rest and strict self-protection."

In both natural childbirth and Caesarean birth, women lose a lot of blood and energy, says Dr Yao Xiaqin, associate chief physician at the Shanghai First Maternity and Infant Hospital.

"The woman is especially vulnerable to pathogenic energy in that period as much blood and energy is consumed," says Dr Xu Yizhen, associate chief physician of TCM Obstetrics and Gynecology Department of Yueyang Hospital.

Deficient energy and blood, as well as blood stasis are typical among new mothers. Blocking invasions of pathogenic energy is the main strategy. This is the reason for avoiding wind, cold food and any contact with cold/cool water.

But with modern heating and bathrooms, the worries about pathogenic energy needn't prevent good hygiene, says Dr Yao.

Gradual gentle exercise, like occasional walking, can help recovery.

Both doctors say women must avoid cold-temperature and cold-energy yin foods during yue zi. Updating ancient practice

Joyce Zhang

To ensure a good yue zi for postpartum recovery, there are lots of ancient rules and prohibitions. Quite a few of them, however, need to be updated ¨? notably prohibitions against bathing, exercise and balanced diet.

No drafts

The rule: Wind is the enemy of the new mother. All windows and doors in the mother's room must be closed, even in hot weather. The woman should keep warm, wearing long sleeves, trousers and a hat.

Suggestion: Avoid drafts and cold air, but ventilation is good; it's not necessary to seal the mother's room. In summer, turn the air-conditioner on in the next room and let the cool air flow into the mother's room.

Bed rest, no movement

Rule: The mother is especially weak. She needs complete rest and should not move at all. She should stay in bed throughout the yue zi.

Suggestion: The mother does need rest, but not moving at all is not helpful to recovery. Too much bed rest makes people weak. Gentle movement and exercise like walking can improve circulation and promote expulsion of lochia, which can take from four to six weeks. Depending on her condition and doctor's advice, a woman should exercise carefully.

No bathing, hair washing

Rule: The mother should avoid all contact with water, including bathing and washing her hair. Otherwise she will have joint and bone problems such as arthritis.

Suggestion: Depending on her condition and doctor's advice, a brief warm (36 degrees Centigrade) shower is recommended two days after giving birth.

No teeth-brushing

Rule: The mother should not brush her teeth during yue zi, otherwise they will become loose and can fall out.

Suggestion: Loose teeth are not caused by brushing, but calcium lost in breast feeding should be replenished. Calcium supplements as prescribed.

Reinforcing soup diet

Rule: Soup, soup and more soup. Rich chicken, pork, fish and mushroom soup are recommended, along with many eggs. No fruits or veggies.

Suggestion: Reinforcing soup is nutritious but a recovering mother needs to eat a balanced diet, including vegetables, fruits, carbohydrates, nuts and other foods. Brown sugar and ginger, both yang (hot) energy foods, are recommended.


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