Barbara Higham asks is the practice of traditional cleansing customs postpartum a right to be enjoyed or a burden that restricts a new mother in certain cultures?

In many cultures around the world during the postpartum periodmothers are regarded as contaminated or “polluted” and subjected to various cleansing practices, some of which are based on little more than superstition. Historical and irrational feelings of disgust continue to stigmatize women’s bodies in the 21st century, shaming women for what is a fundamental part of childbearing—our blood and our milk.

Human cultures are, however, complex and the preservation of traditional customs, as a part of the care new mothers receive, may represent an important ritual element in childbearing. Without observing familiar rites that are believed to protect cleanliness, a new mother may feel she is failing to do the right thing, and this may even put her at greater risk for postpartum depression (Dennis, Fung, Grigoriadis, Robinson, Romans, & Ross, 2007).

Jordanian mothers in Sydney, living outside of their traditional postpartum care context, which involves specific washing rituals, experienced a severe loss of control over emotions of loneliness, hopelessness, and feelings of being a bad mother (Nahas & Amasheh, 1999).

In Arabic, Thai and Chinese cultures, women are thought to be unclean until they stop bleeding postpartum and their time for resting has ended. Until then, they are often prohibited from sexual intercourse. According to traditional Chinese custom, women should be confined to home and assisted with household tasks for one month after giving birth. This is referred to as “doing the month.”  Chien, Tai, Ko, Huang, & Sheu, 2006 explored the association between adherence to doing-the-month practices, physical symptoms and depression among postpartum women in Taiwan. Adherence to doing-the-month practices, in 202 women participants at 4–6 weeks after delivery, was associated with lower severity of physical symptoms and lower odds of postpartum depression, after adjustment for potential confounders.

hygiene rituals
Ken Tackett

How many new mothers in your community are “doing the month”? My guess is few, if any. The old cleansing rituals of many cultures require the new mother to be attended by a group of women relatives, which may simply not be possible in modern hospital settings or practical in societies where women no longer live in close knit communities and return to work, often within a matter of weeks following the birth of a baby. 

Fonte & Horton-Deutsch, 2005, in an article on postpartum depression among immigrant Muslim women, said that nurses must be educated about the cultural beliefs and health practices within specific patient populations to provide comprehensive health care. For instance, Muslim women take a purification bath called a ghusl after postpartum blood loss has ceased. They pointed out that distinct challenges face nurses who treat a growing population of ethnically, racially, and culturally diverse patients. New mothers may feel uneasy about drinking cold water, having a shower, or other routine hospital practices shortly after giving birth, yet may feel compelled to comply.

Cleansing Customs To Protect New Mothers: A Cultural Right or Burden?
Ken Tackett

In the Hmong tradition, the first 30 days after birth is seen as the most dangerous period for a new mother. There are several beliefs and practices that women must observe. Lying near the fire in the first three days is one of them. There are rules to restrict and confine the mother during the postpartum period that the Hmong observe after the birth in order to regain strength and avoid poor health in the future. The new mother is prohibited from entering other people’s homes, or entering through the front door of her own home to avoid offending guardian gods or spirits (Rice, 2000). Religious significance aside, being confined to her own home gives the new mother time to recuperate, get to know her baby and establish breastfeeding. Since midwives and nurses will continue to encounter many traditional beliefs and practices of the Hmong when providing birthing care, it is essential that their cultural beliefs and practices be taken into account. This will not only help to avoid misunderstanding, but also result in culturally appropriate and sensitive care for immigrant women.

Among Hindus, the new mother is not allowed to cook or receive male visitors until the tenth or twelfth day postpartum, by which point she is considered “clean” and able to carry out normal household chores again (Gatrad, 2004). In the Middle East an observance of seclusion characterizes the 40-day postpartum period, during which family members may be unwilling to eat food prepared by the new mother to avoid illness or death (Hundt, Beckerleg, Kassem, et al., 2000). Whether or not this is the intention, such practices, while stigmatizing women as unclean, have the benefit of ensuring the new mother is temporarily freed from a domestic obligation. On the other hand, postpartum checkups, family planning counseling, and immunization services may not be routinely available or used because of the mother’s seclusion. 

In Pakistan, heavy postpartum bleeding is considered “healthy” in order to release the “unclean” menstrual blood that accumulated prenatally (Fikree, Ali, Durocher, & Rahbar, 2004), which illustrates the need for postpartum community-based health care programs. In some Eastern Indian Hindu and Chinese beliefs, air conditioners and fans are considered dangerous for new mothers (Leung, Arthur, & Martinson, 2005) which raises the question of how women can adapt ritual to fit everyday modern life. The study findings suggest bridging (rather than closing) the gap between traditional and modern postpartum practices.

Cleansing Customs To Protect New Mothers: A Cultural Right or Burden?
Ken Tackett

A steam bath (sitting on hot bricks or inhaling steamed medicinal herbs) is prescribed in Thailand to sweat out poisonous water and absorb good water, dry the perineum and assist healing (Liamputtong, 2004). Poor rural women hold on to their traditions more strongly than their urban counterparts. But modernization has brought with it medical dominance and doctors may attempt to dismiss traditional practices. Postpartum care that incorporates local traditions involving help from a group of women may be good for new mothers at this the most vulnerable stage of their lives (Kaewsarn, Moyle, & Creedy, 2003).

Mothers are massaged with hot salt to loosen tendons and prevent blood clots. They are kept warm to avoid the “wind” and prevent headaches, facial wrinkling, varicose veins and other health problems (Davis, 2001; Small, Rice, Yelland, & Lumley,1999; Fisher, Feekery, & Rowe, 2004). In Cambodia heated rocks placed on the new mother’s stomach prevent blood clots and flatten their stomach (White, 2004). This care is provided as an integral part of a social structure that enables the new mother more easily to transition to her new role in the group and to adopt her status as a mother.

The assistance and seclusion required by the cleansing rituals during a period of rest frees the new mother of her workload and helps protect her physical and mental well-being. The significance of all these sorts of ritual care lies not in the efficacy of the science behind any of it, but in the recognition that this is (or should be) a period during which the new mother requires special care and attention, both of which, sadly, are frequently absent in modern healthcare.

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References

childbirth educationChien, L.-Y., Tai, C.-J., Ko, Y.-L., Huang, C.-H., & Sheu, S.-J. (2006). Adherence to “doing-the-month” practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan. Research in Nursing & Health, 29(5), 374–383. doi:10.1002/nur.20154

Davis, R. E. (2001). The postpartum experience for Southeast Asian women in the United States. MCN, The American Journal of Maternal/Child Nursing, 26(4), 208–213. doi:10.1097/00005721-200107000-00011

Dennis, C.-L., Fung, K., Grigoriadis, S., Robinson, G. E., Romans, S., & Ross, L. (2007). Traditional postpartum practices and rituals: A qualitative systematic review. Women’s Health, 3(4), 487–502. doi:10.2217/17455057.3.4.487

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Fikree, F. F., Ali, T., Durocher, J. M., & Rahbar, M. H. (2004). Health service utilization for perceived postpartum morbidity among poor women living in Karachi. Social Science & Medicine, 59(4), 681–694. doi:10.1016/j.socscimed.2003.11.034

Fisher, J, Feekery, C, Rowe, H. (2004). Treatment of maternal mood disorder and infant behavior disturbance in an Australian private mothercraft unit: a follow-up study. Arch. Women Ment. Health 7(1), 89–93

Fonte, J., & Horton-Deutsch, S. (2005). Treating postpartum depression in immigrant muslim Women. Journal of the American Psychiatric Nurses Association, 11(1), 39–44. doi:10.1177/1078390305276494

Gatrad, A. R. (2004). Hindu birth customs. Archives of Disease in Childhood, 89(12), 1094–1097. doi:10.1136/adc.2004.050591

It Just Got RealHundt, G.L., Beckerleg, S., Kassem, F., et al. (2000). Women’s health custom made: building on the 40 days postpartum for Arab women. Health Care Women Int. 21(6), 529–542.

Kaewsarn, P., Moyle, W., Creedy, D. (2003). Thai nurses’ beliefs about breastfeeding and postpartum practices. J. Clin. Nurs. 12(4),467–475. 

Leung, G, S., Arthur, D., & Martinson, I. M. (2005). Perceived stress and support of the Chinese postpartum ritual “doing the month.” Health Care for Women International, 26(3), 212–224. doi:10.1080/07399330590917771

Liamputtong, P. (2004). Yu Duan practices as embodying tradition, modernity and social change in Chiang Mai, Northern Thailand. Women & Health, 40(1), 79–99. doi:10.1300/j013v40n01_05

Nahas, V., & Amasheh, N. (1999). Culture care meanings and experiences of postpartum depression among Jordanian Australian women: A transcultural study. Journal of Transcultural Nursing, 10(1), 37–45. doi:10.1177/104365969901000113

Rice, P. L. (2000). Nyo dua hli– 30 days confinement: traditions and changed childbearing beliefs and practices among Hmong women in Australia. Midwifery, 16(1), 22–34. doi:10.1054/midw.1999.0180

Small, R., Rice, P. L., Yelland, J., Lumley, J. (1999). Mothers in a new country: the role of culture and communication in Vietnamese, Turkish and Filipino women’s experiences of giving birth in Australia. Women & Health 28(3), 77–10.

White, P. (2004). Heat, balance, humors, and ghosts: Postpartum in Cambodia. Health Care for Women International, 25(2), 179–194. doi:10.1080/07399330490267477

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